Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Sclerema Neonatorum Treatment & Management

  • Author: India Mayo Hill, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Apr 07, 2016
 

Medical Care

Recognition and the prompt institution of therapy specific for the underlying disease are mandatory. Careful monitoring, correction of electrolyte abnormalities, respiratory support, correction of hypovolemia, and control of hypothermia are important in sclerema neonatorum patients.

Antibiotics

Some authors advocate the prompt institution of prophylactic broad-spectrum antibiotic therapy for possible associated sepsis.

Systemic steroids

The value of systemic steroids is controversial. No controlled studies have demonstrated improved survival with the use of systemic steroids in sclerema neonatorum, although they are often used and have been observed to limit the extent and development of new lesions.[2, 8]

Exchange transfusions

Several reports document the beneficial effect of exchange transfusions on survival.[1, 3, 4, 16] A randomized controlled trial demonstrated a 50% survival rate in septic neonates with sclerema neonatorum who were treated with exchange transfusion used early in the course of the disease, compared with 5% who were not. Exchange transfusion may enhance humoral and cellular immunity in these immunologically immature neonates, and may improve peripheral and pulmonary circulation, thereby also improving oxygen exchange.[2, 16]

Intravenous immunoglobulin

One case report describes the use of intravenous immunoglobulin in a neonate. There was transient improvement in the skin disease, but thoracic constriction from sclerema neonatorum ultimately led to the child's death.[5]

Next

Consultations

Infants with sclerema neonatorum are best cared for in a neonatal intensive care unit by an intensivist.

Depending on the underlying illness (eg, sepsis), consultation to the appropriate specialists should be made.

Previous
Next

Complications

Unless the underlying disease is identified and treated, the course of sclerema neonatorum is one of rapid deterioration in the general health of the infant and, ultimately, death.

Previous
 
 
Contributor Information and Disclosures
Author

India Mayo Hill, MD Resident Physician, Department of Dermatology, University of Alabama at Birmingham School of Medicine

India Mayo Hill, MD is a member of the following medical societies: Alabama Dermatology Society, American Academy of Dermatology, American Society for Dermatologic Surgery, Society for Pediatric Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, Chemoprevention Program Director, Comprehensive Cancer Center, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: University of Alabama at Birmingham; University of Alabama Health Services Foundation<br/>Serve(d) as a speaker or a member of a speakers bureau for: Ferndale Laboratories<br/>Received research grant from: NIH, Veterans Administration, California Grape Assn<br/>Received consulting fee from Astellas for review panel membership; Received salary from Massachusetts Medical Society for employment; Received salary from UpToDate for employment. for: Astellas.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel Mark Siegel, MD, MS Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Association for Physician Leadership, American Society for Dermatologic Surgery, American Society for MOHS Surgery, International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Acknowledgements

Gloria H Nguyen, MD Cutaneous Oncology Research Fellow, Department of Dermatology, University of Alabama at Birmingham School of Medicine

Gloria H Nguyen, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Amy J Theos, MD Director of Pediatric Dermatology, Associate Professor, Department of Dermatology, University of Alabama at Birmingham

Amy J Theos, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

References
  1. Warwick WJ, Ruttenberg HD, Quie PG. Sclerema neonatorum--a sign, not a disease. JAMA. 1963 Jun 1. 184:680-3. [Medline].

  2. Zeb A, Darmstadt GL. Sclerema neonatorum: a review of nomenclature, clinical presentation, histological features, differential diagnoses and management. J Perinatol. 2008 Jul. 28(7):453-60. [Medline].

  3. Kellum RE, Ray TL, Brown GR. Sclerema neonatorum. Report of a case and analysis of subcutaneous and epidermal-dermal lipids by chromatographic methods. Arch Dermatol. 1968 Apr. 97(4):372-80. [Medline].

  4. Breukhoven PE, Kerkhof GF, Willemsen RH, Hokken-Koelega AC. Fat mass and lipid profile in young adults born preterm. J Clin Endocrinol Metab. 2012 Apr. 97(4):1294-302. [Medline].

  5. Zeb A, Rosenberg RE, Ahmed NU, Saha SK, Chowdhury A, Ahmed S, et al. Risk factors for sclerema neonatorum in preterm neonates in Bangladesh. Pediatr Infect Dis J. 2009 May. 28(5):435-8. [Medline].

  6. Bwibo NO, Anderson BT. Sclerema neonatorum (a study of 16 cases in the special care unit, Mulago Hospital, Kampala). East Afr Med J. 1970 Jan. 47(1):50-5. [Medline].

  7. Afroze F, Pietroni MA, Chisti MJ. Recurrent sclerema in a young infant presenting with severe sepsis and severe pneumonia: an uncommon but extremely life-threatening condition. J Health Popul Nutr. 2013 Dec. 31:538-42. [Medline]. [Full Text].

  8. Milunsky A, Levin SE. Sclerema neonatorum: a clinical study of 79 cases. S Afr Med J. 1966 Jul 2. 40(27):638-41. [Medline].

  9. Chisti MJ, Saha S, Roy CN, et al. Predictors of mortality in infants with sclerema presenting to the Centre for Diarrhoeal Disease, Dhaka. Ann Trop Paediatr. 2009 Mar. 29(1):45-50. [Medline].

  10. Taeusch, HW, Ballard RA, Gleason CA, Avery ME. Avery's Diseases of the Newborn. 8th ed. Philadelphia, PA: Elsevier Saunders; 2005. 1516-8.

  11. Fretzin DF, Arias AM. Sclerema neonatorum and subcutaneous fat necrosis of the newborn. Pediatr Dermatol. 1987 Aug. 4(2):112-22. [Medline].

  12. Lindenberg JA, Milstein JM, Cox KL. Sclerema neonatorum: a sign of transient hyperammonemia of the newborn. J Pediatr Gastroenterol Nutr. 1987 May-Jun. 6(3):474-6. [Medline].

  13. Battin M, Harding J, Gunn A. Sclerema Neonatorum following hypothermia. J Paediatr Child Health. 2002 Oct. 38(5):533-4. [Medline].

  14. Navarini-Meury S, Schneider J, Bührer C. Sclerema neonatorum after therapeutic whole-body hypothermia. Arch Dis Child Fetal Neonatal Ed. 2007 Jul. 92(4):F307. [Medline].

  15. Polcari IC, Stein SL. Panniculitis in childhood. Dermatol Ther. 2010 Jul-Aug. 23(4):356-67. [Medline].

  16. Sadana S, Mathur NB, Thakur A. Exchange transfusion in septic neonates with sclerema: effect on immunoglobulin and complement levels. Indian Pediatr. 1997 Jan. 34(1):20-5. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.