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Skin-nontumor / Clinical Dermatology

Other dermatoses

Subcutaneous fat necrosis of newborn


Reviewer: Mowafak Hamodat, MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns, Canada (see Reviewers page)
Revised: 2 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Uncommon disorder of infants in good health with lesions on trunk, extremities, buttocks, cheeks
● Hypercalcemia has been reported in some cases; thrombocytopenia, hypoglycemia and hypertriglyceridemia may also develop
● Lactic acidosis and hyperferritinemia were each present in one case
● Numerous possible causes, including obstetrical trauma, hypothermia, asphyxia, anemia, forceps delivery, macrosomia, exposure to active or passive smoking during pregnancy, prostaglandin E administration, maternal exposure to cocaine or calcium channel blockers

Case reports
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● Two cases (Dermatol Online J 2004;10:12)

Clinical description
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● Indurated areas and distinct nodules with a predilection for the cheeks, shoulders, buttocks, thighs and calves

Micro description
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● Basophilic fat necrosis, clusters of needle like clefts in lipocytes and histiocytes
● Clefts may contain refractile crystals
● Variable granulomatous inflammation and small calcium deposits
● Normal epidermis and dermis with an underlying lobular panniculitis
● Focal fat necrosis is present and this may lead to fat cyst formation
● Lymphocytes, histiocytes, foreign body giant cells and sometimes a few eosinophils wedged between the fat cells
● Many fat cells retain their outline but contain fine, eosinophilic cytoplasmic strands and granules, between which are narrow clefts radiating from a point near the periphery of the cell; clefts contain doubly refractile crystals, representing triglycerides, on frozen section
● Similar fine, needle-like crystals can be seen in giant cells
● Older lesions have fibrosis between fat cells

Micro images
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Subcutaneous fat necrosis of newborn

EM description
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● Intact and necrotic fat cells containing needle-shaped crystals arranged radially or in parallel
● Dense granular material is also present in necrotic fat cells, which are surrounded by macrophages

Additional references
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eMedicine

End of Skin-nontumor / Clinical Dermatology > Other dermatoses > Subcutaneous fat necrosis of newborn


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