ABSTRACT
Of the wide range of treatment modalities available to dermatologists, few possess the history, efficacy, and safety of phototherapy. It should be emphasized that dermatologists are the only group of physicians optimally trained and qualified to understand the medical indications of phototherapy. Phototherapy, recognized for its cost-effectiveness, should remain a consideration in patient treatment. Continued training and education in residency and thereafter is needed to maintain the proficiency of physicians. In addition, payors need continued education to ensure that insurance coverage of phototherapy is not a barrier for patients to access this therapy. To further improve and optimize the outcome, phototherapy research needs to be supported.
Subject(s)
Biological Factors/economics , Phototherapy/economics , Phototherapy/statistics & numerical data , Skin Diseases/pathology , Skin Diseases/therapy , Biological Factors/therapeutic use , Cost-Benefit Analysis , Dermatology/standards , Dermatology/trends , Female , Humans , Incidence , Male , PUVA Therapy/economics , PUVA Therapy/methods , PUVA Therapy/statistics & numerical data , Phototherapy/methods , Psoriasis/economics , Psoriasis/therapy , Risk Assessment , Skin Diseases/economics , Treatment Outcome , Ultraviolet Therapy/economics , Ultraviolet Therapy/methods , Ultraviolet Therapy/statistics & numerical dataABSTRACT
Juvenile xanthogranuloma is a benign histiocytic tumor predominantly occurring in children as yellowish papules on the head and trunk. Presentations on the volar surfaces are rare and may cause diagnostic confusion with pyogenic granuloma, eccrine poroma and digital fibrokeratoma. We report two patients with unusual presentations of solitary juvenile xanthogranuloma on the palm or sole. Both had lesions lacking the classic yellowish color and demonstrating a well-defined, peripheral hyperkeratotic rim. Histopathological evaluation revealed prominent orthokeratosis corresponding to the rim. Additional histological features, including dermal histiocytes and Touton giant cells, were consistent with the diagnosis of juvenile xanthogranuloma. Given the unusual locations and colors of the lesions, we conclude that histopathological evaluation is central to diagnosing volar juvenile xanthogranuloma. We additionally suggest that juvenile xanthogranuloma should be included in the differential diagnoses of volar lesions displaying a peripheral hyperkeratotic rim.
