Jessner Lymphocytic Infiltration of the Skin Clinical Presentation

  • Author: Bassam Zeina, MD, PhD; Chief Editor: William D James, MD   more...
 
Updated: Feb 13, 2012
 

History

Patients with Jessner lymphocytic infiltrate commonly present with asymptomatic, nonscaly, erythematous papules or plaques predominantly 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.[5] 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.

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Physical

Pertinent physical findings are limited to the skin. Note the images below.

Jessner lymphocytic infiltration of the skin. Jessner lymphocytic infiltration of the skin. Jessner lymphocytic infiltration of the skin. Jessner lymphocytic infiltration of the skin.

Primary lesions are as follows:

  • Lymphocytic infiltration of the skin usually begins as nonscaly erythematous papules, which expand peripherally, forming well-demarcated, slightly infiltrated erythematous 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 is as follows:

  • 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.
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Causes

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 recent studies have disputed this association. Borrelia infection may present with similar histology findings and can represent a pseudolymphomatous reaction (Borrelia -associated pseudolymphoma) and should be excluded, especially in countries with high rates of Borrelia infections.[6] 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.

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Contributor Information and Disclosures
Author

Bassam Zeina, MD, PhD  Consulting Staff, Department of Dermatology, Milton Keynes Hospital, UK

Bassam Zeina, MD, PhD is a member of the following medical societies: British Association of Dermatologists, British Medical Association, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Nicole Sakka, MBBS  Foundation Year 2, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK

Disclosure: Nothing to disclose.

Sohail Mansoor, MBBS, MSc  Dermatologist and Lead Physician in Dermatologic Surgery, Department of Dermatology, Barnet Hospital, UK

Sohail Mansoor, MBBS, MSc is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Dermatology, American Society for Dermatologic Surgery, Royal College of Physicians and Surgeons of Glasgow, and Royal College of Physicians of the United Kingdom

Disclosure: Nothing to disclose.

Marjan Shah, MBBS, Msc Dermatology (UK)  Specialty Physician in Dermatology, Milton Keynes NHS Trust, UK

Disclosure: Nothing to disclose.

Specialty Editor Board

Peter Fritsch, MD  Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria

Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Daniel S Loo, MD  Associate Professor of Dermatology, Residency Program Director, Department of Dermatology, Tufts Medical Center

Daniel S Loo, MD is a member of the following medical societies: American Academy of Dermatology and Association of Professors of Dermatology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Mohsin Ali, MBBS, FRCP, MRCP, to the development and writing of this article.

References

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