Subcutaneous Fat Necrosis of the Newborn 

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

Background

Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon disorder characterized by firm, erythematous nodules and plaques over the trunk, arms, buttocks, thighs, and cheeks of full-term newborns. The nodules and plaques appear in the first several weeks of life. Subcutaneous fat necrosis of the newborn usually runs a self-limited course, but it may be complicated by hypercalcemia and other metabolic abnormalities.

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Pathophysiology

The exact pathogenesis of subcutaneous fat necrosis of the newborn in not known. It is postulated that cold or stress-induced injury to immature fat results in the development of solidification and necrosis. A granulomatous infiltrate forms subsequently and nonrenal absorption of calcium increases. Staining of biopsy specimens demonstrates increased levels of 25-hydroxyvitamin D3 -1 alpha-hydroxylase within the granulomatous infiltrate as is seen in other granulomatous conditions such as sarcoidosis.[1] No other organ systems are involved, unless hypercalcemia intervenes.

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Epidemiology

Frequency

United States

Frequency is unknown; subcutaneous fat necrosis of the newborn is rare.

International

Frequency is unknown; subcutaneous fat necrosis of the newborn is rare.

Mortality/Morbidity

Subcutaneous fat necrosis of the newborn is a harmless, self-limited condition. Significant morbidity (seizures, blindness, failure to thrive) and even mortality (from infection and cardiac arrest) can result from the associated hypercalcemia.

Race

Race does not play a role in this condition.

Sex

Sex does not play a role in subcutaneous fat necrosis of the newborn.

Age

Subcutaneous fat necrosis of the newborn occurs in the first several weeks of life. Hypercalcemia, if it occurs, begins in children aged 1-2 months.

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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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  7. Tajirian A, Ross R, Zeikus P, Robinson-Bostom L. Subcutaneous fat necrosis of the newborn with eosinophilic granules. J Cutan Pathol. Jul 2007;34(7):588-90. [Medline].

  8. Rice AM, Rivkees SA. Etidronate therapy for hypercalcemia in subcutaneous fat necrosis of the newborn. J Pediatr. Mar 1999;134(3):349-51. [Medline].

  9. Hung SH, Tsai WY, Tsao PN, Chou HC, Hsieh WS. Oral clodronate therapy for hypercalcemia related to extensive subcutaneous fat necrosis in a newborn. J Formos Med Assoc. Nov 2003;102(11):801-4. [Medline].

  10. Khan N, Licata A, Rogers D. Intravenous bisphosphonate for hypercalcemia accompanying subcutaneous fat necrosis: a novel treatment approach. Clin Pediatr (Phila). Apr 2001;40(4):217-9. [Medline].

  11. Alos N, Eugene D, Fillion M, Powell J, Kokta V, Chabot G. Pamidronate: Treatment for severe hypercalcemia in neonatal subcutaneous fat necrosis. Horm Res. 2006;65(6):289-94. [Medline].

  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].

  13. Alos N, Eugene D, Fillion M, Powell J, Kokta V, Chabot G. Pamidronate: Treatment for severe hypercalcemia in neonatal subcutaneous fat necrosis. Horm Res. 2006;65(6):289-94. [Medline].

  14. Burden AD, Krafchik BR. Subcutaneous fat necrosis of the newborn: a review of 11 cases. Pediatr Dermatol. Sep-Oct 1999;16(5):384-7. [Medline].

  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].

  18. Kaya Z, Ergenekon E, Erol I, Poyraz A, Koc E, Atalay Y. Subcutaneous fat necrosis. Indian J Pediatr. Nov 2004;71(11):1041. [Medline].

  19. Montes LF. Subcutaneous fat necrosis of the newborn with eosinophilic granules. J Cutan Pathol. Jul 2008;35(7):699; author reply 700. [Medline].

  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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