Post steroidal panniculitis "Sclerema Neonatarunz,,rubeutaneous fat necrosis of the newborn and poststeroid panniculitis give are physical panniculitis identical histological pictures" These three entities i.e. sclerema neonatarum, subcutaneous fat necrosis of the newborn and poststeroid panniculitis physical panniculitis and are histologically similar and are characterized histologically by "formation of needle shaped clefts arranged in a radial fashion both within adipocytes and within giant cells". "Histopathology also reveals lobular panniculitis characterized by patchy infiltrates of lymphocytes, histiocytes and multinueleated giant cells". (Panniculitis Inflammation of the subcutaneous, fat) Physical panniculitis Panniculitis that occurs. from physical factors Subcutaneous fat necrosis of the newborn - It is a lobular panniculitis - It occurs in full term or post term healthy infants typically at 1-6 weeks of life or soon thereafter. - The lesion consists of one or small number of finn, nontender, erythematous nodules or plaques on the face buttocks, and or extremities. - The nodules may often break down and discharge oily material. - Over the next.few weeks or month the nodules resolve spontaneously. Subcutaneous fat necrosis of the newborn is complicated by hypercalcemia - Hypercalcemia is the only significant complication and founately it occurs in minority of patients. - Manifestations of hypercalcemia include irritability. failure to thrive, hypeonia, nausea, vomiting. Pathogenesis is unknown with several hypotheses -The etiology of subcutaneous .fat necrosis is unknown but in some patients., bih trauma, asphyxia, difficult labour or hypothermia have been noted. - Perhaps diffuse tissue hypoxia predisposes to these conditions. Some believe that it occurs because of the differences in the composition of fatty acids. - In contrast to adult. fat, the subcutaneous fat of infants is thought to prone to crystal formation because of a higher content of saturated fatty acid including palmitic acid and stearic acid, and lower content of unsaturated fatty acid such as oleic acid. - The increased saturated to unsaturated fatty acid ratio results in higher melting point for stored fat and promotes crystallization. Treatment - Treatment will not he required as the lesion will resolve - Most infants have resolution of the lesion within 1-2 in - Parents should be reassured of the benign nature of this - They should be educated about the sign and symptoms o - Serum calcium should be measured whenever symptoms Post setorid panniculitis It is rare .form of panniculitis, occurs predominantly coicosteroids during rapid coicosteroid withdraw'. coicosteroid therapy. Firm subcutaneous nodules begin to appear within a month of tapering of the coicosteroids. Areas of abundant subcutaneous fat are oured i.e. cheek, trunks, proximal extremities. Most cases resolve spontaneously but if severe, the steroids must be reinstituted and tapered more slowly. Histologically the changes are identical to those seen in subcu- taneous fat necrosis of the newborn -There is a lobular panniculitis with necrosis of adipocytes and needle shaped clefts in both adipocytes and histiocytes. Foamy histiocytes are also present. - It was believed that the withdrawl of coicosteroids therapy leads to abnormal lipid metabolism resulting in the elevation of saturated to unsaturated fatty acid ratio. Sclerema Neonataram Sclerema neonatarum is much less common than subcutaneous fat necrosis but much serious and life threatening. It affects preteen and term baby. In this entity premature or term babies, develop, rapidly progressive diffuse nonedematous hardening of subcutaneous tissue beginning on the trunk or buttocks and extending to the entire body surface area. These infants have difficulty in maintaining body temperature with recurrent or persistent hypothermia. The newborns are usually sick. In most of the cases there is a history of complication during labor and delivery and the babies may be weak and cyanotic at bih. Sclerema newborn Subcutaneous fat necrosis of newborn * Sick newborn * Healthy newborn or infant * Diffuse hardening * Discrete nodules * Noninflanunatory * Inflammatory * Poor prognosis * Good prognosis In sclerema neonatarum the histological picture is identical to that of subcutaneous fat necrosis of the newborn.