| Summary: | Background: Childhood granulomatous periorificial dermatitis incidence is increasing, yet topical therapies remain suboptimal with chronicity and scarring risks in severe cases. Systemic alternatives are urgently needed. Although oral clarithromycin shows promise, its efficacy/safety evidence in pediatric populations lacks robustness. Objective: This study evaluated the effect of clarithromycin on a pediatric group with granulomatous periorificial dermatitis. Methods: This retrospective study analyzed 43 patients treated with oral clarithromycin, with outcomes including treatment efficacy, adverse event incidence, and scar incidence. Results: All patients completed clarithromycin therapy (median 10 weeks; 2-26). At 6 months, 95.4% (41/43) cleared, with 2.3% each recurrence and nonresponse. Treatment duration correlated with both baseline severity (r = 0.592, P < .01) and disease duration (r = 0.590, P < .01). Scarring (14.6%) occurred only in moderate-to-severe cases, which showed greater severity (P = .039) and longer courses (P = .028). No severe adverse events occurred. Limitations: This is a retrospective study without case controls and is subject to interviewer and memory bias. Conclusion: For moderate-to-severe or stubborn cases, timely evaluation and tailored systemic interventions are critical to mitigate scarring risks. Clarithromycin is an effective and tolerated therapy in children with moderate-to-severe and refractory granulomatous periorificial dermatitis.
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