PMC7790589_01
Photographs of the neonate with a cleft palate and diffusely indurated purplish skin in the neck region (a), thighs, buttocks, and groin (b) that could not be pinched or pitted.
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The initial physical examination revealed severe respiratory distress, meconium-stained skin, left cleft palate (Figure 1(a)), and bilaterally undescended testis which were also not palpable in the inguinal canals. The patient was normothermic, had no dysmorphic features, and cardiac auscultation was normal. Affected skin was smooth, purplish (Figures 1(a) and 1(b)), indurate, and nonpitting and could not be picked up and pinched.
Histology findings of skin biopsy showing extensive fibrosis with dense subepithelial collagen deposition, sparse inflammatory cell infiltration (black arrow), and entrapment of the dermal adnexa between the collagen fibers (white arrow) (a, b). Atrophy of the epidermis and loss of epidermal papilla (c) (H&E stain x10).
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These findings suggested sclerema (Figure 2).