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Oral Macrolides Demonstrate Efficacy in Aseptic Facial Granuloma


The condition may present as a manifestation of pediatric rosacea.

A retrospective case series1 published in Pediatric Dermatology found that treatment with oral macrolides demonstrated efficacy and was well-tolerated in 12 children with aseptic facial granulomas (AFGs), which may present as a manifestation of pediatric rosacea.

Alessandro Grandini/Adobe Stock
Alessandro Grandini/Adobe Stock

According to investigators, AFGs may be associated with childhood granulomatous rosacea. They cited previous research2 demonstrating the presence of at least 2 clinical signs of rosacea in a cohort of 38 patients with AFG.

Pediatric patients who had been diagnosed with AFG (n=12) between 2015 and 2022 were evaluated. During this time frame, all patients had received treatment with oral macrolides, receiving either 30–50 mg/kg erythromycin (n=11) or 7.5 mg/kg roxithromycin (n=1) on a daily basis.

Before treatment and at 3 and 6 months post treatment, dermatologists from the Department of Dermatology in Tuebingen, Germany, evaluated patients using scoring systems to measure size of the AFG lesions, induration of one or more nodules, and the intensity of the patients’ erythema. A score of 0 indicated complete clearance while a score of 4 represented the highest severity.

From before therapy to after therapy, the average lesion size score had decreased from 2.61 to 0.90, a 65.5% reduction, while the induration score had decreased from 2.7 to 0.61. Likewise, the average erythema score had also decreased significantly from 2.81 to 0.84.

On average, the total persistence of lesions was 7.7 months, with an average treatment duration of 5.25 months. None of the patients experienced relapse of their AFG.

Regarding adverse effects, 2 patients developed diarrhea, leading 1 patient to stop treatment early before completion. This patient, along with 1 additional patient, underwent surgical removal of their residual nodules.

“The extent of the spontaneous regression could not be addressed, which is a limitation of the study,” wrote study authors Lenders et al. “The two patients undergoing surgery after therapy were not considered treatment failures, as both patients showed a significant therapeutic response. Due to the therapy, surgery could be performed as a minor procedure resulting in less scarring. We, therefore, suggest the use of oral macrolides in the therapy of AFG.”


  1. Lenders D, Lenders MM, Jäger M, Schaller M. Treatment of aseptic facial granuloma as a manifestation of pediatric rosacea with oral macrolides. Pediatr Dermatol. Published online September 5, 2023. doi:10.1111/pde.15420
  2. Prey S, Ezzedine K, Mazereeuw-Hautier J, et al. IFAG and childhood rosacea: a possible link? Pediatr Dermatol. 2013; 30(4): 429-432. doi:10.1111/pde.12137
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