Subcutaneous Fat Necrosis of the Newborn Treatment & Management

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

Medical Care

Subcutaneous fat necrosis of the newborn (SCFN) is a self-limited process that does not require treatment.

Treat symptomatic hypercalcemia aggressively. The first line of treatment is fluid loading and calcium-wasting diuretics, such as furosemide. Feed affected infants a low-calcium, low-vitamin D diet. Prednisone may be used if these measures fail. It interferes with the metabolism of vitamin D to the active form, 1,25-dihydroxyvitamin D, and it may inhibit production of this metabolite by macrophages involved in the granulomatous inflammatory process. Several articles have reported the use of first- and second-generation bisphosphonates to control hypercalcemia.[8, 9, 10] This works by reducing bone resorption. Pamidronate at 0.25-0.50 mg/kg/dose for 3-4 doses was used to successfully treat hypercalcemia in 4 neonates with subcutaneous fat necrosis of the newborn.[11, 12]

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Surgical Care

Fluctuant areas of fat necrosis may require needle aspiration or surgical incision and drainage, but this seldom is needed.

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Consultations

Consultations include a dermatologist or pediatric dermatologist. A plastic surgeon or pediatric surgeon may be needed if aggressive debridement is warranted.

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Diet

A diet low in calcium and vitamin D is recommended if hypercalcemia is a complicating feature of subcutaneous fat necrosis of the newborn.

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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

  1. Farooque A, Moss C, Zehnder D, Hewison M, Shaw NJ. Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in subcutaneous fat necrosis. Br J Dermatol. Feb 2009;160(2):423-5. [Medline].

  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].

  5. Srinath G, Cohen M. Imaging findings in subcutaneous fat necrosis in a newborn. Pediatr Radiol. Apr 2006;36(4):361-3. [Medline].

  6. Vasireddy S, Long SD, Sacheti B, Mayforth RD. MRI and US findings of subcutaneous fat necrosis of the newborn. Pediatr Radiol. Jan 2009;39(1):73-6. [Medline].

  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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