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Differential Diagnosis & Pitfalls

• Infectious cellulitis or panniculitis may appear very similar to cold panniculitis. However, infants with infections are often febrile and appear ill.
• Identical appearing nodules may form 1-2 weeks after abrupt cessation of systemic steroids; however, they usually affect more extensive areas of the body (face, trunk, and extremities).
• In newborns, especially those with unusually large plaques (ie, those greater than 3 cm) or affected by perinatal complications (asphyxia, hypothermia, seizures, preeclampsia, or meconium aspiration), subcutaneous fat necrosis of the newborn should be highly considered.
• Traumatic panniculitis (blunt trauma or injection) should be distinguished by history.
• Sclerema neonatorum is characterized by diffuse bound-down hardening of the skin that is cold rather than warm on palpation.
• Metastatic neuroblastomas are firm bluish nodules rather than ill-defined and erythematous.

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