A recent report suggests that, although noninflammatory fibrosis of the fat and fascia is typical but not specific for incisional biopsies of stiff skin syndrome, the presence of a lattice-like array of thickened, horizontally oriented collagen bundles may be a clue to diagnosis.37. Immaturity of the neonatal lipoenzymes is further compromised by hypothermia, infection, shock, dehydration, and surgical and environmental stresses. Diffuse sclerodermatous changes associated with systemic sclerosis, which is extremely rare in the newborn, can also mimic sclerema. Affected infants typically present with one or several indurated, variably circumscribed, violaceous or red plaques or subcutaneous nodules from one to several centimeters in diameter on the buttocks, thighs, trunk, face, and/or arms (Figs 27.1–27.4). Necrotizing enterocolitis, pneumonia, intracranial hemorrhage, hypoglycemia, and electrolyte disturbances are also often associated with sclerema. The involved fat lobules contain pathognomonic needle-shaped clefts surrounded by a mixed inflammatory infiltrate composed of lymphocytes, histiocytes, fibroblasts, and foreign body giant cells.5 Fine-needle aspiration biopsy is a safe and reliable alternative.14, Although laboratory tests are usually normal, hypercalcemia occurs occasionally from 1 to 4 months after the appearance of skin lesions.9,11–13 The risk of hypercalcemia increases with the severity of the perinatal insult and extent of fat necrosis.15 Rarely hypercalcemia is severe, and has been implicated in the deaths of three infants. Nevus lipomatosus cutaneous superficialis (NLCS) is a malformation of the subcutaneous tissue consisting of multiple or solitary papules, usually occurring on the lower trunk, buttocks, or upper thighs. A biopsy reveals granulomatous inflammation in the fat lobules and needle-shaped clefts within histiocytes identical to those of SCFN. Skin biopsies will demonstrate fat necrosis with granulomatous inflammation. As a consequence, at-risk infants should be monitored for the first 6 months of life and should not receive vitamin D supplementation for rickets prophylaxis during this period.3,15 Treatment of hypercalcemia may require intravenous saline, calcium-wasting diuretics, and rarely, intravenous corticosteroids. Blood cultures and cultures of other body fluids may also be positive. The diagnosis is apparent when one or several nodules develop in a vaccination injection site. 18 Diseases of the Skin and Subcutaneous Tissue (ICD-10-CM Chapter 12, Codes L00-L99) Chapter Outline ICD-10-CM Official Guidelines for Coding and Reporting Anatomy and Physiology Disease Conditions Infections of the Skin and Subcutaneous Tissue (L00-L08) Bullous Disorders (L10-L14) Dermatitis and Eczema (L20-L30) Papulosquamous Disorders (L40-L45) Urticaria … Skin picking disorder (SPD) is characterized by deliberate and repetitive manipulation of the skin, causing tissue damage. The clinical features of scleroderma overlap with some cases of stiff skin syndrome. It occasionally occurs in older infants up to 4 months of age with severe underlying disease. As a consequence, at-risk infants should be monitored for the first 6 months of life and should not receive vitamin D supplementation for rickets prophylaxis during this period. Recently, low-grade gliomas and intracranial vascular malformations have also been described. Although lesions can develop in infants with a normal delivery and neonatal course, SCFN has been associated with perinatal complications, including asphyxia, hypothermia, seizures, pre-eclampsia, meconium aspiration, and intrapartum medication. The earliest changes 24 h after cold injury include an infiltrate of macrophages and lymphocytes at the dermoepidermal junction extending into the dermis and fat. Congenital diseases and disorders of skin From Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings R20–R23. Most patients report that lesions were present at birth or appeared in the first two decades of life. Although onset is most commonly noted at 4–6 weeks of age and usually resolves by 4 months, some cases have reported to persist for 6 months. Ocular and cutaneous lesions appear to be static and amenable to surgical repair. Similar cases have been reported following the use of ice to induce hypothermia before cardiac surgery, and the application of ice bags to the face for management of supraventricular tachycardia. In ICD-9-CM, there are 2 codes available for lipomas of the skin and subcutaneous tissue, differentiated between face and other site. Lipomas are soft, rounded or lobulated, mobile, slightly compressible, subcutaneous tumors with smooth margins ( Fig. The study of Skin And Subcutaneous Tissue Disorders has been mentioned in research publications which can be found using our bioinformatics tool below. In primary cutaneous infection, superficial tissue destruction by the invading organism and ischemia from invasion of local blood vessels and lymphatics leads to necrosis and ulceration of the skin and deeper soft tissue structures. However, new lobules may develop slowly for decades, and recurrent lesions after excision or progression may be associated with infiltration of the underlying muscle. Although lesions are usually unilateral, bilateral involvement has been reported.

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