What is Jessner's lymphocytic infiltrate of the skin?

Jessner's Lymphocytic Infiltration of the Skin

Jessner's lymphocytic infiltration of the skin (JLIS) is a benign, chronic T-cell infiltrative disorder characterized by erythematous papules or plaques primarily on the face, neck, and back, with a distinctive CD8+ polyclonal lymphocytic infiltrate in the dermis and no epidermal involvement.

Clinical Features

• Presentation:

  • Erythematous papules and plaques (88% of cases)
  • Annular lesions (12% of cases) 1
  • Common locations: face (38%), trunk and arms (50%), or both sites (12%) 1

• Demographic characteristics:

  • Affects both males and females (54% female, 46% male in large studies) 2
  • No clear age predilection

• Clinical course:

  • Chronic and recurrent
  • Non-scarring
  • May be persistent and treatment-resistant 3

Histopathology

• Key histological features:

  • Dense perivascular and periadnexal lymphocytic infiltrate in the dermis
  • No epidermal involvement (unlike lupus erythematosus) 4, 1
  • Absence of mucin deposition
  • Negative direct immunofluorescence studies 4

• Immunohistochemistry:

  • Predominantly T-cell infiltrate (100% of cases)
  • CD8+ T-cell predominance in 77% of cases 1
  • Polyclonal T-cell population (98% of tissue samples) 1

Differential Diagnosis

JLIS must be distinguished from:

1. Cutaneous lupus erythematosus:

   • JLIS lacks epidermal changes and basement membrane thickening
   • Direct immunofluorescence is negative in JLIS but positive in lupus 5
   • JLIS has significantly higher percentage of Leu 8 positive lymphocytes (65% vs 15% in lupus) 5

2. Polymorphous light eruption:

   • May coexist with JLIS in some patients (10% in one study) 2
   • Different histopathological features

3. Lymphocytoma cutis:

   • Shows germinal center formation
   • Different immunophenotype

4. Cutaneous lymphoma:

   • JLIS shows polyclonal rather than monoclonal T-cell population 1

Treatment Options

Treatment options are limited, with variable efficacy:

1. First-line therapy:

   • Pulsed dye laser (595nm) has shown excellent results in small studies
   • Complete resolution in 3/5 patients after a single session, and in all patients after 2-3 sessions 4
   • Long-term remission observed in 3 patients at 4-8 years follow-up 4

2. Other treatments:

   • Topical corticosteroids (inconsistent response) 4
   • Systemic corticosteroids for refractory cases 3
   • Antimalarials (hydroxychloroquine) have been used with variable success

Prognosis

• Generally excellent prognosis with no progression to malignancy
• No documented progression to cutaneous lupus erythematosus or lymphoma 2
• Chronic course with potential for recurrence
• May be refractory to treatment in some cases 3

Clinical Pearls

• JLIS is a distinct entity and not a variant of lupus erythematosus or polymorphous light eruption
• Biopsy is essential for diagnosis, showing the characteristic dermal lymphocytic infiltrate without epidermal changes
• Persistent indurated plaques of the face may represent a variant of JLIS that is particularly resistant to treatment 3
• Pulsed dye laser therapy may be considered as a first-line treatment option with minimal side effects 4