What is Jessner lymphocytic infiltrate?
Jessner lymphocytic infiltrate is an uncommon skin condition that presents as non-scaly red patches and lumps on the face, neck and upper back. They are usually painless and do not itch. Lesions may go through periods of remission and exacerbation over months or years. Total spontaneous resolution has also occurred in some cases.
The condition is known by many other names including benign lymphocytic infiltration, Jessner disease, Jessner-Kanof syndrome, and benign chronic T-cell infiltrative disorder. It has been thought to be in the same disease spectrum as lupus erythematosus (lupus tumidus) but on histology, monoclonal antibody Leu 8 staining indicates they may be separate conditions.
What causes Jessner lymphocytic infiltrate?
The cause of Jessner lymphocytic infiltrate is unknown. It is classified as a benign T-cell lymphoproliferative disorder. Some cases have been associated with Borrelia infection, the cause of Lyme disease.
Cases of drug-induced Jessner lymphocytic infiltrate have been described due to duloxetine, ramipril, leflunomide, glatiramer acetate and ustekinumab.
What are the signs and symptoms of Jessner lymphocytic infiltrate?
Jessner lymphocytic infiltrate plaques usually start off as defined, small, slightly raised red spots that gradually enlarge peripherally to create a well demarcated red plaque. Sometimes the centre of the lesion is left clear, ie forming an annular and arciform shape. Single or multiple lesions may occur and they range from 2 mm to 2 cm in diameter.
Seasonal activity of Jessner lymphocytic infiltrate is variable: more patients deteriorate in winter than summer and yet flares may be associated with sun exposure. Usually, they are symptomless but some patients may complain of itching or burning.
Jessner lymphocytic infiltrate
How is the diagnosis of lymphocytic infiltrate made?
The diagnosis is made on clinical grounds and skin biopsy.
The main differential diagnoses are tumid lupus erythematosus, lymphocytoma cutis, and polymorphous light eruption.
What treatment is available for Jessner lymphocytic infiltrate?
Usually, no treatment is necessary for Jessner lymphocytic infiltrate.
Cosmetic camouflage may be used to hide lesions and improve appearance.
There is a variable response to the following treatments:
- Topical and intralesional corticosteroids
- Antimalarial medications, such as hydroxychloroquine
- UVA1 phototherapy or photochemotherapy (PUVA)
- Photodynamic therapy
All patients should be advised to follow sun protection measures, regardless of their history of photo-aggravation.
What is the outlook for Jessner lymphocytic infiltrate?
After persisting for several months or years, lesions disappear spontaneously without leaving scars or causing other problems. Occasionally they may recur at the same site or elsewhere.