Juvenile plantar dermatosis

Jessner’s lymphocytic infiltrate is a benign T-cell lymphocytic infiltration of the skin that presents as non-scaly red patches and lumps on the face, neck and upper back.

Cause

It is caused by a benigh proliferation of T-cell lymphocytes. Why this happens is uncertain. Some cases have been associated with borrelia infection, the cause of Lyme disease.

Signs

Red tumid papules, nodules or plaques. Lesions occasionally have an arciform (arc-like) shape
The skin surface is smooth without scale or plugging.
Size varies from 2 mm to 2 cm
May be single or multiple.
Lesions enlarge gradually and in some cases clear in the centre to give a annular (ring-like) or arciform (arc-like) shape.
Lesions may improve and worsen over months or years and seasonal activity is variable with most patients experiencing more active symptoms over the winter. Sometimes, they may resolve completely.

Diagnosis
A skin biopsy is necessary to confirm the diagnosis and exclude other conditions such as cutaneous lymphoma, tumid lupus erythematosus, lymphocytoma cutis, sarcoid, granuloma faciale and polymorphous light eruption. It was believed that irt was in the same spectrum as tumid lupus erythematosus monoclonal antibody Leu 8 staining suggests that they are probably separate conditions.

Outlook
Harmless. May persist for months or years and resolve without leaving scars or causing other problems. Recurrence may occur at the same site or elsewhere.

What you can do
Photoprotection may help since lesions often arise on UV-exposed sites, regardless of their history of photo-aggravation.

Treatment
Usually no treatment is necessary for Jessner lymphocytic infiltrate as it usually resolves after periods of a few months to years,
Cosmetic camouflage may be used to hide lesions and improve appearance.
There is variable response to the following treatments:
Potent topical or intralesional steroids
Antimalarial medications, such as hydroxychloroquine, which has an anti-inflammatory effect in the skin
UVA1 phototherapy or photochemotherapy (PUVA)
Photodynamic therapy
Cyclophosphamide
Thalidomide
Radiotherapy

This is a type of glazed fissured dermatitis affecting the feet of children, especially boys between 7 - 12 years of age.

Causes

• JPD is believed to be caused bt repeated friction inside footwear. The frictional force is increased in sweaty feet which is why the the wearing of occlussive footwear such has heavy winter shoes and synthetic shoes predisposes to it.
• 'Atopic' children with atopic dermatitis (eczema), asthma, or hay fever are predisposed to JPD.
• Symptoms
• Glazed, cracked skin affecting the forefeet and toe pads, sparing the toe webs and insteps.
• Affects both feet symmetrically.
• Itching is usually absent.
• Cracks may cause pain.
• The hands may sometimes be affected, as well.

  Juvenile plantar dermatosis. Click on image for larger view

  Complications

• Cracking and bleeding.
• Secondary bacterial infection.

  What you can do

• You should consult a doctor.
• Wear well fitting shoes, preferably leather
• Use cotton socks which allow better ventilation.
• Moisturise the skin so it is less likely to crack.

  What the doctor may do

• Prescribe mild topical steroids and tar preparations.
• Exclude other causes such as atopic dermatitis, contact dermatitis, psoriasis, keratolysis exfoliativa, or a fungal infection (see tinea pedis).
• Perform patch tests to exclude allergy to footwear.

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JJuvenile xanthogranuloma (JXG) is a rare type of non-Langerhan's cell histiocytosis (Class IIb) that is benign. More common in children. This disease may have been first reported by Rudolf Virchow in 1871 and again in 1905 by H.G. Adamson. In 1954, it was named juvenile xanthogranuloma to reflect the appearance of the cells under a microscope.

Cause

• JXG is caused by the over-production of a kind of histiocyte called a dendritic cell (not a macrophage) but why this happens is not known.

Signs

• It presents as skin lesions predominantly in infants and young children, more often males, and is present at birth in 20% of cases. However, 10% of cases are adults. It is more common in Caucasians than in those of oriental origin.
• Smooth and pink papule, which later develops a yellowish hue and may become scaly.
• Usually solitary but may be multiple.
• Usually occur on the head, neck and trubk but may occur anywhere.
• mainly affects infants and small children with an average age of 2 years, although it can also occur in adults of all ages. more males are affected than females.
• However 20% also have café au lait macules. Multiple café au lait birthmarks are associated with neurofibromatosis type 1.
• JXG can affect the eye, most commonly in young children with multiple skin lesions. Less commonly JXG may involve locations such as the lung, liver, adrenal gland, appendix, bones, bone marrow, pituitary gland, central nervous system, kidney, heart, small and large intestines, and spleen.

Variants - Juvenile xanthogranuloma is difficult to distinguish from several other conditions.

• Benign cephalic histiocytosis - Usually occurs in infants less than one year of age. Presents with multiple small reddish-brown bumps on the skin, mostly on the head and neck. They are increasingly thought of as the same condition.
• Generalised eruptive histiocytosis - Usually affects adults. Presents with hundreds of reddish-brown, blue-red or skin-coloured papules (less than 1cm) on the skin of the trunk, face, upper arms and thighs. Recurrent crops of lesions may appear and spontaneously resolve after several months. May leave scars.
• Papular xanthogranuloma - Occurs in children and adults. Papules occur in the skin and in adults, in the lining of the mouth, Spontaneously resolves in children but may persist in adults. There is no effective treatment at this time

Diagnosis

The diagnosis of juvenile xanthogranuloma and related conditions can be confirmed by a skin biopsy. The lesions are composed of collections of histiocytes. In older lesions, the histiocytes may appear foamy, filled with lipids (fats) or hugely enlarged (giant cells).

Treatment

• Skin lesions are self-limited and rarely require treatment in most patients.
• Those with large abdominal masses, liver, bone marrow, or central nervous system involvement may do well with treatment such as chemotherapy similar to that used for Langerhans cell histiocytosis. Because this disease is so rare, no large studies have been performed, and there is no established, proven treatment for the more complicated cases.
• Unless they occur in the eyes, juvenile xanthogranulomas are harmless growths and disappear eventually over 2 to 3 years, usually without scarring.
• Although individual lesions can be cut out, this will leave a scar. Removal is seldom necessary.