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 Jan 1:1066896917751052. Epub 2018 Jan 1.

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

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

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 Feb 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 Feb 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

J La State Med Soc 2014 May-Jun;166(3):97-9. Epub 2014 Jun 10.

Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan.

Subcutaneous fat necrosis of the newborn (SCFN) is a rare, benign, and self-limiting panniculitis of neonates that presents in the first few weeks of life and is most commonly associated with birth asphyxia and meconium aspiration. There have been few case reports of SCFN following therapeutic hypothermia. With the increasing use of therapeutic whole-body hypothermia, SCFN may become more prevalent. Read More

Arch Dis Child Fetal Neonatal Ed 2014 Sep 6;99(5):F419-21. Epub 2014 Jun 6.

Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.

Objective: Subcutaneous fat necrosis (SCFN) is a rare form of panniculitis in infants that generally occurs following birth trauma, meconium aspiration, or therapeutic cooling. Severe hypercalcaemia occurs in a subset of patients, but data on its presentation, management and outcomes are limited. This report details the clinical course and complications of infants treated for severe hypercalcaemia (peak serum calcium ≥3. Read More

J Perinatol 2014 Jun;34(6):492-3

Neonatology Service, Hospital Sant Joan de Déu, Barcelona, Spain.

Subcutaneous fat necrosis (SCFN) is a rare entity that occurs generally in term or post-term newborns exposed to perinatal stressing factors. These cutaneous lesions appear during the first weeks of life and their potential complications, such as hypercalcemia, determine the prognosis. We present a full-term newborn with SCFN lesions that appeared at the age of 12 days and who, 1 week later, developed moderate hypercalcemia. Read More

Eur J Pediatr Surg 2015 Apr 28;25(2):189-94. Epub 2014 Mar 28.

Department of Paediatric Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.

Background: Meningomyelocele is a defect of the spinal cord, vertebrae, and the overlying skin and is the most common form of open spinal dysraphism. Rapid closure of the back defect in the early postnatal period is mandatory to reduce the frequency of infection-related complications of the central nervous system. Majority of the cases present with small defects, which can be closed primarily, with or without subcutaneous dissection. Read More

An Pediatr (Barc) 2014 Dec 26;81(6):e36-7. Epub 2014 Feb 26.

Sección del Servicio de Neonatología, Hospital Doce de Octubre, Madrid, España.

Br J Dermatol 2014 Jul 6;171(1):183-5. Epub 2014 Jun 6.

Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud - University of Rennes 1, 16 Boulevard de Bulgarie, Rennes, 35200, France.

Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon and transient disease characterized by defined areas of fat necrosis and overlying cutaneous nodule lesions. It usually becomes apparent within the first 6 weeks of life in full-term or post-term infants. It is caused by generalized and/or local tissue hypoperfusion. Read More

An Bras Dermatol 2013 Nov-Dec;88(6 Suppl 1):154-7

Federal University of São Paulo, Paulista Medical School, department of dermatology, São PauloSP, Brazil.

Subcutaneous fat necrosis of the newborn is an unusual form of panniculitis, with few cases described in medical literature. The disease affects newborns at term or post-term, with normal general health. We describe two cases of newborns affected by the disease. Read More

Ann Pathol 2013 Oct 18;33(5):360-2. Epub 2013 Oct 18.

Service d'anatomie et de cytologie pathologiques, hôpital Charles-Nicolle, Tunis, Tunisie. Electronic address:

Case Rep Pediatr 2013 9;2013:254089. Epub 2013 Jul 9.

Zekai Tahir Burak Maternity Teaching Hospital, Neonatology, 06230 Ankara, Turkey.

Subcutaneous fat necrosis (SCFN) is an inflammatory disorder of adipose tissue. The main risk factors for the development of SCFN are perinatal asphyxia and hypothermia. Presented here is a case of a newborn who developed SCFN in association with polycythemia and hypocalcemia following treatment by passive cooling. Read More

Indian J Dermatol 2013 Jul;58(4):328

Department of Dermatology, KPC, Medical College and Hospital, Kolkata, India.

Subcutaneous fat necrosis of infancy is a rare disorder of subcutaneous adipose tissue that is sometimes complicated by hypercalcemia. Complete resolution is common. From the pediatrician's point of view, the disease is a rare but important cause of inconsolable cry in a newborn. Read More

G Ital Dermatol Venereol 2013 Aug;148(4):371-85

Dipartimento di Scienze Clinico-Chirurgiche Diagnostiche e Pediatriche, Sezione di Dermatologia Università di Pavia, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italia -

This paper will give a comprehensive view of the most frequent panniculitides seen in childhood, with emphasis on the types exclusively found in infancy, and for all other types of panniculitides also found in adults. Aim of this paper is also to analyze the clinical differences between panniculitis in childhood and in adulthood, and to give reliable histopathologic criteria for a specific diagnosis. A review of the literature is here integrated by authors' personal contribution. Read More

J Coll Physicians Surg Pak 2013 Jul;23(7):528

Arch Pediatr 2013 Jul 29;20(7):768-71. Epub 2013 May 29.

Unité de néphrologie pédiatrique, pédiatrie III, hôpital d'enfants Abderrahim-Harouchi, CHU Ibn Rochd, rue El Faidouzi, Casablanca, Maroc.

Subcutaneous fat necrosis is an uncommon disease that may be complicated with potentially fatal hypercalcemia or with nephrocalcinosis. We report on the case of a patient with a history of significant perinatal asphyxia, hospitalized for a urinary tract infection. Lesions of subcutaneous fat necrosis were noted, with asymptomatic hypercalcemia at 3. Read More

Turk J Pediatr 2012 Nov-Dec;54(6):667-70

Division of Pediatric Nephrology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

Subcutaneous fat necrosis of the newborn is an uncommon disorder affecting the adipose tissue of term infants. It is usually known as a transient, benign and self-limited disease, characterized by painful skin lesions beginning within the first week of life. The prognosis of the disease is generally good, but it may be complicated by potentially life-threatening metabolic alterations, including hypercalcemia, thrombocytopenia, hypoglycemia, and hypertriglyceridemia. Read More

Pediatr Int 2013 Apr;55(2):e23-4

Department of Neonatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.

Hypoxic-ischemic encephalopathy in neonates causes irreversible damage to tissue and organs and results in multiple organ failure and poor outcome. Therapeutic hypothermia is the most effective therapy in neonates with hypoxic-ischemic encephalopathy. We report here a case of subcutaneous fat necrosis (SCFN) after therapeutic hypothermia by selective head cooling. Read More

Adv Neonatal Care 2012 Dec;12(6):345-8

Women's Hospital-Greensboro, Greensboro, NC 27408, USA.

Whole-body cooling, or therapeutic hypothermia, is increasingly becoming the standard of treatment for moderate to severe neonatal encephalopathy because it reduces neurodevelopmental disabilities and mortality in term neonates. Subcutaneous fat necrosis (SCFN) of the newborn has been identified as a potential side effect of birth asphyxia. In recent literature, there has been an increase in SCFN in infants who received whole-body cooling in treatment of neonatal encephalopathy. Read More

Neonatal Netw 2012 Nov-Dec;31(6):409-12

Legacy Health, Portland, OR 97211, USA.

Because neuroprotective cooling for hypoxic ischemic encephalopathy (HIE ) becomes more commonplace in NICU s, health care providers should be familiar with the complications of this therapy. Therapeutic cooling improves neurodevelopmental outcomes and has relatively few side effects. One unexpected outcome that has been reported is subcutaneous fat necrosis (SCFN). Read More

Vet Res Commun 2013 Mar 23;37(1):1-10. Epub 2012 Oct 23.

Animal Biosciences and Biotechnology Laboratory, Beltsville Agricultural Research Center, USDA/ARS, BARC-East, Beltsville, MD 20705, USA.

The neonatal pig is susceptible to stress and infection, conditions which favor tumor necrosis factor α (TNFα) secretion. This study examined whether TNFα can alter metabolic activity and cytokine gene expression within neonatal pig adipose tissue. Cell cultures were prepared from neonatal subcutaneous adipose tissue using standard procedures. Read More

Ann Dermatol Venereol 2012 Aug-Sep;139(8-9):601-2. Epub 2012 Jul 12.

Unité fonctionnelle de dermatologie, hôpital René-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France.

Med Glas (Zenica) 2012 Aug;9(2):429-31

Clinic of Pediatric, Clinical Center of Kragujevac, Kragujevac, Serbia.

Subcutaneous fat necrosis of newborns is a transient, benign process in full- term or postmature neonates. It is associated with perinatal distress. Newborn stress inhibits immature enzyme system, which already has relative inability to desaturate saturated fatty acids. Read More

BMJ Case Rep 2012 Jan 10;2012. Epub 2012 Jan 10.

Department of Paediatrics, Macclesfield District General Hospital, Cheadle, UK.

J Matern Fetal Neonatal Med 2012 Oct 14;25(10):2115-21. Epub 2012 May 14.

Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department, A. Meyer University Children's Hospital, Florence, Italy.

Objective: To present the results of a strategy designed to reduce the incidence of skin complications in newborns with hypoxic-ischemic encephalopathy treated with moderate whole-body hypothermia.

Design: Retrospective study.

Setting: Neonatal Intensive Care Unit (NICU). Read More