Published date: Feb 13 2023

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: Jan–Mar 2023, Volume 18, Issue 1

Pages: 130 – 134

DOI: 10.18502/jovr.v18i1.12733

Alexandra Van Brummenavanbrum@uw.eduDepartment of Ophthalmology, University of Washington, Seattle, WA, USA

Shu FengDepartment of Ophthalmology, University of Washington, Seattle, WA, USA

Emily LiDepartment of Ophthalmology, University of Washington, Seattle, WA, USA

Arash J. AmadiDepartment of Ophthalmology, University of Washington, Seattle, WA, USA

Sarah JacobsDepartment of Ophthalmology, University of Alabama, Birmingham, AL, USA

Purpose: To demonstrate novel treatments for patients with high juvenile xanthogranuloma ( JXG) eyelid lesion burden.
Case Report: A 14-year-old girl was referred to the oculoplastic surgery service for management of worsening extensive bilateral eyelid and adnexal lesions in the setting of JXG. The patient underwent intra-lesional steroid injections, serial excisions, and reconstruction with skin grafts. She was subsequently treated with CO2 laser-assisted topical steroid application, which resulted in lesion regression.
Conclusion: A novel multimodal approach to treatment of severe periocular JXG, incorporating surgical debulking, skin autograft, CO2 laser, and intra-lesional steroids, can be effective for lesion control.

Keywords: CO2 Laser, Juvenile Xanthogranuloma, Laser-assisted Steroid Delivery

1. Wollina U, Burgdor WHC, Haroske G. Disseminated Juvenille Xanthogranuloma. JDDG 2006;4:45–48.

2. Freyer DR, Kennedy R, Bostrom BC, Kohut G, Dehner LP. Juvenile xanthogranuloma: Forms systemic disease and their clinical implications. J Pediatr 1996;129:227–237.

3. Samara WA, Khoo CTL, Say EAT, Saktanasate J, Eagle Jr RC, Shields JA, et al. Juvenile xanthogranuloma involving the eye and ocular adnexa. Ophthalmology 2015;122:2130–2138.

4. Chang MW, Frieden IJ, Good W. The risk of intraocular juvenile xanthogranuloma: Survey of current practices and assessment of risk. J Am Acad Dermatol 1996;34:445– 449.

5. Park JH, Chun JY, Lee JH. Laser-assisted topical corticosteroid delivery for treatment of keloids. Lasers Med Sci 2017;32:601–608.

6. Cambiaghi S, Restano L, Caputo R. Juvenile xanthogranuloma associated with neurofibromatosis 1:14 patients without evidence of hematologic malignancies. Pediatr Dermatol 2004;21:97–101.

7. Zvulunov A, Barak Y, Metzker A. Juvenile xanthogranuloma, neurofibromatosis, and juvenile chronic myelogenous leukemia: World statistical analysis. Arch Dermatol 1995;131:904–908.

8. Vijapura JA, Fulbright JM. Use of radiation in treatment of central nervous system juvenile xanthogranulomatosis. Pediatr Hematol Oncol 2012;29:440–445.

9. Elner V, Mintz R, Demirci H, Hassan AS. Local corticosteroid treatment of eyelid and orbital xanthogranuloma. OPRS 2006;22:36–40.

10. Kuruvilla R, Excaravage GK, Finn AJ, Dutton JJ. Infiltrative subcutaneous juvenile xanthogranuloma of the eyelid in a neonate. OPRS 2009;25:330–332.

11. Klemke CD, Held B, Dippel E, Goerdt S. Multiple juvenile xanthogranulomas successfully treated with CO2 laser. JDDG 2007;5:30–33.

12. Vieira V, Del Pozo J, Martinez W, Veiga-Barreiro JA, Fonseca E. Necrobiotic xanthogranuloma associated with lymphoplasmacytic lymphoma. Palliative treatment with carbon dioxide laser. Eur J Dermatol 2005;15:182–185.