Idiopathic Facial Aseptic Granuloma in a 13-Year-Old Boy Dramatically Improved with Oral Doxycycline and Topical Metronidazole: Evidence for a Link with Childhood Rosacea

Orion, C.; Sfecci, Alicia; Tisseau, Laurent; Darrieux, Laure; Safa, Gilles

doi:10.1159/000447624

Cited by 15 publications

(12 citation statements)

References 7 publications

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“…Moreover, a relevant number of children with IFAG have at least some of the clinical findings, mainly flushing, papules, and pustoles [5], which are considered essential criteria for the diagnosis of rosacea in children [6]. Finally, as in rosacea, some cases of IFAG rapidly respond to local and systemic antibiotic therapy [7].…”

Section: Introductionmentioning

confidence: 99%

A Cheek Nodule in a Child: Be Aware of Idiopathic Facial Aseptic Granuloma and Its Differential Diagnosis

Miconi

Principi

Cassiani

et al. 2019

IJERPH

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Background: Idiopathic facial aseptic granuloma (IFAG) is a rare skin disease that typically presents in children with one or more nontender, erythematous to violaceous nodules located on the cheeks or eyelids. Lesions are not accompanied by other skin abnormalities. IFAG remains a diagnostic challenge in pediatric dermatology, because several diseases may present with similar signs. Case presentation: A three-year-old girl with a previous negative clinical history was referred to our hospital for the evaluation of some asymptomatic nodules on the convexity of the left cheek. The nodules had appeared two months before, and had gradually increased in size. Her mother denied any association with trauma or insect bites. The nodules had a hard-elastic consistency, were moderately firm, and were not fluctuant. No associated lymphadenopathy was observed. The girl was afebrile and in good general condition. A histologic evaluation of a biopsy specimen revealed an inflammatory, granulomatous-diffuse infiltrate in the superficial and deep dermis consisting of giant cells, histiocytes, lymphocytes, neutrophils, eosinophils, and plasma cells. The Ziehl–Neelsen stains, Gram-stains, and cultures were negative. Suspecting an IFAG, treatment with topical fusidic acid and oral clarithromycin for 14 days was started. After two months, the lesion resolved and did not recur. Conclusion: This case shows how to differentiate IFAG from other dermatologic diseases associated with a negative evolution. Treatment with oral clarithromycin was effective in our patient. However, more scientific evidence is needed to evaluate the most suitable antibiotic therapy. Further studies are also needed to establish whether antibiotics actually impact IFAG prognosis.

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Section: Introductionmentioning

confidence: 99%

A Cheek Nodule in a Child: Be Aware of Idiopathic Facial Aseptic Granuloma and Its Differential Diagnosis

Miconi

Principi

Cassiani

et al. 2019

IJERPH

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“…Lesions tend to grow rather quickly over a few weeks then resolve without sequelae over a longer period of weeks to months . The clinical presentation can be alarming and conjure a broad differential diagnosis including lymphoproliferative disorders, infections, acne, pilomatrixoma, xanthogranuloma, arthropod assault, inflamed cysts (dermoid or epidermoid), chalazion, or hemangiomas, to name a few …”

Section: Microscopic Description and Discussionmentioning

confidence: 99%

“…The etiology of IFAG is poorly understood, and there are no established risk factors or pertinent associated personal or family history . A hypothetical link with childhood rosacea has been proposed in part because lesions tend to improve with rosacea treatments such as doxycycline and/or topical metronidazole, but also because a significant proportion of patients with IFAG will subsequently develop rosacea . In light of this link, referral to ophthalmology should be considered .…”

Section: Microscopic Description and Discussionmentioning

confidence: 99%

Painless red nodule on the face of an adolescent male

Cardis

Gehris

Koch

et al. 2019

Pediatric Dermatology

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A previously healthy 13-year-old boy presented to clinic with an enlarging red nodule on the chin. It began 3 weeks prior, initially looking like a "pimple." He was evaluated by his primary care physician and referred to dermatology for what appeared to be cystic acne. The patient reported that the nodule was asymptomatic, never producing pain or exudate. There was no history of prior trauma, and he denied a personal or family history of acne. He tried over-the-counter benzoyl peroxide gel along with warm compresses, neither of which helped. Physical examination revealed an approximately 1.5 cm firm, nonfluctuant pink-red nodule on the right side of the chin (Figure 1). Dermoscopic evaluation revealed follicular accentuation with perifollicular hypopigmentation and rare branching vessels (Figure 2). Few small red papules and comedones were noted on other areas of the face, and a lymph node examination was negative. A 3 mm punch biopsy was performed and submitted for histologic examination, of which representative hematoxylin and eosin-stained sections are shown (Figure 3A, original magnification x20; Figure 3B, original magnification x100).

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“…articles reporting on 69 patients were identified. 17,23,24,27,32,[34][35][36]39,42,[44][45][46][52][53][54]57,[64][65][66][67][68][69][70][71][72] Thirty patients (30/69, 43%) were diagnosed with periorificial dermatitis. 23,46,64,[68][69][70][71][72] Thirteen of these patients were treated with topical metronidazole monotherapy, with all but 1 patient achieving complete remission within 6 months.…”

Section: N Cases Usedmentioning

confidence: 99%

Efficacy of treatments for rosacea in the pediatric population: A systematic review

Geng,

Bourkas,

Sibbald

et al. 2023

JEADV Clinical Practice

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The prevalence of rosacea in the pediatric population is rare and treatment recommendations specific to the pediatric population are lacking. Our objective is to perform a systematic review of the published literature to identify treatments used for rosacea in the pediatric population (age <18 years) and describe their efficacy. Literature searches were performed in four electronic databases: Medline, Embase, CINAHL and EBM Reviews. Data extraction included rosacea subtype, treatment regimen and clinical outcomes. Seventy‐six studies were included, reporting on a total of 389 patients. The most commonly reported treatments included erythromycin, metronidazole, azithromycin, tacrolimus/pimecrolimus and corticosteroids in topical formulations. Isotretinoin and physical treatment modalities were reported to be effective in treating severe recalcitrant cases of rosacea. In our review, we describe the most commonly reported therapies with demonstrated efficacy in treating pediatric rosacea. The evidence supports therapy with topical anti‐inflammatory options initially, with the addition of systemic antibiotics for cases refractory to topical monotherapy.

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Idiopathic Facial Aseptic Granuloma in a 13-Year-Old Boy Dramatically Improved with Oral Doxycycline and Topical Metronidazole: Evidence for a Link with Childhood Rosacea

Cited by 15 publications

References 7 publications

A Cheek Nodule in a Child: Be Aware of Idiopathic Facial Aseptic Granuloma and Its Differential Diagnosis

A Cheek Nodule in a Child: Be Aware of Idiopathic Facial Aseptic Granuloma and Its Differential Diagnosis

Painless red nodule on the face of an adolescent male

Efficacy of treatments for rosacea in the pediatric population: A systematic review

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