By Gary M. White, MD
Courtesy O. Dale Collins, MD
Subcutaneous fat necrosis is the inflammation and necrosis of the subcutaneous fat layer in an infant.
Multiple, deep, subcutaneous nodules or a panniculitis appearing within the first few weeks of life is characteristic. The skin may be red-purple or flesh-colored. The lesions are nontender. The newborn is usually full term. The distribution of lesions may be in areas of trauma, e.g., from forceps. Hypercalcemia may be associated. Signs and symptoms of hypercalcemia include irritability, poor feeding, and vomiting. Death has occurred from infection and cardiac arrest. Thrombocytopenia, hypoglycemia, and hyperlipidemia have also been associated. Usually, a history of obstetric trauma, meconium aspiration, neonatal asphyxia, hypothermia, or peripheral hypoxia can be elicited.
The diagnosis is usually suspected clinically. Fine needle aspiration biopsy can confirm the diagnosis within minutes [PD 2016;33;220]. Look for necrotic fat cells with refractile needle-shaped crystals using, e.g., a Papanicolaou stain [Acta Cytol 1995;39;759].
There is no specific treatment for the skin changes. They will spontaneously remit within weeks to months. The patient should be monitored for elevated calcium until the skin lesions resolve.
Dermatology Online Journal 16(2)
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