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Dermatol Ther 2020 Jul 2. Epub 2020 Jul 2.

Department of Dermatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.

BMJ Case Rep 2020 Jun 11;13(6). Epub 2020 Jun 11.

Pediatrics-Neonatology, University of Calgary, Calgary, Alberta, Canada.

A term, large for gestational age male newborn, was admitted to the neonatal intensive care unit with meconium aspiration syndrome and severe hypoxic-ischaemic encephalopathy. The baby was treated with therapeutic hypothermia using a total body cooling blanket. After 48 hours, the baby developed tender, indurated subcutaneous nodules consistent with subcutaneous fat necrosis (SCFN). Read More

Case Rep Hematol 2020 21;2020:5742394. Epub 2020 Feb 21.

Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA.

Background: Subcutaneous fat necrosis (SFN) is a form of transient panniculitis that presents commonly in infants with a history of perinatal insult, particularly hypothermia. It is characterized by subcutaneous nodules and plaques that appear over bony prominences on cheeks, shoulders, buttock, and thighs. SFN is usually associated with various complications including hypercalcemia, thrombocytopenia, hypertriglyceridemia, and hyperglycemia. Read More

BMJ Case Rep 2019 Dec 15;12(12). Epub 2019 Dec 15.

Neonatology, Rotunda Hospital, Dublin, Ireland.

A term infant developed subcutaneous fat necrosis of the newborn (SFNN) 17 days following completion of therapeutic hypothermia for hypoxic ischaemic encephalopathy. Initial calcium was normal, however hypercalcaemia requiring hyperhydration and furosemide developed at 4 weeks. Parathyroid hormone and vitamin D were suppressed. Read More

Dermatopathology (Basel) 2019 Apr-Jun;6(2):147-152. Epub 2019 Jun 26.

Department of Radiology, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts, USA.

Subcutaneous fat necrosis of the newborn (SCFNN) is a rare form of panniculitis classically affecting healthy full-term infants. There are a number of predisposing factors including perinatal asphyxia. The condition generally has a benign course with spontaneous resolution, but monitoring for metabolic complications, in particular the potentially life-threatening complication of hypercalcaemia, is critical. Read More

J Perinat Med 2019 Nov;47(9):986-990

Neonatal-Perinatal Medicine, The State University of New York, University at Buffalo, Buffalo, NY, USA.

Objective To describe the clinical characteristics and risk factors in infants with subcutaneous fat necrosis (SFN) following therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). Methods A case-control study was performed by a retrospective chart review of infants with moderate or severe HIE admitted to a level IV regional perinatal center and who underwent whole-body cooling. Results A total of 14 (8. Read More

Neonatal Netw 2019 Jul 8;38(4):236-241. Epub 2019 Jul 8.

Subcutaneous fat necrosis (SCFN) is a rare complication, usually occurring in otherwise healthy full-term infants who have experienced some level of trauma that causes ischemic injury to adipose tissue. Tissue injury usually occurs in areas of the body that are exposed to excessive pressure as during delivery. Tissue injury has also been described secondary to therapeutic cooling. Read More

Am J Perinatol 2019 07 25;36(S 02):S134-S138. Epub 2019 Jun 25.

U.O.C. Neonatologia - TIN - Nido, ARNAS Civico, Palermo, Italy.

Objective: Subcutaneous fat necrosis (SCFN) is a rare condition that may occur in the neonatal period. SCFN is an inflammatory disorder of the adipose tissue, usually found in full-term healthy infants who have a history of intrauterine or perinatal distress. It is usually a self-limited condition; however, in some cases, it can get complicated, leading to severe hypercalcemia that may be life-threatening. Read More

Rev Chil Pediatr 2019 Apr;90(2):229-231

Departamento de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, España.

Skinmed 2019;17(1):63. Epub 2019 Mar 19.

From Private Practice, Fort Lauderdale, FL.

BMJ Case Rep 2019 Feb 19;12(2). Epub 2019 Feb 19.

Paediatric Dermatology, KK Women's and Children's Hospital, Singapore.

We present a case that illustrates the fluctuations in calcium levels to be expected while managing an infant with maternal gestational diabetes mellitus who also develops subcutaneous fat necrosis (SCFN). There is initial hypocalcaemia due to functional hypoparathyroidism, requiring judicious calcium replacement. But with increased extrarenal production of 1,25-dihydroxyvitamin D due to granulomatous inflammation of subcutaneous adipose tissue, hypercalcaemia ensues. Read More

Acta Cytol 2019;63(1):75-77. Epub 2018 Dec 13.

Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Glob Pediatr Health 2018 1;5:2333794X18803552. Epub 2018 Oct 1.

Wayne State University, Detroit, MI, USA.

Newborn skin nodules are usually benign and self-resolving skin condition. Differential diagnosis of such lesions include cysts, hemangioma, abscess, cellulitis, sclerema neonatorum, subcutaneous fat necrosis, neurofibromatosis, benign tumors, or malignant tumors such as rhabdomyosarcoma, infantile fibrosarcoma, or neuroblastoma. We report a case of congenital subcutaneous fat necrosis in a 7-day-old baby presenting with multiple erythematous mass on back. Read More

Pediatr Dermatol 2019 Jan 6;36(1):24-30. Epub 2018 Sep 6.

Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Subcutaneous fat necrosis of the newborn is an uncommon disorder, and although usually benign, associated hypercalcemia can lead to complications such as failure to thrive and renal failure. Many sources suggest screening for hypercalcemia for 6 months following resolution of skin lesions, but little data are available to support this recommendation. This study examines existing published literature to better guide practitioners regarding screening evaluations of asymptomatic patients with subcutaneous fat necrosis. Read More

Clin Pediatr (Phila) 2018 10 9;57(12):1468-1471. Epub 2018 Jul 9.

2 Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.

Arch Dis Child Educ Pract Ed 2019 10 3;104(5):248-249. Epub 2018 Jul 3.

Paediatrics, Oxford University Hospitals NHS Foundation Trust , Horton General Hospital, Banbury, UK.

An Bras Dermatol 2018 Jun;93(3):412-414

Department of Pathology, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Subcutaneous fat necrosis of the newborn is a rare benign panniculitis found in term and post-term neonates. Diagnosis is based on clinical characteristics and specific alterations in the adipocytes, detected by anatomical pathology. Subcutaneous fat necrosis of the newborn can occur in uncomplicated pregnancy and childbirth. Read More

Saudi Med J 2018 Jun;39(6):622-626

Department of Pediatric, Section of Pediatric Critical Care, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail.

Subcutaneous fat necrosis of newborn is a form of noninfectious panniculitis. It is an uncommon condition and mostly occurs in full-term infants within first weeks of life that have had a significant condition such as hypoxic-ischemic encephalopathy at the time of birth. Subcutaneous fat necrosis of newborn is usually a self-limiting condition but may be associated with hypercalcemia, which may lead to life threatening levels. Read More

Indian J Radiol Imaging 2018 Jan-Mar;28(1):107-110

Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta and Emory University, 1405 Clifton Road NE, Atlanta, Georgia 30322.

Objective: To describe the radiographic appearance of subclinical calcified brown fat necrosis and the associated clinical and laboratory findings.

Materials And Methods: Picture Archiving and Communications Sytem (PACS) was searched using keywords "soft tissue calcification" and "chest." The clinical record was searched for prior cardiac surgery, bypass, Extracorporeal Membrane Oxygentation (ECMO) and prostaglandin use. Read More

Dermatol Online J 2018 Mar 15;24(3). Epub 2018 Mar 15.

Dermatology Department, Hospital de Santarém EPE, Santarém, Portugal.

Subcutaneous fat necrosis of the newborn is an uncommon, transient, and self-healing panniculitis, mostly affecting term newborns with perinatal complications. The authors present a case of a female full-term neonate, born from an uncomplicated pregnancy, admitted into the neonatology unit 5 hours after delivery because of refractory multifocal seizures in the context of hypoxic-ischemic encephalopathy. Nine days after birth, indurated and erythematous nodules and plaques were noted on the left arm and back. Read More

J Pediatr Endocrinol Metab 2018 Mar;31(4):469-472

Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, Division of Pediatric Endocrinology, New Brunswick, NJ, USA.

Background: Subcutaneous fat necrosis (SCFN) is a rare, self-limiting condition that has been associated with several complications including hypercalcemia.

Case Presentation: We present the case of a 6-week-old male who presented to his pediatrician with a dime-sized erythematous nodule consistent with SCFN, who was also found to have supraventricular tachycardia (SVT). Laboratory findings revealed hypercalcemia and hyperkalemia. Read More

Int J Surg Pathol 2018 10 16;26(7):621-622. Epub 2018 Jan 16.

2 Government Medical College and Hospital, Chandigarh, Punjab, India.

JPRAS Open 2018 Mar 26;15:61-65. Epub 2017 Dec 26.

Plastic Surgery Department, Frenchay Hospital, Bristol, UK.

We report an infant who developed subcutaneous fat necrosis of the newborn (SCFN) secondary to cooling treatment for hypoxic ischaemic encephalopathy (HIE). While SCFN is usually self-limiting, this patient went on to develop a large haematoma on his back with overlying skin necrosis necessitating debridement and split thickness skin grafting. Initially, the area affected on his back showed a number of small fluctuant swellings. Read More

Oman Med J 2017 Nov;32(6):518-521

Special Care Baby Unit, Department of Nursing Services, St Philomena Catholic Hospital, Benin City, Nigeria.

Subcutaneous fat necrosis of the newborn (SCFNN) is a rare benign inflammatory disorder of the adipose tissue but may be complicated by hypercalcemia or less frequently, hypocalcemia, resulting in morbidity and mortality. Here we report the case of a neonate with subcutaneous fat necrosis who surprisingly developed hypocalcemia instead of hypercalcemia. A full-term female neonate was delivered by emergency cesarean section for fetal distress and was subsequently admitted to the Special Care Baby Unit. Read More

Pediatr Dev Pathol 2018 Sep-Oct;21(5):502-506. Epub 2017 Nov 6.

1 Department of Pathology, Women and Infants Hospital, Providence, Rhode Island.

Therapeutic hypothermia (head or whole-body cooling) improves survival and neurodevelopmental outcome in term newborns with moderate-to-severe encephalopathy. Hypothermia treatment is well tolerated; the most common side effect is thrombocytopenia. In about 1% of infants, focal subcutaneous fat necrosis has been reported. Read More

J Cutan Med Surg 2018 Mar/Apr;22(2):223-225. Epub 2017 Sep 21.

1 Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada.

Subcutaneous fat necrosis of the newborn (SFNN) is a rare disorder characterised by indurated plaques or nodules with or without erythema, typically distributed over the cheeks, extremities, posterior trunk, buttocks, and thighs, and appears during the first 2 weeks of life. It is commonly associated with perinatal asphyxia and, while usually self-limited, can lead to severe hypercalcemia. There is no known familial association. Read More

Br J Dermatol 2017 04;176(4):e32

Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon, 16247, Korea.

Pediatr Neonatol 2017 02 26;58(1):85-88. Epub 2014 Nov 26.

Dermatology Department, Hospital Sant Joan de Déu, Barcelona, Spain.

Subcutaneous fat necrosis of the newborn (SCFN) is a rare, self-limited disorder of the panniculus which appears in the first few weeks of life. SCFN generally follows an uncomplicated course. However, there are important complications for which the patient must be regularly monitored, including thrombocytopenia, hypoglycemia, hypertriglyceridemia, and most importantly, hypercalcemia. Read More

Semin Diagn Pathol 2017 May 27;34(3):261-272. Epub 2016 Dec 27.

Section of Dermatopathology,Dermatopathology, Division of Surgical Pathology & Cytopathology, University of Virginia Medical Center, Charlottesville, VA, USA. Electronic address:

The diagnosis of panniculitis is felt to be a confusing topic by some pathologists. This summarical article presents inflammatory diseases of the subcutis in a systematic fashion, based on whether they are centered on fibrovascular septa or the adipose lobules, and whether morphologic vasculitis is present or not. Septocentric, non-vasculitis disorders include erythema nodosum, panniculitis that follows the use of "biological" therapeutic agents, lipodermatosclerosis, post-irradiation panniculitis, morphea profunda, and necrobiosis lipodica profunda. Read More

Pediatr Dermatol 2016 Nov 30;33(6):e353-e355. Epub 2016 Aug 30.

Section of Pediatric Dermatology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada.

Subcutaneous fat necrosis of the newborn (SFN) is a rare form of panniculitis that can be complicated by hypercalcemia and nephrocalcinosis. We conducted a 20-year retrospective cohort study of 30 patients to describe the clinical characteristics of SFN and the prevalence of hypercalcemia and other complications. Hypoxia and therapeutic hypothermia (TH) seem to play an important role in the development of SFN. Read More

Rev Med Interne 2016 Nov 16;37(11):743-750. Epub 2016 Jun 16.

Clinique dermatologique, hôpitaux universitaires de Strasbourg, faculté de médecine, université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.

Panniculitis is an inflammation of the subcutaneous fat. Skin biopsy plays a critical role in the differential diagnosis of panniculitis. The most common approach to diagnosis relies on the differentiation between predominantly septal or lobular panniculitis, followed by the distinction between lesions with and without vasculitis. Read More

Minerva Pediatr 2016 Aug;68(4):316-7

Neonatal Intensive Care Unit, Azienda Ospedaliera Istituti Ospitalieri di Cremona, Cremona, Italy -

J Am Acad Dermatol 2016 Jul 4;75(1):177-185.e17. Epub 2016 May 4.

Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California. Electronic address:

Background: The inflammatory infiltrate seen in biopsy specimens obtained from patients with subcutaneous fat necrosis of the newborn (SCFN) has classically been described as consisting mostly of histiocytes. However, we encountered patients with SCFN whose biopsy specimens revealed mostly neutrophils, prompting infection to be an initial consideration.

Objectives: We sought to describe cases of SCFN in which neutrophils formed the majority of the infiltrate at our institution and in the literature. Read More

Acta Paediatr 2016 Sep 3;105(9):e396-405. Epub 2016 Jun 3.

Division of Newborn Medicine, Department of Pediatrics, McGill University, Montreal, QC, Canada.

Aim: To identify additional risk factors other than asphyxia and hypothermia in newborns developing subcutaneous fat necrosis (SCFN).

Methods: We conducted a prospective cohort study of all term asphyxiated newborns treated with hypothermia from 2008 to 2015. The presence and location of SCFN were recorded at the time of discharge or at follow-up visits. Read More

Pediatr Dermatol 2016 May 29;33(3):e220-1. Epub 2016 Apr 29.

Dermatology, University of Stellenbosch, Cape Town, South Africa.

A 5-day-old boy presented with cellulitis-like, fluctuant lesions since birth. Clinically, subcutaneous fat necrosis was suspected, but an infective lesion could not be excluded. By performing a fine-needle aspiration biopsy, a diagnosis was established within minutes. Read More

Arch Argent Pediatr 2016 Feb;114(1):e13-6

Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, 50009, España.

Therapeutic hypothermia is the current standard treatment in newborns with moderate to severe hypoxic-ischemic encephalopathy, changing the outcome of these children. It is considered a safe technique with almost no side effects. A possible adverse side event is subcutaneous fat necrosis, which is an acute self-limiting panniculitis that develops during the first weeks of life. Read More

Pediatr Dermatol 2016 Mar-Apr;33(2):e134-6. Epub 2016 Jan 29.

Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK.

Subcutaneous fat necrosis (SCFN) of the neonate is a rare panniculitis of early life that occurs in association with gestational diabetes and preeclampsia, as well as perinatal asphyxia, hypothermia, and trauma. A characteristic feature of this condition is its self-limiting and monophasic nature. We report a highly unusual case of delayed SCFN in a male neonate involving an anatomically discrete eruption, reminiscent of erythema nodosum, occurring many weeks after his original eruption had resolved. Read More

Clin Case Rep 2015 Dec 5;3(12):1017-20. Epub 2015 Nov 5.

Pediatric Dermatology Unit "Dell'Angelo" Hospital Venice Italy.

Subcutaneous fat necrosis (SCFN) is a rare fat tissue inflammation of the newborn. Risk factors include cord prolapse, perinatal asphyxia, therapeutic hypothermia, meconium aspiration, and sepsis. When present, hypercalcemia comes with lethargy, hypotonia, irritability, vomiting, polyuria, polydipsia, constipation, and dehydration. Read More

Lancet Neurol 2016 02 19;15(2):145-153. Epub 2015 Dec 19.

Centre for the Developing Brain, Division of Imaging Sciences and Bioengineering, King's College London, London, UK.

Background: Moderate cooling after birth asphyxia is associated with substantial reductions in death and disability, but additional therapies might provide further benefit. We assessed whether the addition of xenon gas, a promising novel therapy, after the initiation of hypothermia for birth asphyxia would result in further improvement.

Methods: Total Body hypothermia plus Xenon (TOBY-Xe) was a proof-of-concept, randomised, open-label, parallel-group trial done at four intensive-care neonatal units in the UK. Read More

Case Rep Pediatr 2015 8;2015:638962. Epub 2015 Oct 8.

University of Nigeria Teaching Hospital, PMB 01129, Enugu, Nigeria.

Background. Subcutaneous fat necrosis (SFN) is a rare, temporary, self-limited pathology affecting adipose tissue of full-term or postmature neonates. It is a rare entity especially in Nigeria and usually occurs in the first weeks following a complicated delivery. Read More

G Ital Dermatol Venereol 2015 Dec;150(6):766-8

Department of Health Sciences, Dermatologic Unit, San Paolo Hospital, Milan, University of Milan, Italy -

Indian J Pediatr 2016 Feb 8;83(2):189-90. Epub 2015 Oct 8.

Neonatal Intensive Care Unit, Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 06230, Hamamonu, Ankara, Turkey.

BMJ Case Rep 2015 Jul 15;2015. Epub 2015 Jul 15.

Department of Clinical Biochemistry, South-West London Pathology Network, Croydon, UK.

Hypercalcaemia in neonates is rare and often asymptomatic, but can have significant morbidity. If severe, it can cause symptoms including irritability, vomiting and seizures. We present the case of a baby girl, born at term after a traumatic delivery, who developed severe hypercalcaemia with nephrocalcinosis. Read More

BMC Pediatr 2015 Jul 9;15:73. Epub 2015 Jul 9.

Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.

Background: Neonates with hypoxic ischaemic encephalopathy (HIE) are routinely treated with therapeutic hypothermia (TH) for 72 h in order to improve neurological outcome. Subcutaneous fat necrosis (SCFN) is an adverse event occurring in neonates with HIE.

Methods: We analyzed risk factors for SCFN regarding demographic factors, cooling methods and deviation from target temperature range during hypothermia therapy. Read More

Acta Med Port 2015 Jan-Feb;28(1):119-22. Epub 2015 Feb 27.

Departamento de Pediatria. Hospital de Santa Maria. Lisboa. Portugal.

Subcutaneous fat necrosis of the newborn is an uncommon, transient and self-healing panniculits. This entity generally follows an uncomplicated course, however there are rare and important complications. The authors present a case of a newborn with subcutaneous fat necrosis complicated by hypercalcemia and nephrocalcinosis. Read More

J Cutan Pathol 2015 Jun 1;42(6):413-5. Epub 2015 Apr 1.

Department of Dermatology, Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain.

Panniculitis with lipid crystallization within adipocytes may be seen in several disorders, including crystal-storing histiocytosis, gouty panniculitis, subcutaneous fat necrosis of the newborn, post-steroid panniculitis, sclerema neonatorum, oxalosis and subcutaneous fungal infections by mucormycosis, zygomycosis or aspergillosis. Panniculitis at the sites of subcutaneous injection of drugs are frequent, but to our knowledge no crystals have been described in the drug-induced panniculitis at the sites of subcutaneous injections. We report on a patient who developed a panniculitis with lipid crystallization at the site of etanercept injection. Read More

Pediatr Dermatol 2015 May-Jun;32(3):427-9. Epub 2014 Dec 10.

Department of Dermatology, University of Siena, Siena, Italy.

A 7-day-old infant developed erythematous indurated plaques on the back, left shoulder, and arm a few days after therapeutic hypothermia. Ultrasonographic study along with Doppler blood flow analysis of lesional skin areas revealed flogistic fat involvement and calcifications. On the basis of clinical appearance, patient history, and ultrasonographic study, a diagnosis of subcutaneous fat necrosis of the newborn was established. Read More

Arch Pediatr 2015 Feb 4;22(2):191-4. Epub 2014 Dec 4.

Service de dermatologie, centre hospitalier du Mans, LUNAM université, CHR, 194, avenue Rubillard, 72000 Le Mans, France. Electronic address:

Moderate therapeutic hypothermia (MTH) significantly reduces the risk of death or long-term neurodevelopmental disability. Subcutaneous fat necrosis (SCFN) is a rare particular form of panniculitis in full-term newborns. It can occur in preterm infants with predisposing risk factors (birth asphyxia, gestational diabetes, etc. Read More

AJP Rep 2014 Nov 19;4(2):e93-6. Epub 2014 Nov 19.

Section of Neonatology, Peter Lougheed Centre, Calgary, Alberta, Canada ; Section of Neonatology, University of Calgary, Calgary, Alberta, Canada.

Subcutaneous fat necrosis (SCFN) is a noninfectious panniculitis that occurs in term infants who experience significant distress in the 1st weeks of life, including hypoxic ischemic encephalopathy (HIE). Since the introduction of therapeutic hypothermia for HIE, there have been a few published case reports of SCFN, following this modality of treatment. Although, most cases of SCFN resolve spontaneously, SCFN may be associated with hypercalcemia, which may sometimes reach dangerous levels. Read More