Reoccurrence of the lesion, typically at the same site, is common While rare, a subcutaneous, generalized, and perforating form of granuloma annulare exists in children and should prompt referral to a dermatologist FIGURE 120.19 Granuloma annulare Juvenile Xanthogranuloma Juvenile xanthogranuloma (JXG) present as nodular or plaque-like lesions with a firm or rubbery consistency Initially reddish in color, they evolve to have a distinct yellow or orange hue ( Fig 120.20 ) While many are noted at birth, others appear within the first several months They range in diameter from 0.5 to cm Like hemangiomas, they tend to grow rapidly in infancy, then spontaneously regress in early childhood leaving a hyperpigmented scar Common sites include the scalp and face, proximal extremities, groin, and occasionally, the subungual area of a digit or a mucocutaneous junction Histologically, xanthogranulomas are composed of lipid-laden macrophages or histiocytes within a granulomatous matrix The inciting source is unknown The majority of children have solitary lesions In rare cases, multiple, giant, or disseminated lesions may occur Patients who have multiple lesions are more likely to have systemic or ocular involvement The most common noncutaneous lesions are ocular lesions, specifically lesions of the iris that have been associated with spontaneous anterior chamber hemorrhage and glaucoma Unlike cutaneous