Figure 22-2
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. 22-2.
Figure 22-3
Subcutaneous fat necrosis 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 to 4 weeks, but some last significantly longer. There is usually no residual atrophy or scarring. Subcutaneous fat necrosis is occasionally associated with hypercalcemia, as was the case in this patient.
Figure 22-4
Sclerema neonatorum 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.