With SCFN, painful, indurated, erythematous-violaceous nodules or plaques present on the arms, shoulders, back, and less commonly on the face, legs, and buttocks, in the first weeks of life.1,2,4 It is categorized as a localized form of lobular panniculitis.5 The differential diagnosis of lobular panniculitides is narrow in this age group, including sclerema neonatorum, traumatic panniculitis (eg, forceps delivery), and poststeroid panniculitis in addition to SCFN. Distinguishing SCFN and sclerema neonatorum is based on histopathologic review and clinical history. Needle-shaped crystals in a radial arrangement are a characteristic histologic feature present in both conditions (Figure 3).
The 2 conditions are distinguished by an absence of an inflammatory infiltrate in sclerema neonatorum that is normally present in SCFN.6 Sclerema neonatorum usually presents as diffuse hardening of the skin in severely ill, hypoxic, septic, and premature infants. Poststeroid panniculitis occurs typically in children on high-dose systemic steroids whose doses were rapidly decreased or steroid therapy abruptly stopped. The cutaneous findings appear roughly 1 to 10 days after cessation of the high-dose systemic steroids and typically manifest on the cheeks because this area is where the most accumulation of fat is induced by steroids. Additionally, SCFN can be distinguished from poststeroid panniculitis based on the clinical history; however, a biopsy may still be used to differentiate the 2 diagnoses if necessary.
Subcutaneous fat necrosis of the newborn is generally a benign, self-limiting disorder that resolves in a period of weeks to months. The management strategy includes monitoring metabolic derangements, specifically, frequent monitoring of calcium levels.5 Subtle chronic hyperglycemia may persist for 4 to 6 months. Treatment of severe hypercalcemia generally includes intravenous isotonic fluids, loop diuretics, and corticosteroids. Di Bari and colleagues implemented zoledronic acid, a bisphosphonate, in a patient who was refractory to standard treatments.7 However, most patients without severe hypercalcemia improve without treatment.
The patient’s initial chemistry profile demonstrated a mildly elevated calcium of 10.9 mg/dL (normal range, 8.7-10.4 mg/dL). Dermatology was consulted. A punch biopsy showed necrotic adipocytes containing needle-shaped crystals in a radial arrangement typical of subcutaneous fat necrosis (Figure 2).
The patient’s mother and grandmother were educated regarding her condition and reassured that her lesions would improve over weeks to months. At her 2-week follow-up, her calcium level was stable at 10.8 mg/dL and her lesions were noted to be smaller. At the 4-month follow-up, the patient’s lesions were barely palpable.
1. Rubin G, Spagnut G, Morandi F, Valerio E, Cutrone M. Subcutaneous fat necrosis of the newborn. Clin Case Rep. 2015;3(12):1017-1020.
2. Canpolat N, Özdil M, KuruÄoÄlu S, ÇalÄ±Åkan S, Sever L. Nephrocalcinosis as a complication of subcutaneous fat necrosis of the newborn. Turk J Pediatr. 2012;54:667-670.
3. Shumer DE, Thaker V, Taylor GA, Wassner AJ. Severe hypercalcaemia due to subcutaneous fat necrosis: presentation, management and complications. Arch Dis Child Fetal Neonatal Ed. 2014;99(5):F419-F421.
4. Del Pozzo-Magaña BR, Ho N. Subcutaneous fat necrosis of the newborn: a 20-year retrospective study. Pediatr Dermatol. 2016;33(6):e353-e355.
5. Coondoo A, Lahiry R, Choudhury A, Sengupta S. Tender skin nodules in a newborn. Indian J Dermatol. 2013;58(4):328.
6. Requena L, Sánchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol. 2001;45(3):325-361.
7. Di Bari JA, Nead JA, Schurman SJ. Zoledronic acid for neonatal subcutaneous fat necrosis. Clin Case Rep. 2017;5(5):567-569.