Section 19

This is a self-resolving and benign condition that is seen in healthy newborns. The etiology of this disorder is probably ischemic injury to subcutaneous fat. Lesions often develop at sites of pressure. The infants develop single or multiple firm red-purple nodules or plaques that are asymptomatic. Cheeks, back, buttocks, and thighs are the most common locations. It is difficult to capture the quality of panniculitis in the figure, but a sense of it can be appreciated on the back of the patient pictured in Fig. 19-2.

###### Figure 19–2

Lesions may be present at birth, or they may develop during the first month of life. Most lesions resolve spontaneously over a period of 2–4 weeks, but some last significantly longer. There is usually no residual atrophy or scarring. Subcutaneous fat necrosis is occasionally associated with hypercalcemia.

###### Figure 19–3

Unlike the condition just described, sclerema neonatorum presents itself as symmetrical areas of induration on cheeks, shoulders, buttocks, and calves. The skin over involved subcutaneous fat is uniformly board-like, cold, and livid in color, as though frozen. Infants so affected appear rigid because mobility is interfered with by the sclerema and they are severely ill. Mortality is high. The condition is more common in premature infants and in those with severe underlying disease, such as sepsis or dehydration.

###### Figure 19–4

Red, tender, subcutaneous nodules on the extensor aspects of the legs between knees and ankles are a common condition of many causes, some clear, some likely, and many obscure. The most important conditions that are heralded or attended by erythema nodosum are such infections as streptococcal upper-respiratory infections, ulcerative colitis, histoplasmosis, coccidioidomycosis, tuberculosis, syphilis, and leprosy. Another condition that is sometimes revealed by investigation of erythema nodosum is sarcoidosis. Drugs, including oral contraceptives, appear to be the cause of particular cases of erythema nodosum. In many cases, however, no clear cause can be found.

###### Figure 19–6

This is a rare panniculitis in children that is characterized by recurrent crops of tender subcutaneous plaques and nodules in association with fever. The lower extremities are primarily involved, although the upper extremities, trunk, and face may also be involved. Myalgias and arthralgias may also occur. The etiology of Weber-Christian syndrome is unknown.

###### Figure 19–7

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