Oral macrolides effective for treating children with aseptic facial granuloma: Study

In the retrospective case series involving 12 children with aseptic facial granuloma, treatment with oral macrolides (roxithromycin or erythromycin) resulted in the healing of the lesions within a mean treatment time of 5.25 months with no recurrences, and the treatment was well-tolerated.

Aseptic facial granuloma is a rare pediatric disorder with the characteristics of painless inflammatory nodules localized to the eyelids or cheeks. Evidence has shown its association with granulomatous rosacea in childhood as some studies reported at least two clinical signs of rosacea, such as erythema, flushing, telangiectasias, papules and pustules in 42% and ocular involvement in 32% of 38 patients with AFG.

Aseptic facial granuloma remains a diagnostic and therapeutic challenge due to the limited case series reported in the literature. Daniela Lenders, Department of Dermatology, University of Tuebingen, Tuebingen, Germany, and colleagues performed a single centre, retrospective case series in the Department of Dermatology in Tuebingen, Germany, involving children diagnosed with AFG from 2015 to 2022.

Patients were treated orally with either roxithromycin 7.5 mg/kg or erythromycin 30–50 mg/kg daily. Ten dermatologists estimated the intensity of erythema, size of the lesion(s), and induration of the nodule(s) by photo documentation before the start of the therapy and after three to 6 months of the therapy.

The scoring system comprised the following parameters: 0: clear, 1: almost clear, 2: mild, 3: moderate, and 4: severe. A minimal 50% reduction of the respective score was considered a treatment response.

From 2015 to 2022, 20 patients were diagnosed with AFG. Due to insufficient follow-up data, eight patients were excluded. Twelve patients were included comprising 58% males. Eleven patients were treated with erythromycin and one patient was treated with roxithromycin orally. The mean treatment duration was 5.25 months. The mean age was 5.5 years.

75% of the patients showed signs of rosacea, namely erythema, pustules or papules. 16% had telangiectasias on the eyelids as well, and 33% had associated recurrent blepharitis, conjunctivitis, or chalazia. The mean duration of the lesions before starting therapy was 8.25 months.

The study led to the following findings:

• The mean erythema score was 2.81 before treatment and 0.84 after treatment, resulting in an improvement of erythema score of 70.1%.

• There was a reduction in the induration score from 2.7 to 0.61, which is a 77.4% score reduction under therapy.

• There was a decrease in the size score from 2.61 to 0.90, resulting in a 65.5% score reduction.

• Patients with an early therapy start within 8 months from lesion onset to therapy initiation (n = 7 patients) were analyzed to assess for the possibility of spontaneous resolution. The mean total persistence of lesions in this group was 7.7 months (range: 5–10 months).

• While treatment was generally well tolerated, 16% of patients developed diarrhoea and one stopped therapy early after 2 months.

• The other patients did not report any adverse side effects. None of the patients experienced a relapse.

• Two patients underwent surgery to remove residual nodules after treatment, one being the patient who stopped therapy early after only 2 months due to diarrhoea.

"Oral macrolides may be an effective treatment option for children with aseptic facial granuloma," the researchers concluded.

Reference:

Lenders, D., Lenders, M. M., Jäger, M., & Schaller, M. Treatment of aseptic facial granuloma as a manifestation of pediatric rosacea with oral macrolides. Pediatric Dermatology. https://doi.org/10.1111/pde.15420