Subcutaneous Fat Necrosis of the Newborn Clinical Presentation

  • Author: Howard Pride, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 19, 2012
 

History

Newborns who develop subcutaneous fat necrosis of the newborn usually are healthy and full-term at delivery but have had some antecedent obstetric trauma, meconium aspiration, asphyxia, hypothermia, or peripheral hypoxemia. Within the first several days to weeks of life, hard, indurated nodules and plaques with ill-defined overlying erythema develop on the trunk, arms, buttocks, thighs, or cheeks. The lesions are not warm. Pain may occur, with a frequency as high as 25% in one series.[2] Congenital ulceration has been reported.

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Physical

The infants usually appear well and are afebrile. The condition begins as an area of edema and progresses to variably circumscribed nodules and plaques that have a deep, indurated feel, implying a panniculitis. The overlying skin may be red, purple, or flesh-colored and may look taut and shiny. Lesions may become fluctuant and spontaneously drain necrotic fat.

Ill-defined erythema overlying an indurated plaqueIll-defined erythema overlying an indurated plaque of a newborn. Bruiselike indurated plaque of subcutaneous fat neBruiselike indurated plaque of subcutaneous fat necrosis of the newborn on the lower back of a newborn. Ill-defined erythema and induration of subcutaneouIll-defined erythema and induration of subcutaneous fat necrosis of the newborn on the posterior calf of a newborn.

If mild hypercalcemia is present, findings might be absent, or the child may display weight loss, irritability, apathy, or hypotonia. Examination may reveal growth and mental retardation, hypertension, seizure activity, and tissue calcification with more severe hypercalcemia.

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Causes

The cause of subcutaneous fat necrosis of the newborn is not known. Neonatal stress and hypothermia from various sources, such as Rh factor incompatibility, meconium aspiration, placenta previa, umbilical cord prolapse, anoxia, seizures, preeclampsia, maternal cocaine abuse, and hypothermic cardiac surgery, play some role in instigating the process.[3] Some evidence implicates a maternal hypercoagulable state, such as protein C deficiency and antiphospholipid syndrome, but this is quite variable.[2] One infant developed subcutaneous fat necrosis of the newborn after ice-bag placement for treatment of supraventricular tachycardia. Three possible mechanisms for the development of the necrosis have been proposed.

  • An underlying defect in fat composition or metabolism may be present, whereby inadequately developed enzyme systems involved in fatty acid desaturation result in increased saturated fatty acids within the subcutaneous tissue. Neonatal stress may exacerbate this defect and increase the susceptibility to subcutaneous fat necrosis of the newborn.
  • The fat of neonates is composed of saturated fatty acids (stearic and palmitic acids) with a relatively high melting point. Neonatal stress resulting in hypothermia may induce fat to undergo crystallization, leading to necrosis.
  • Local pressure trauma during delivery from macrosomia, forceps, or prolonged trauma may play a role in the induction of necrosis. Subcutaneous fat necrosis of the newborn has been reported in children delivered by cesarean delivery, suggesting that pressure necrosis cannot be the only cause.
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Contributor Information and Disclosures
Author

Howard Pride, MD  Associate Professor, Departments of Pediatrics and Dermatology, Geisinger Medical Center

Howard Pride, MD is a member of the following medical societies: American Academy of Dermatology and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel Mark Siegel, MD, MS  Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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  2. Mahe E, Girszyn N, Hadj-Rabia S, Bodemer C, Hamel-Teillac D, De Prost Y. Subcutaneous fat necrosis of the newborn: a systematic evaluation of risk factors, clinical manifestations, complications and outcome of 16 children. Br J Dermatol. Apr 2007;156(4):709-15. [Medline].

  3. Hogeling M, Meddles K, Berk DR, Bruckner AL, Shimotake TK, Cohen RS, et al. Extensive Subcutaneous Fat Necrosis of the Newborn Associated with Therapeutic Hypothermia. Pediatr Dermatol. Sep 9 2011;[Medline].

  4. Tran JT, Sheth AP. Complications of subcutaneous fat necrosis of the newborn: a case report and review of the literature. Pediatr Dermatol. May-Jun 2003;20(3):257-61. [Medline].

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  12. Akin MA, Akin L, Sarici D, Yilmaz I, Balkanli S, Kurtoglu S. Follow-up during early infancy of newborns diagnosed with subcutaneous fat necrosis. J Clin Res Pediatr Endocrinol. Dec 2011;3(4):216-8. [Medline]. [Full Text].

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  15. Cook JS, Stone MS, Hansen JR. Hypercalcemia in association with subcutaneous fat necrosis of the newborn: studies of calcium-regulating hormones. Pediatrics. Jul 1992;90(1 Pt 1):93-6. [Medline].

  16. Fenniche S, Daoud L, Benmously R, et al. Subcutaneous fat necrosis: report of two cases. Dermatol Online J. Oct 15 2004;10(2):12. [Medline].

  17. Hicks MJ, Levy ML, Alexander J, Flaitz CM. Subcutaneous fat necrosis of the newborn and hypercalcemia: case report and review of the literature. Pediatr Dermatol. Sep 1993;10(3):271-6. [Medline].

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  20. Sharata H, Postellon DC, Hashimoto K. Subcutaneous fat necrosis, hypercalcemia, and prostaglandin E. Pediatr Dermatol. Mar 1995;12(1):43-7. [Medline].

 
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Ill-defined erythema overlying an indurated plaque of a newborn.
Bruiselike indurated plaque of subcutaneous fat necrosis of the newborn on the lower back of a newborn.
Ill-defined erythema and induration of subcutaneous fat necrosis of the newborn on the posterior calf of a newborn.
 
 
 
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