This rare skin condition was first described in 1953 by Jessner and Kanof.1
It is characterised clinically by flat erythematous plaques and papules commonly affecting the head and upper trunk. The lesions vary in size from 2 mm to 2 cm in diameter, and may be arranged in crescents or rings. These may be solitary or numerous and do not typically cause significant symptoms.2
The condition usually occurs in the fourth and fifth decade of life with lesions occurring slightly earlier in females.3
The condition may wax and wane with remissions and exacerbations. In some patients the lesions may persist for several years and eventually disappear without sequelae. The lesions have been known to reappear at the original site or in previously unaffected areas.
Histologically, the condition is characterised by the presence of a normal epidermis and perivascular dermal lymphocytic infiltrate (). Immunohistochemical studies have identified that the infiltrates consist of predominantly mature T lymphocytes4
Skin biopsy: perivascular moderate chronic inflammatory cell infiltrate, with no involvement of the epidermis.
Perivascular CD3 positive T cells (brown cells) identified on immunochemistry.
The gold standard for diagnosis is a skin biopsy performed on a new untreated lesion. Photo-testing with ultraviolet (UV) A or UVB can elicit typical lesions in some patients with Jessner’s lymphocytic infiltrate and has led to the hypothesis that the condition may be a variant of lupus erythematosus.5
Ectropion typically occurs as a result of age related horizontal lid and canthal tendon laxity. Studies have shown a close correlation with increasing age with a prevalence as high as 17% in those aged 80 years or older.6
Current management of Jessner’s lymphocytic infiltrate includes topical and systemic steroids, oral antimalarials and cryotherapy of small solitary lesions. Successful treatment of a case using a pulsed dye laser has also been described.7
This case is most unusual as Jessner’s lymphocytic infiltration rarely presents in the elderly. A comprehensive personal and family history did not identify any other possible causes for his cicatricial skin changes. We were unable to identify any other reports in the literature of Jessner’s lymphocytic infiltration causing a recurrent bilateral lid ectropion.
Clinicians are advised to be aware of this possible presentation as the clinical appearance may mimic an age related involutional ectropion. Surgery for cicatricial ectropion carries a higher risk of surgical failure than for involutional ectropion, and thus patients should be counselled appropriately preoperatively.8
- Ectropion occurs commonly in the elderly, frequently as a result of age related involutional skin changes.
- Surgical correction is usually successful with dramatic functional and cosmetic improvement.
- Jessner’s lymphocytic infiltrate is a rare dermatological condition which can affect the periorbital skin and cause severe cicatrical ectropion. This may be mistaken for an age related ectropion, particularly in the elderly.
- The surgical outcome in cases of cicatrising ectropion due to Jessner’s lymphocytic infiltrate is poorer than in age related ectropion, and clinicians managing such patients should provide appropriate counselling.