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Double toenail is a rare abnormality that usually affects the fifth toe. It is considered as an inherited condition that may represent an incomplete form of polydactyly. Underlying bone abnormalities should be ruled out. We present a case of a double toenail of the second toe, a location that has not previously been described, with underlying bone involvement noted on ultrasound and plain films.

Subcutaneous fat necrosis of the newborn is a rare lobular panniculitis. It is characteristic of term or post-term neonates with a history of perinatal compromise or maternal gestational pathology. The cutaneous manifestations consist of erythematous and indurated subcutaneous plaques and nodules located over the dorsal region and the shoulders. Diagnosis is clinical and pathological. Histopathological findings include lobular panniculitis with a lymphohistiocytic inflammatory infiltrate with few neutrophils, fatty necrosis, deposition of radial needle-shaped crystals in the adipocytes, and possible calcification and hemorrhage. The cutaneous ultrasound shows hyperechoic and avascular subcutaneous cellular tissue and acoustic shadows may appear corresponding to calcifications. The clinical differential diagnosis includes sclerema neonatorum and post-corticosteroid panniculitis. Histologically crystal-forming panniculitis conditions are in the differential diagnosis. The disease is usually self-limited but complications such as hypercalcemia, hypoglycemia, hypertriglyceridemia, thrombocytopenia, and anemia may occur. Complications should be ruled out and treated at diagnosis and during follow-up. The most important complication is hypercalcemia.La necrosis grasa subcutanea neonatal es una paniculitis lobulillar infrecuente. Es caracteristica de neonatos a termino o postermino con antecedentes de sufrimiento perinatal o patologia gestacional materna. Las manifestaciones cutaneas consisten en placas y nodulos subcutaneos eritematosos e indurados localizados preferentemente en la region dorsal y los hombros. El diagnostico es clinicopatologico. Los hallazgos histopatologicos comprenden una paniculitis lobulillar con un infiltrado inflamatorio linfohistiocitario con escasos neutrofilos, necrosis grasa, deposito de cristales radiados en los adipocitos y posibles focos de calcificacion y hemorragia. En la ecografia cutanea se observa hiperecogenicidad y avascularizacion del tejido celular subcutaneo y pueden aparecer sombras acusticas posteriores que se correspondencon calcificaciones. El diagnostico diferencial clinico se debe realizar con el escleredema neonatorum y la paniculitis postesteroidea, e histologicamente con las paniculitis con formacion de cristales. La enfermedad suele ser autolimitada pero pueden aparecer complicaciones como la hipercalcemia, la hipoglucemia, la hipertrigliceridemia, latrombocitopenia y la anemia. Las complicaciones deben ser descartadas y tratadas en el diagnostico y durante el seguimiento. La complicacion masimportante es la hipercalcemia.