What is Subcutaneous Fat Necrosis?
Subcutaneous fat necrosis (SCFN) is a rare, self-limiting condition that affects neonates. It involves inflammation and necrosis of the subcutaneous fat, leading to the formation of firm, erythematous nodules or plaques. SCFN typically presents within the first few weeks of life and is more common in full-term or post-term infants who have experienced perinatal stress or trauma.
Perinatal asphyxia
Hypothermia
Meconium aspiration
Hypocalcemia
Maternal diabetes
Cesarean section
It is believed that these factors may lead to localized hypoxia and subsequent injury to the adipose tissue.
How is SCFN Diagnosed?
Diagnosis of SCFN is primarily clinical, based on the appearance of characteristic skin lesions. These lesions are usually firm, indurated, and can range from
red to purple in color. They are most commonly found on the back, buttocks, thighs, and cheeks.
In some cases, a
skin biopsy may be performed to confirm the diagnosis. Histopathological examination typically reveals necrosis of fat cells, inflammatory infiltrates, and the presence of needle-shaped clefts within the fat.
Hypercalcemia: Elevated levels of
calcium in the blood can occur in up to 50% of affected infants. This can lead to symptoms like irritability, vomiting, and lethargy.
Infection: Secondary bacterial infection of the necrotic tissue is a potential risk.
Skin Atrophy: Long-term atrophy or scarring of the affected skin may occur.
How is SCFN Managed?
Management of SCFN is largely supportive. The primary goals are to monitor and manage complications, especially hypercalcemia. Treatment strategies may include:
Monitoring: Regular monitoring of
serum calcium levels is crucial. Hypercalcemia, if present, may require treatment with hydration, diuretics, or corticosteroids.
Supportive Care: Ensuring adequate nutrition and hydration, and managing any secondary infections with appropriate
antibiotics.
Pain Management: Pain associated with the lesions can be managed with analgesics.
What is the Prognosis?
The prognosis for infants with SCFN is generally good. The skin lesions often resolve spontaneously within weeks to months, and most infants do not experience long-term complications. However, close follow-up is necessary to monitor for and manage any complications that may arise.
Conclusion
Subcutaneous fat necrosis is a rare but important condition in neonates, often associated with perinatal stress. While it is usually self-limiting, careful monitoring and management of complications such as hypercalcemia are essential for ensuring a good outcome. Early recognition and supportive care can help mitigate potential risks and promote recovery.
