Sclerema Neonatorum

Figure 1.53. Subcutaneous fat necrosis of the cheek in an infant following forceps delivery. In subcutaneous fat necrosis, which is usually detected towards the end of the first week of life, the lesions have an inflammatory or ecchymotic appearance. The underlying tissue may be indurated and feels diffusely hardened. With breakdown of the subcutaneous tissue after several days there may be an area in the center which is fluctuant. If managed conservatively, spontaneous healing usually occurs. This condition should not be mistakenly treated as an infection.

Figure 1.54. This infant, aged 5 days and delivered as a breech presentation, developed the extensive reddish-purple discoloration and swelling of the skin over the back with induration of the underlying subcutaneous tissue. This is an example of extensive subcutaneous fat necrosis. With conservative treatment, improvement occurred within 2 to 3 weeks. Differential diagnosis includes sclerema neonatorum in which there is progressive hardening of the subcutaneous tissue associated with severe illness of the infant. In sclerema the involved areas are hard and non-pitting and the palms and soles are spared.

Sclerema Neonatorum
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