From the Guidelines
Subcutaneous fat necrosis of the buttock in a toddler is typically caused by trauma, such as from a fall or injection, and the primary management is conservative treatment and monitoring. For pediatric fat necrosis, the approach involves:
- Observing and monitoring the area for changes
- Applying warm compresses to the affected area for 15-20 minutes, 3-4 times daily
- Gentle massage of the area to promote circulation
- Pain management with acetaminophen or ibuprofen if needed, dosed appropriately for the child's weight
- Avoiding further trauma to the area Although a study on scrotal fat necrosis 1 provides insight into fat necrosis in general, its specific focus on scrotal fat necrosis and the context of cold exposure does not directly apply to subcutaneous fat necrosis of the buttock in toddlers.
The management strategy is based on the principle that fat necrosis occurs when adipose tissue is damaged, leading to inflammation and scarring, and in children, the softer subcutaneous tissue is more susceptible to damage from external forces. Conservative management allows the body's natural healing processes to resolve the necrosis while minimizing further trauma to the area. If the indentation persists or enlarges, or if there are signs of infection (redness, warmth, swelling), consultation with a pediatrician for further evaluation is necessary. In rare cases, surgical excision may be considered for persistent lesions, but this is uncommon in children.
Given the lack of direct evidence from the provided study 1 on the management of subcutaneous fat necrosis of the buttock in toddlers, the approach is guided by general principles of managing similar conditions in pediatric patients, prioritizing conservative management to minimize morbidity and promote quality of life.
From the Research
Causes of Subcutaneous Fat Necrosis of the Buttock in Toddlers
- Subcutaneous fat necrosis of the newborn (SCFN) is caused by generalized and/or local tissue hypoperfusion 2
- Perinatal asphyxia is a common condition associated with SCFN, with 70% of cases having a history of perinatal asphyxia 3
- Fetal distress, including obstetric trauma, can also contribute to the development of SCFN 4
- Therapeutic hypothermia, used to treat severe neonatal asphyxia, may also increase the risk of SCFN and hypercalcemia 5
Management of Subcutaneous Fat Necrosis in Pediatric Patients
- The treatment of SCFN is generally supportive, with close monitoring of serum calcium levels to detect hypercalcemia 3
- Hypercalcemia, a potentially fatal complication, can be treated with oral prednisolone 3
- Skin biopsy can be performed to confirm the diagnosis of SCFN, and imaging studies such as ultrasonography can help with diagnosis and treatment 6
- Surgical management may be necessary in rare cases where there is a lack of improvement or extensive calcifications 2