Beyond the Lesion: A Retrospective Study of Idiopathic Facial Aseptic Granuloma in Children Focusing on Ultrasound Findings and Their Association with Chalazia
Keywords:
IFAG, rosacea, granulomatous rosacea, chalaziaAbstract
Introduction: Idiopathic facial aseptic granuloma (IFAG) is an uncommon granulomatous lesion associated with childhood rosacea. Affected children often experience recurrent eyelid chalazia.
Objectives: We present a single-center retrospective study of 16 cases of IFAG in order to assess their clinical course and discuss any therapeutic intervention.
Methods: Children presenting with facial lesions persisting for at least six weeks which exhibited clinical features of an (IFAG) were included in the study.
Results: There were 10 females and six males, with a mean age of 6.4 (± 4) years. The mean time from the onset of treatment to complete resolution of lesions was 11 months for the children treated with a topical regimen and 7.2 months for those children treated with both topical and systemic antibiotics respectively (P<0.005).
Ultrasound examination revealed a solid, hypoechoic lesion with increased perilesional or intralesional blood flow in the hypodermis without any calcium deposit as an early finding. Skin biopsies were performed in seven children. Recurrent chalazia were reported in all 16 cases.
Conclusions: IFAG is a benign lesion that may persist for several months before resolution. Ultrasound examination is a valuable tool for establishing a diagnosis. Clinicians should monitor children with IFAG for potential ocular complications that may arise later in life.
References
Martinez-Diaz GJ, Kim J, Bruckner AL. A toddler with facial nodules: a case of idiopathic facial aseptic granuloma. Dermatol Online J. 2010;16(1):9. Published 2010 Jan 15. PMID: 20137751.
Roul S, Léauté-Labrèze C, Boralevi F et al. Idiopathic aseptic facial granuloma (pyodermite froide duvisage): a pediatric entity? Arch Dermatol 2001; 137:1253–5. PMID: 11559236.
Camille Orion,Alicia Sfeccia, Laurent Tisseau, et al. Idiopathic Facial Aseptic Granuloma in a 13-Year-Old Boy Dramatically Improved with Oral Doxycycline and Topical Metronidazole. Case Rep Dermatol 2016;8:197-201. DOI: 10.1159/000447624 .
Boralevi F, Leaute-Labreze C, Lepreux S, et al. Idiopathic facial aseptic granuloma: a multicentre prospective study of 30 cases.Br J Dermatol. 2007;156:705-708. DOI: 10.1111/j.1365-2133.2006.07741.x .
Knopfel N, Gomez-Zubiaur A, Noguera-Morel L,et al. Ultrasound findings in idiopathic facial aseptic granuloma: case series and literature review. Pediatr Dermatol. 2018;35(3):397-400. DOI: 10.1111/pde.13324 .
Miconi F, Principi N, Cassiani L, et al. A Cheek Nodule in a Child: Be Aware of Idiopathic Facial Aseptic Granuloma and Its Differential Diagnosis. Int J Environ Res Public Health. 2019 Jul 11;16(14):2471. DOI: 10.3390/ijerph1614247.
Noguera-Morel L, Gerlero P, Torrelo A,et al. Ivermectin therapy for papulopustular rosacea and periorificial dermatitis in children: a series of 15 cases. J Am Acad Dermatol 2017;76:567-570. DOI: 10.1016/j.jaad.2016.10.034.
Vazquez-Osorio I, Alvarez-Cuesta CC, Rodr ıguez-Gonzalez L,et al.Idiopathic facial aseptic granuloma: usefulness of cutaneous ultrasound. Actas Dermosifiliogr. 2017;108:266-268. DOI: 10.1016/j.ad.2016.09.017.
Rodríguez-Bandera AI, Feito-Rodríguez M, Maseda-Pedrero R,et al. Idiopathic facial aseptic granuloma: Clin-ical and ultrasound findings in 3 cases. Actas Dermosifiliogr.2018;109:e1-5. DOI: 10.1016/j.ad.2017.08.016 .
Knöpfel N, Gómez-Zubiaur A, Noguera-Morel L,et al. Ultrasound findings in idiopathic facialaseptic granuloma: Case series and literature review. PediatrDermatol. 2017;35:397-400. DOI: 10.1111/pde.13324.
Hasbun ZC, Ogueta CI, Dossi CT, et al. Idiopathic facial aseptic granuloma: updated review of diagnostic and therapeutic difficulties. Granuloma aseptico facial idiopatico: revision actualizada de las dificultades diagnosticas y terapeuticas. Actas Dermosifiliogr (Engl Ed). 2019;110(8):637-641. DOI:10.1016/j.ad.2019.01.005.
Zitelli KB, Sheil AT, Fleck R, Schwentker A, Lucky AW. Idiopathic facial aseptic granuloma: review of an evolving clinical entity. Pediatr Dermatol. 2015;32:e136-e139. DOI: 10.1111/pde.12571 .
Prey S, Ezzedine K, Mazereeuw-Hautier J, Eschard C, et al.Groupe de Recherche Clinique en Dermatologie Pédiatrique: IFAG and childhood rosacea: a possible link? Pediatr Dermatol 2013;30:429-432. DOI: 10.1111/pde.12137 .
Kellen R, Silverberg NB. Pediatric rosacea. Cutis. 2016;98(1):49‐53. PMID: 27529708.
Baroni A, Russo T, Faccenda F, et al. Idiopathic facial aseptic granuloma in a child: a possible expression of childhood rosacea. Pediatr Dermatol. 2013;30:394-395. DOI: 10.1111/j.1525-1470.2012.01805.x.
Neri I, Raone B, Dondi A, et al. Should idiopathic facial aseptic granuloma be considered granulomatous rosacea? Report of three pediatric cases. Pediatr Dermatol. 2013;30:109-111. DOI: 10.1111/j.1525-1470.2011.01689.x .
Nazir SA, Murphy S, Siatkowski RM, et al.Ocular rosacea in childhood. Am J Ophthalmol. 2004;137(1):138‐144. DOI: 10.1016/s0002-9394(03)00890-0 .
Satta R, Montesu M, Biondi G, et al. Idiopathic facial asepticgranuloma: Case report and literature review. Int J Dermatol.2016;55:1381-7. DOI: 10.1111/ijd.13161.
Errichetti E, Neri I, Argenziano G, et al. Dermoscopy of idiopathic facial aseptic granuloma (IFAG): an observational controlled study. Int J Dermatol. 2025;64(2):422-424. DOI:10.1111/ijd.17389.
Di Brizzi EV, Piccolo V, Moscarella E, et al. Dermoscopy of pilomatricoma: Retrospective descriptive study on 35 paediatric patients. J Eur Acad Dermatol Venereol. 2025;39(2):e141-e143. DOI:10.1111/jdv.20183.
Di Brizzi EV, Moscarella E, Scharf C, Argenziano G, Piccolo V. Dermoscopy of juvenile xanthogranuloma: a retrospective descriptive study on 35 paediatric patients. J Eur Acad Dermatol Venereol. 2022;36(10):e846-e848. DOI:10.1111/jdv.18316
Rodríguez-Bandera AI, Feito-Rodríguez M, Maseda-Pedrero R, et al. Idiopathic facial aseptic granuloma: Clinical and ultrasound findings in 3 cases. Actas Dermosifiliogr.2018;109:e1-5. DOI: 10.1016/j.ad.2017.08.016.
Wortsman X. Role of color Doppler ultrasound in the diagnosis of idiopathic facial aseptic granuloma. Actas Dermosifiliogr.2018;109:581. DOI:10.1016/j.ad.2017.11.006 .
Galindo-Ferreiro A, Marques-Fernandez VE, Juarez Martın, et al. Eyelid nodules in idiopathicfacial aseptic granuloma. Arch Soc Esp Oftalmol (Engl Ed). 2021;96(10):556-560. DOI:10.1016/j.oftale.2020.07.008.
Chamaillard M, Mortemousque B, Boralevi F, et al. Cutaneous and ocular signs of childhood rosacea. Arch. Dermatol. 2008;144:167-171. DOI: 10.1001/archdermatol.2007.50.
Ozer P.A, Gurkan A, Kurtul BE, et al. Comparative clinical outcomes of pediatric patients presenting with eyelid nodules of idiopathic facial aseptic granuloma, hordeola, and chalazia. J. Pediatr. Ophthalmol. Strabismus 2016;53:206-211. DOI: 10.3928/01913913-20160511-03.
Two A.M, Wu W, Gallo R.L, et al. Rosacea: Part II. Topical and systemic therapies in the treatment of rosacea. J. Am. Acad. Dermatol. 2015;72:761-770. DOI: 10.1016/j.jaad.2014.08.027 .
Orion C, Sfecci A, Tisseau L, et al. 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. Case Rep Dermatol. 2016;8(2):197–201. DOI: 10.1159/000447624 .
Weir S. A, Amin S, Higgins A, et al. (2023). Idiopathic facial aseptic granuloma: case series and review of histological findings. Proceedings (Baylor University. Medical Center), 36(4), 458–460. DOI: 10.1080/08998280.2023.2210964.
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