Jessner’s lymphocytic infiltrate (syn. Jessner-Kanof syndrome)

Jessner’s lymphocytic infiltrate is a chronic benign T-cell lymphoproliferative condition of the skin. The characteristic lesions are non-scaly red papules, nodules and plaques, usually affecting the face, neck, and upper back.

This chapter is set out as follows:

•  The cause is unknown

• The conditions mainly affects adults younger than 50 years
• Lesions are usually asymptomatic
• Lesions may go through periods of remission and exacerbation over months or years, and seasonal activity is variable with most patients experiencing more active symptoms over the winter. Total spontaneous resolution may occur

Distribution

• Lesions can be solitary or numerous
• The face, neck and upper back are the most commonly affected site

Morphology

• Red tumid papules, nodules or plaques. Lesions occasionally have an arciform (arc-like) shape
• The skin surface is normal with no scale, plugging or atrophy
• Lesions enlarge gradually up to a size of 2 cm
• The differential diagnosis includes sarcoid, lupus erythematosus tumidus, granuloma faciale, deep gyrate erythema (a variant of erythema annulare centrifugum) and cutaneous lymphoma

• An incisional biopsy is required to confirm the diagnosis and exclude other conditions such as lymphoma

• Histology - the epidermis is usually normal with no atrophy, follicular plugging or basement membrane thickening. There is a moderately dense superficial and deep perivascular dermal lymphocytic infiltrate. The infiltrate contains small mature lymphocytes, with occasional large lymphoid cells, plasmacytoid and plasma cells. Immunohistochemistry confirms a mixed lymphocytic infiltrate with a dominant population of CD8+ cells. Molecular analysis of both T‐cell and B‐cell populations are polyclonal on molecular analysis (reference: Rook's Textbook of Dermatology)

• If the nature of the rash changes further biopsies may be needed

• Photoprotection may be of benefit as lesions often arise on UV-exposed sites  

• Treatment is often unsatisfactory. Treatments sometimes tried include:
• Potent topical or intralesional steroids
• Oral hydroxychloroquine, which has an anti-inflammatory effect in the skin

• The condition may resolve spontaneously