Topical Tacrolimus as a Novel Treatment for Refractory Idiopathic Facial Aseptic Granuloma in a Pediatric Patient

This report describes the case of a four-year-old girl with idiopathic facial aseptic granuloma (IFAG) who developed persistent, treatment-resistant eyelid and facial inflammation despite multiple courses of antibiotics and corticosteroids. Her presentation included recurrent hordeola, severe blepharitis, and a cheek nodule, with a clinical picture more consistent with IFAG than pilomatrixoma despite histologic evidence of the latter. Standard therapies provided only transient benefit and were limited by systemic side effects. Initiation of topical tacrolimus 0.03% ointment led to rapid and sustained improvement in redness, irritation, and nodularity. This case highlights topical tacrolimus as a promising non-steroidal option for children with prolonged or refractory IFAG.