Jessner Lymphocytic Infiltration

of the Skin

Jessner and Kanof first described this uncommon condition in 1953. The condition now known as Jessner lymphocytic infiltration of the skin (LIS) has remained poorly understood, and indeed, the very existence of such a condition has been questioned. One argument is that patients with this condition are simply displaying the early manifestations of some other disorder. Older literature would suggest that this is not correct and that certain patients monitored for as long as 30 years remain within the spectrum of lymphocytic infiltration of the skin with no progression. However, more recent literature suggests that lymphocytic infiltration of the skin cannot be separated from lupus erythematosus tumidus (LET) clinically, histologically, or photobiologically.

Whether Jessner lymphocytic infiltrate constitutes a separate disease entity and to what extent it is related to other benign cutaneous lymphocytic infiltrates is not entirely clear. The following 4 views have been expressed:

• It represents an entirely separate entity.
• Although some cases represent a separate entity, other reported cases are discoid lupus erythematosus (DLE).
• All cases are DLE or LET, which is a subtype of DLE.
• It represents an initial phase or abortive stage of any of the other diseases with a patchy dermal lymphocytic infiltrate.

Lymphocytic infiltration of the skin can be viewed as a broad-spectrum photosensitivity disorder, which may demonstrate a delayed provocative phototest reaction. The relationship to sun exposure, consequently, is not always noted by the patient.

The frequency of this condition in the United States is unknown.

The incidence and prevalence internationally is unknown. It is considered uncommon.

Lymphocytic infiltration of the skin is not associated with increased mortality. The lesions are commonly asymptomatic, although some patients report burning or pruritus.

Lymphocytic infiltration of the skin has no known racial predilection.

The reported sex ratio varies depending upon the source consulted. Some have reported a male-to-female ratio as high as 10:1, while others have noted a slight female predominance.Age

Lymphocytic infiltration of the skin affects mostly adults younger than 50 years. It has been reported in children. Familial occurrence has been reported.

Patients with Jessner lymphocytic infiltrate commonly present with asymptomatic, nonscaly, erythematous papules or plaques on the face and neck of several months duration.

Onset or exacerbation of lesions following sun exposure may or may not be noted. Some patients report burning or pruritus, and rarely, a familial occurrence has been noted.The course of lymphocytic infiltration of the skin is variable and unpredictable, most often lasting months to years. Periods of remission and exacerbation may be observed, as well as spontaneous resolution. A history of active lesions involving covered skin or occurrence during winter months can be a helpful clue favoring a diagnosis of lymphocytic infiltration of the skin over polymorphous light eruption.

Pertinent physical findings are limited to the skin.

• Primary lesion
  • Lymphocytic infiltration of the skin usually begins as nonscaly erythematous papules, which expand peripherally, forming well-demarcated, slightly infiltrated red plaques.
  • Central clearing may occur.
  • The surface of the lesions appears normal and, in particular, shows no follicular plugging or atrophy.
  • The size of papules or plaques varies from 2 mm to 2 cm in diameter, and they may be arranged in crescents or rings.
  • One, a few, or numerous lesions may be present.
  • After persisting for several months or several years, lesions usually disappear without sequelae, but they may recur at either the same sites or elsewhere.
• Distribution
  • The malar area of the face and the upper back are the most common sites of involvement.
  •  Other parts of the body may be affected as well, including the forehead, neck, mastoid region, arms, legs, chest, and abdomen.

The cause of lymphocytic infiltration of the skin is unknown. Over the years, a number of etiologies have been proposed. Several studies have linked Borrelia infection with lymphocytic infiltration of the skin, yet most more recent studies have disputed this association. Other data suggest that a history of photosensitivity in patients with Jessner lymphocytic infiltration of the skin should be sought and confirmed using provocative phototesting. In cases in which photosensitivity is relevant, antimalarials are expected to be effective.