Jessner’s lymphocytic infiltrate

Published on 19/03/2015 by admin

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Last modified 22/04/2025

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[level-membership-for-dermatology-category]

Jessner’s lymphocytic infiltrate

Joanna E. Gach

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Jessner’s lymphocytic infiltrate (JLI) is a chronic inflammatory condition presenting with erythematous or reddish brown papules, annular or arciform plaques which can expand peripherally and sometimes develop central healing. The lesions are usually seen in adults and affect the face, neck, or upper trunk. Although they are frequently asymptomatic, some patients report itch or burning. The lesions can persist from weeks to years and disappear without sequelae, but may recur.

Management strategy

JLI runs a waxing and waning course marked by intermittent improvement and subsequent exacerbations, which makes the evaluations of therapeutic effectiveness difficult. Patients demand treatment because they find the lesions disfiguring or itchy.

Potent topical steroids applied once or twice daily for 4 weeks are the first-line treatment for many dermatologists. Unfortunately, the results of treatment are variable, and, most importantly, only short-lasting. If the response is inadequate, injection of intralesional corticosteroids into localized lesions or the use of potent topical steroid under occlusive dressing may be beneficial, but is associated with a greater risk of skin atrophy. Topical tacrolimus may be a safer alternative.

In cases where ultraviolet exposure has been reported to induce or exacerbate lesions, additional therapy with sunscreen may be needed. This group of patients may respond to antimalarials, in particular hydroxychloroquine.

A variety of other therapies have been reported to be effective in the management of JLI. Thalidomide, oral gold, and retinoids proved to be helpful in some cases, but their use may be limited by the adverse effects, which may be difficult for the patient and physician to accept, especially as JLI is harmless.

Many other treatments, including bismuth sub-salicylate injections, nicotinamide, vitamin E, phenindamine, para-aminobenzoic acid, penicillin, chlortetracycline, minocycline, dapsone, quinacrine (mepacrine), and radiotherapy, have been tried unsuccessfully.

Specific investigations

The diagnosis can be made on clinical grounds. The investigations are helpful in differentiating the condition from discoid lupus erythematosus, lupus erythematous tumidus, and cutaneous lymphoma.

First-line therapies

image Potent topical/intralesional corticosteroids C
image Topical immunomodulators E

Second-line therapies

image Systemic corticosteroids E
image Antimalarials D
image Retinoids E
image Photodynamic therapy E
image Methotrexate E
image Laser therapy E
image Proquazone C

Third-line therapy

image Auranofin E
image Thalidomide A

[/level-membership-for-dermatology-category][not-level-membership-for-dermatology-category]

Jessner’s lymphocytic infiltrate

Joanna E. Gach

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Jessner’s lymphocytic infiltrate (JLI) is a chronic inflammatory condition presenting with erythematous or reddish brown papules, annular or arciform plaques which can expand peripherally and sometimes develop central healing. The lesions are usually seen in adults and affect the face, neck, or upper trunk. Although they are frequently asymptomatic, some patients report itch or burning. The lesions can persist from weeks to years and disappear without sequelae, but may recur.

Management strategy

JLI runs a waxing and waning course marked by intermittent improvement and subsequent exacerbations, which makes the evaluations of therapeutic effectiveness difficult. Patients demand treatment because they find the lesions disfiguring or itchy.

Potent topical steroids applied once or twice daily for 4 weeks are the first-line treatment for many dermatologists. Unfortunately, the results of treatment are variable, and, most importantly, only short-lasting. If the response is inadequate, injection of intralesional corticosteroids into localized lesions or the use of potent topical steroid under occlusive dressing may be beneficial, but is associated with a greater risk of skin atrophy. Topical tacrolimus may be a safer alternative.

In cases where ultraviolet exposure has been reported to induce or exacerbate lesions, additional therapy with sunscreen may be needed. This group of patients may respond to antimalarials, in particular hydroxychloroquine.

A variety of other therapies have been reported to be effective in the management of JLI. Thalidomide, oral gold, and retinoids proved to be helpful in some cases, but their use may be limited by the adverse effects, which may be difficult for the patient and physician to accept, especially as JLI is harmless.

Many other treatments, including bismuth sub-salicylate injections, nicotinamide, vitamin E, phenindamine, para-aminobenzoic acid, penicillin, chlortetracycline, minocycline, dapsone, quinacrine (mepacrine), and radiotherapy, have been tried unsuccessfully.

Specific investigations

The diagnosis can be made on clinical grounds. The investigations are helpful in differentiating the condition from discoid lupus erythematosus, lupus erythematous tumidus, and cutaneous lymphoma.