Derm Dx: A rash on the cheek and forehead - Clinical Advisor

Derm Dx: A rash on the cheek and forehead

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The patient is a 43-year-old Hispanic man who complains of a rash affecting his right cheek and forehead. The eruption was first noted 3 weeks ago and is asymptomatic. He has had 2 similarly appearing episodes within the past 3 years, which resolved following oral prednisone. Examination reveals erythematous, indurated plaques of the affected areas.

Jessner lymphocytic infiltrate is a chronic benign disease of the skin associated with T-cell infiltration. The disorder was first described more than 60 years ago by Jessner and Kanof.1 The etiology is uncertain; some postulate that it is a variant...

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Jessner lymphocytic infiltrate is a chronic benign disease of the skin associated with T-cell infiltration. The disorder was first described more than 60 years ago by Jessner and Kanof.1 The etiology is uncertain; some postulate that it is a variant of lupus erythematosus or a CD8 polyclonal reactive pseudolymphoma.2

Patients present with asymptomatic erythematous papules or plaques of the face or trunk. The diagnosis is confirmed by biopsy, which demonstrates perivascular or periadnexal lymphocytic infiltration with normal epidermis. Differential diagnosis includes polymorphous light eruption, pseudolymphomas, and cutaneous lupus erythematosus.

Topical, intra-lesional, and systemic corticosteroids may promote resolution. Other options are antimalarials, tetracycline, dapsone, cryotherapy, and methotrexate.3,4

Rebecca Geiger, PA-C, is a physician assistant on staff at the DermDox Dermatology Center in Hazleton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

References

  1. Jessner M, Kanof NB. Lymphocytic infiltration of the skin. Arch Dermatol. 1953;68:447-449.
  2. Remy-Leroux V, Leonard F, Lambert D, Wechsler J, Cribier B, Thomas P, et al. Comparison of histopathologic-clinical characteristics of Jessner’s lymphocytic infiltration of the skin and lupus erythematous tumidus: Multicenter study of  46 cases. J Am Acad Dermatol. 2008;58:217-223.
  3. Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Elsevier; Saunders: 2012.
  4. Laurinaviciene R, Clemmensen O, Bygum A. Successful treatment of Jessner’s lymphocytic infiltration of the skin with methotrexate. Acta Derm Venereol.  2009;89:542-543.
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