SUBCUTANEOUS FAT NECROSIS
Amar Surjushe, Vinayak Kulkarni*, Ravindranath Chavan, Minal Thakre**
Department of Dermatology, Venereology and Leprology, Department of Pediatrics*, Department of Pathology***, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India.
Address for Correspondence
Amar Surjushe, Department of Dermatology, Venereology and Leprology, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India.
Email
dramarsurjushe@rediffmail.com
A two month old infant presented with multiple swellings on the body. He was full term at birth. There was history of obstructed labour at birth for which forceps were applied. After that the post natal period was uneventful. The swellings were noticed 10 days after birth, had gradually increased in size and were bilaterally in the neck, shoulders and back. They ranged from 1.5 to 4cm and were mobile, firm, non-tender, indurated and not attached to the underlying structures. His hemogram, serum calcium levels were normal. Parents were not ready for invasive procedures like fine needle aspiration cytology or biopsy. The patient is under follow up with monitoring of serum calcium level monthly.

Subcutaneous fat necrosis or adiponecrosis is a rare, benign, temporary, self-limited pathology affecting adipose tissue of full-term or postmature neonates, usually occurs in the first weeks following a fetal distress. (1, 2) It is characterized by rubbery firm, mobile nodules and erythematous violaceous plaques. The nodules tend to be symmetrically distributed and show a predilection for buttocks, thighs, shoulders, back, cheeks and arms. Histopathologically, it is a variant of lobular panniculitis characterized by focal areas of fat necrosis and a granulomatous infiltrate composed of lymphocytes, histiocytes and multinucleated giant cells.(3) A variety of insults appear to have contributed in individual cases such as maternal pre-eclampsia, (4) maternal diabetes ,(5) obstetric trauma ,(6) neonatal hypoxia (1,2) and hypothermia. (7). In many cases there is no convincing history of theses putative predisposing causes. Though most cases of subcutaneous fat necrosis are self-limiting, a small but significant percentage of cases develop hypercalcemia. If detected, hypercalcemia must be treated with fluid loading, calcium wasting diuretics and low calcium/ vitamin D diet with monitoring of serum calcium. The differential diagnosis includes erythema nodosum and sclerema neonatorum. (8, 9) The diagnosis is mainly made depending upon the clinical presentation. When the clinical diagnosis is not typical, the histopathological features are helpful .(2) Spontaneous resolution without sequelae is the norm. The patients should be followed for development of late complications, especially hypercalcemia for upto 6 months.(10)
Funding
None
Conflict of Interest
None
References :
  1. Burden AD, Krafchik BR. Subcutaneous fat necrosis of the newborn: a review of 11 cases. Pediatr Dermatol. 1999; 16: 384-387.
  2. Mahe E, Descamps V, Belaich S, Crickx B. Cytosteatonecrosis of the newborn infant. Presse Med. 2002; 31: 612-616.
  3. Tsuji T. Subcutaneous fat necrosis of the newborn: Light and electron microscopic studies. Br J Dermatol. 1976; 95: 407-416.
  4. Flory CM. Fat necrosis of the newborn; report of a case with necrosis of the subcutaneous and visceral fat. Arch Pathol (Chic). 1948; 45: 278-288.
  5. Steiness I. Subcutaneous fat necrosis of the newborn and maternal diabetes mellitus. Acta Med Scand. 1961; 170: 411-416.
  6. Mogilner BM, Alkalay A, Nissim F, Frumkin A. Subcutaneous fat necrosis of the newborn. Clin Pediatr (Phila). 1981; 20: 748-750.
  7. Duhn R, Schoen EJ, Siu M. Subcutaneous fat necrosis with extensive calcification after hypothermia in two newborn infants. Pediatrics. 1968; 41: 661-664.
  8. Maize JC, Burgdorf W, Hurt MA, LeBoit PE, Metcalf JS, Smith T, et al . Cutaneous pathology. Philadelphia: Churchill Livingstone 1998; 36: 337-338.
  9. Thomsen RJ. Subcutaneous fat necrosis of the newborn and idiopathic hypercalcemia. Report of a case. Arch Dermatol. 1980; 116: 1155-1158.
  10. Tran JT, Sheth AP. Complications of subcutaneous fat necrosis of the newborn: a case report and review of the literature. Pediatr Dermatol. 2003; 20: 257-261.
Last Updated : Sunday, August 01, 2010 Vol 7 Issue 8 Art #47
How to Cite URL :
Surjushe A, Kulkarni V, Chavan R, Thakre M. SUBCUTANEOUS FAT NECROSIS. Pediatric Oncall [serial online] 2010[cited 2010 January 1];7. Art #47. Available From : http://www.pediatriconcall.com/Journal/Article/FullText.aspx?artid=324&type=J&tid=&imgid=&reportid=271&tbltype=
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.