Lymphocytic Infiltrate of Jessner:
Lymphocytic Infiltrate of Jessner (LIJ), also known as Jessner's lymphocytic infiltrate, is a rare chronic inflammatory skin condition that primarily affects the face and neck. It was first described by Dr. Wilhelm Jessner, an Austrian dermatologist, in 1953. LIJ is characterized by the presence of dense infiltrates of lymphocytes in the upper dermis, without any associated epidermal changes.
Clinical Presentation:
LIJ typically presents as multiple, small, pink to red papules or plaques on the face, neck, or upper trunk. The lesions are usually asymptomatic, although some patients may experience mild itching or burning. The condition predominantly affects middle-aged adults, with a slight female predominance.
Pathogenesis:
The exact cause of LIJ remains unknown, and its pathogenesis is not fully understood. However, it is believed to be an immune-mediated disorder. The dense infiltrates of lymphocytes in the upper dermis suggest an abnormal immune response. Some studies have suggested a possible role of infectious agents, such as viruses or bacteria, in triggering the immune response, but no specific infectious agent has been identified.
Diagnosis:
Diagnosing LIJ can be challenging, as it shares clinical and histopathological features with other skin conditions, such as lupus erythematosus and cutaneous lymphoma. A skin biopsy is often necessary to confirm the diagnosis. Histopathological examination reveals a dense infiltrate of lymphocytes in the upper dermis, with no epidermal changes or atypia.
Treatment:
There is no specific cure for LIJ, and treatment aims to control symptoms and prevent disease progression. Topical corticosteroids, such as potent or superpotent formulations, are commonly used as first-line therapy. In some cases, intralesional corticosteroid injections may be necessary for resistant lesions. Other treatment options include topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, and systemic medications like hydroxychloroquine or dapsone. However, the response to treatment varies among individuals, and some patients may experience relapses.
Prognosis:
LIJ is considered a benign condition with no associated mortality. It is generally a chronic and relapsing disorder, with periods of remission and exacerbation. The long-term prognosis is favorable, as the condition tends to improve over time, although it may persist for several years. Rarely, LIJ may evolve into a more aggressive lymphoproliferative disorder, such as cutaneous lymphoma, but this is extremely rare.
Conclusion:
Lymphocytic Infiltrate of Jessner is a rare chronic inflammatory skin condition characterized by dense infiltrates of lymphocytes in the upper dermis. Although its exact cause and pathogenesis are not fully understood, it is believed to be an immune-mediated disorder. Diagnosis can be challenging, and a skin biopsy is often necessary. Treatment focuses on symptom control, with topical corticosteroids being the mainstay of therapy. LIJ is generally a benign condition with a favorable long-term prognosis. However, regular follow-up is recommended to monitor for any potential progression or transformation into more aggressive lymphoproliferative disorders.