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DISORDERS OF SUBCUTANEOUS FAT PANNICULITIS
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Etiology The fat of the newborn appears to be more highly saturated than that of older children and adults where it solidifies at a higher temperature. Cold panniculitis in infancy has almost always follow exposure of the cheeks to extremely cold weather. Clinical Features The lesions appear as indurated, warm, red, subcutaneous plaques and nodules that manifest within hours or days after exposure to cold. The most common sites involved are the cheeks in infants, though they may be seen elsewhere in older children and adults. The induration resolves over a period of a week or so, often leaving some residual postinflammatory hyperpigmentation. No treatment is required, though it is clearly advisable for the child to avoid further cold exposure.
Neonatal cold injury is a disorder, which is due to exposure of neonates to cold. The clinical manifestations are hypothermia associated with lethargy and generalized pitting edema of the skin simulating sclerema neonatorum. Etiology Exposure to cold. Intrauterine growth retardation, which results in a relatively thin panniculus. Tight wrappings, which would restrict muscular activity. Immaturity. Home delivery and traditional behavior of bathing babies immediately after birth with cold water. Clinical Features General manifestations The infant is usually a full-term neonate, born at home, but small for gestational age. In the great majority of cases, presentation is within the first 4 days of life and usually during the first 24 hours which has a high mortality rate. The infant may show different general manifestations such as immobility, drowsiness, poor feeding, vomiting, oliguria, and gastro-intestinal bleeding with vomiting of altered blood or melena. Skin manifestations The most striking features are intense erythema, cyanosis or petechiae of the face and extremities. Firm pitting edema beginning at the extremities and spreading centrally which becomes later progressive and more indurated. The skin feels cold and the baby is usually hypothermic. Differential diagnosis Sclerema neonatorum .The generally healthy state of the infant before the onset of the cutaneous induration and the pitting nature may help in the differential diagnosis. History of cold exposure. Low rectal temperature.
SUBCUTANEOUS FAT NECROSIS OF THE NEW BORN Subcutaneous fat necrosis of the newborn is an uncommon and transient disorder of neonates in which focal areas of fat necrosis cause nodular skin lesions. This nodular necrosis of subcutaneous fat may occasionally be associated with hypercalcaemia. Subcutaneous fat necrosis generally occurs in full-term or post-term infants of normal birth weight, during the first 6 weeks of life. Etiology Different predisposing factors play an important role in the etiology of subcutaneous fat necrosis of the newborn. These include the following:
Transient thrombocytopenia has been reported during the period of initial development of the lesions, possibly due to the sequestration of platelets. Clinical Features Infants who develop subcutaneous fat necrosis are generally full-term or post-term neonates of normal weight. In most cases, the child‘s health is not impaired, and within a few months the nodules disappear. Skin lesions may be single or multiple, rounded or oval, and pea-sized or many centimeters in diameter and symmetrically distributed. They are initially discrete but may fuse to form large plaques. The overlying skin is often red or bluish-red. Nodular thickening of the subcutaneous tissues is usually first detected between the second and 21st day of life. The nodules tend to be multiple and show a predilection for buttocks, thighs, shoulders, back, cheeks and arms. The nodules feel rubbery or hard and are not attached to the deeper structures. New nodules may continue to develop for a week or more. Where calcium deposition is marked the lesions may take rather longer to resolve. Usually no trace of the nodules remains but there may be slight atrophy. Rarely, the nodules may ulcerate, discharge their fatty contents and leave scars. The condition has occasionally been fatal, particularly when visceral fat has been involved. Diagnosis Neonates delivered by forceps may develop subcutaneous nodules at the sites where the forceps were applied, presumably as a result of traumatic fat necrosis. All infants who have subcutaneous fat necrosis should have their serum calcium measured on presentation and a few weeks later. If hypercalcaemia is present, its cause requires thorough investigation to exclude disorders such as primary hyperparathyroidism and vitamin D intoxication. Treatment None is required. Hypercalcaemia will require treatment by: Administration of fursemide. Restriction of dietary calcium and vitamin D. Oral corticosteroids may be required in some cases.
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