Jessner lymphocytic infiltrate

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 intra- lesional corticosteroids into localized lesions or the use of potent topical steroids 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 (UV) exposure has been reported to induce or exacerbate lesions, additional therapy with broad spectrum UVA and UVB protection all year round 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, retinoids, and laser 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 nicotinamide, vitamin E, penicillin, chlortetracycline, minocycline, dapsone, and radiotherapy, have been tried unsuccessfully.

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