eMedicine Specialties > Dermatology > Lymphoma and Related Processes

Jessner Lymphocytic Infiltration of the Skin

Author: Bassam Zeina, MD, PhD, Consulting Staff, Department of Dermatology, Milton Keynes Hospital, UK
Coauthor(s): Sohail Mansoor, MBBS, MSc, Dermatologist and Lead Physician in Dermatologic Surgery, Department of Dermatology, Barnet Hospital, UK
Contributor Information and Disclosures

Updated: Dec 31, 2008

Introduction

Background

Jessner and Kanof1 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.2

Pathophysiology

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.

Frequency

United States

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

International

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

Mortality/Morbidity

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

Race

Lymphocytic infiltration of the skin has no known racial predilection.

Sex

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.

Clinical

History

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.3 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.

Physical

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.

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 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.

More on Jessner Lymphocytic Infiltration of the Skin

Overview: Jessner Lymphocytic Infiltration of the Skin
Differential Diagnoses & Workup: Jessner Lymphocytic Infiltration of the Skin
Treatment & Medication: Jessner Lymphocytic Infiltration of the Skin
Follow-up: Jessner Lymphocytic Infiltration of the Skin
Multimedia: Jessner Lymphocytic Infiltration of the Skin
References
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References

  1. Jessner M, Kanof NB. Lymphocytic infiltration of the skin. Arch Dermatol. 1953;68:447-9.

  2. Weber F, Schmuth M, Fritsch P, Sepp N. Lymphocytic infiltration of the skin is a photosensitive variant of lupus erythematosus: evidence by phototesting. Br J Dermatol. Feb 2001;144(2):292-6. [Medline].

  3. Dippel E, Poenitz N, Klemke CD, Orfanos CE, Goerdt S. Familial lymphocytic infiltration of the skin: histochemical and molecular analysis in three brothers. Dermatology. 2002;204(1):12-6. [Medline].

  4. Ashworth J, Turbitt M, MacKie R. A comparison of the dermal lymphoid infiltrates in discoid lupus erythematosus and Jessner's lymphocytic infiltrate of the skin using the monoclonal antibody Leu 8. J Cutan Pathol. Aug 1987;14(4):198-201. [Medline].

  5. Borges da Costa J, Boixeda P, Moreno C. Pulsed-dye laser treatment of Jessner lymphocytic infiltration of the skin. J Eur Acad Dermatol Venereol. Sep 1 2008;[Medline].

  6. Adamski H, Labrousse AL, Sparsa A, Leonard F, Le Gall F, Labrousse F, et al. [Positive photobiological investigation in Jessner's lymphocytic infiltration of the skin]. Ann Dermatol Venereol. Dec 2002;129(12):1370-3. [Medline].

  7. Anderson NP, Newman BA, Feldman FF. Lymphocytic infiltration of the skin. Arch Dermatol. 1954;70:832.

  8. Arai E, Shimizu M, Hirose T. A review of 55 cases of cutaneous lymphoid hyperplasia: reassessment of the histopathologic findings leading to reclassification of 4 lesions as cutaneous marginal zone lymphoma and 19 as pseudolymphomatous folliculitis. Hum Pathol. May 2005;36(5):505-11. [Medline].

  9. Braun-Falco O, Plewig G, Wolff HH. Pseudolymphomas of the skin. Dermatology. 1984;1074-5.

  10. Calnan CD. Lymphocytic infiltration of the skin (Jessner). Br J Dermatol. May 1957;69(5):169-73. [Medline].

  11. Gottlieb M, Winkelman RK. Lymphocytic infiltration of the skin. Arch Dermatol. 1962;68:626.

  12. Hafejee A, Winhoven S, Coulson IH. Jessner's lymphocytic infiltrate responding to oral auranofin. J Dermatolog Treat. Sep 2004;15(5):331-2. [Medline].

  13. Kuhn A, Richter-Hintz D, Oslislo C, Ruzicka T, Megahed M, Lehmann P. Lupus erythematosus tumidus--a neglected subset of cutaneous Lupus erythematosus: report of 40 cases. Arch Dermatol. Aug 2000;136(8):1033-41. [Medline].

  14. Lever WF, Lever GS. Connective Tissue Diseases. In: Histopathology of the Skin. Baltimore, Md: Lippincott Williams & Wilkins; 1990:505-06.

  15. Mackie RM. Cutaneous Lymphomas and Lymphocytic Infiltrates. In: Textbook of Dermatology. Vol. 3. London, England: Blackwell Science; 1998:2400-01.

  16. Nolden S, Casper C, Kuhn A, Petereit HF. Jessner-Kanof lymphocytic infiltration of the skin associated with glatiramer acetate. Mult Scler. Apr 2005;11(2):245-8. [Medline].

  17. Poenitz N, Dippel E, Klemke CD, Qadoumi M, Goerdt S. Jessner's lymphocytic infiltration of the skin: a CD8+ polyclonal reactive skin condition. Dermatology. 2003;207(3):276-84. [Medline].

  18. Rijlaarsdam JU, Nieboer C, de Vries E, Willemze R. Characterization of the dermal infiltrates in Jessner's lymphocytic infiltrate of the skin, polymorphous light eruption and cutaneous lupus erythematosus: differential diagnostic and pathogenetic aspects. J Cutan Pathol. Feb 1990;17(1):2-8. [Medline].

  19. Toonstra J, Wildschut A, Boer J, Smeenk G, Willemze R, van der Putte SC, et al. Jessner's lymphocytic infiltration of the skin. A clinical study of 100 patients. Arch Dermatol. Nov 1989;125(11):1525-30. [Medline].

  20. Willemze R, Dijkstra A, Meijer CJ. Lymphocytic infiltration of the skin (Jessner): a T-cell lymphoproliferative disease. Br J Dermatol. May 1984;110(5):523-9. [Medline].

  21. Wolf M. Lymphocytic infiltration of the face. Arch Dermatol. 1957;75:136.

  22. Wu JJ, Huang DB, Pang KR, Hsu S, Tyring SK. Thalidomide: dermatological indications, mechanisms of action and side-effects. Br J Dermatol. Aug 2005;153(2):254-73. [Medline].

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Further Reading

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Keywords

Jessner's lymphocytic infiltrate, benign chronic T-cell infiltrative disorder, Jessner LIS, Jessner's LIS, lupus erythematosus tumidus, LET, discoid lupus erythematosus, DLE, broad-spectrum photosensitivity disorder

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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)

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.

Medical Editor

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.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

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.

CME Editor

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, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
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; american college of physicians Honoraria Other

 
 
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