Lymphocytic infiltration is a rare chronic dermatosis characterized by benign infiltration of the skin by lymphocytes. Pathology has an undulating course and a tendency to resolve itself. Clinically, it manifests itself as a rash on intact skin of smooth, flat, bluish-pink papules or plaques that merge with each other into pockets about the size of a palm.
Primary elements have clear boundaries, may peel off. Plaques are usually single, localized on the face, trunk, neck, limbs. This disease is diagnosed with histological confirmation, in some cases, molecular biological examinations are performed. Treatment of pathology consists in the use of hormone therapy, NSAIDs, topical drugs.
Description of this pathology
Lymphocytic infiltrationis a benign pseudolymphoma of the skin with a chronic recurrent undulating course. It is very rare and occurs most often in men after 20 years. The disease has no racial and seasonal differences, it is not endemic. Sometimes there may be an improvement in the patient's condition in the summer.
First mention of the disease
For the first time this disease was described in the medical literature in 1953, when N. Kanof and M. Jessner considered it as an independent pathological process with through infiltration of all skin structures by lymphocytes. The name "pseudolymphoma" was introduced by K. Mach, who combined Jessner-Kanof infiltration into a single group with other types of lymphocytic infiltrations.
In 1975, O. Brown differentiated the type of pathological process and attributed such infiltration to B-cell pseudolymphomas, but a little later, clinicians began to consider this disease as T-pseudolymphoma, since it is T-lymphocytes that provide a benign course of pathology and the possibility of involuntary involutions of the original elements. Subsequent studies have shown that immunity plays a significant role in the development of lymphocytic infiltration, which may be due to the fact that immune cells are located in the gastrointestinal tract, and its defeat is observed in 70% of cases. The study of pathology continues to this day. Understanding the causes of the development of the T-lymphoid process is important in the development of pathogenetic therapy for pseudolymphomas.
Stagesgiven disease
This disease has several stages of development, which are characterized by the severity of the pathological process. Thus stand out:
- Scattered lymphoplasmacytic infiltration. With her, the symptoms of the disease are insignificant and mild.
- Moderate lymphoplasmacytic infiltration. The formation of a single focus of rashes is observed.
- Severe lymphoplasmacytic infiltration. What's this? It is characterized by the formation of multiple foci and lesions.
Causes of disease
The most possible causes of the development of focal lymphoplasmacytic infiltration are considered to be tick bites, hyperinsolation, various infections, pathologies of the digestive system, the use of dermatogenic cosmetics and the irrational use of medications that provoke systemic immune changes, externally represented by infiltrative disorders in the skin.
The mechanism of development of lymphocytic infiltration is the following process: the intact epidermis provides T-lymphocytes with the opportunity to infiltrate the deep layers of the skin, located around the choroid plexuses and in the papillary outgrowths throughout the entire thickness of the skin. Pathology triggers trigger an inflammatory process, to which skin and immune cells react directly. T-lymphocytes are included in the process of eliminating such inflammation, which provide a benign immune response in the form of proliferation of skin epithelial cells.
Stagesinflammatory process
At the same time, inflammation develops, which goes through three stages: alteration, exudation and proliferation with the participation of reticular tissue cells (histocytes). These cells cluster and form islands that resemble lymphoid follicles. At the last stage of stopping the inflammatory reaction, two simultaneous processes of proliferation reinforce and complement each other. Thus, foci of pathology appear.
Since lymphocytes are heterogeneous, the evaluation of their histochemical properties using monoclonal antibodies and immunological markers formed the basis of immunophenotyping. This analysis has significant diagnostic value in dermatology.
Many wonder what it is - lymphoplasmacytic infiltration of the stomach and intestines?
Gastrointestinal disorders
Illness can be expressed in varying degrees. In this case, the glands are shortened, their density is significantly reduced. With lymphoplasmacytic infiltration in the stroma, there is a pronounced increase in reticulin fibers and hyperplasia of smooth muscle walls. Chronic gastritis can be considered reversible if, after the therapy, the infiltration disappears, the restoration of atrophied glands and cell renewal are noted.
The exact mechanisms of the onset of type B gastritis in lymphomacytic infiltration of the stomach are still not clear enough. Etiological factors that contribute to the development of chronic gastritis are usually divided into endogenous and exogenous.
Infiltrationintestines
With this disease, infiltrates in the connective tissue and disruption of the work of not only the stomach, but also other digestive organs are noted. They also include lymphocytic colitis, which is an inflammatory disease of the colon with lymphoplasmacytic infiltration of the mucous membranes. This type of colitis is characterized by the occurrence of recurrent diarrhea with a prolonged course. The treatment of the disease is specific, based on the use of medications to combat the root cause of its development, as well as symptomatic, to eliminate diarrhea and normalize the intestinal microflora.
Symptomatics
The initial element of skin rashes with lymphocytic infiltration is a flat large pink-cyanotic plaque or papule with clear outlines and a smooth surface, which has a tendency to peripheral growth. Merging with each other, the primary elements form arcuate or annular islands with areas of peeling. The resolution of such pathological elements begins, as a rule, from the center, as a result of which confluent foci may have recessions in the central parts. Typical localization is the face, neck, parotid spaces, back of the head, cheeks, forehead and cheekbones. In some cases, rashes can be observed on the skin of the limbs and torso. Usually the primary element is single, a tendency to the spread of the pathological process is somewhat less often observed.
Stroms
Stomas are often formed in the stomach, colon, intestines, which are reticular connective tissue (interstitium), a three-dimensional fine-loop network. Lymphatic and blood vessels pass through the stroma.
Lymphocytic infiltration is characterized by a recurrent undulating course. This disease is resistant to ongoing treatment, capable of spontaneous self-healing. Relapses usually occur in places of previous localization, but they can also capture new areas of the epidermis. Despite the long chronic course, the internal organs are not involved in the pathological process.
Diagnosis of disease
This disease is diagnosed by dermatologists on the basis of clinical symptoms, anamnesis, fluorescent microscopy (a characteristic glow at the border of dermoepidermal junctions is not determined) and histology with a mandatory consultation with an oncologist and immunologist. Histologically, with lymphocytic infiltration, an unchanged superficial skin is determined. In the thickness of all dermal layers, there is a grouping of connective tissue cells and lymphocytes around the vessels.
Other diagnostic methods
In more complex cases, tumor immunotyping, molecular and histochemical testing are performed. K. Fan et al. recommend diagnostics based on the results of DNA cytometry with the study of the number of normal cells (with a givenpathological process - more than 97%). Differential diagnosis is carried out with systemic lupus erythematosus, sarcoidosis, granuloma annulare, Biett's centrifugal erythema, toxicoderma, a group of lymphocytic tumors and syphilis.
Treatment
Treatment of this disease is aimed at eliminating the acute stage of lymphocytic infiltration and lengthening the duration of remission periods. Therapy for this pathology is nonspecific. There is a high therapeutic efficacy in the appointment of antimalarial drugs ("Hydroxychloroquine", "Chloroquine") and anti-inflammatory nonsteroidal drugs ("Diclofenac", "Indomethacin") after preliminary treatment of concomitant pathologies of the digestive tract. If the state of the gastrointestinal system allows, enterosorbents are used. The use of hormonal corticosteroid ointments and creams is indicated locally, as well as injection blockade of skin rashes with Betamethasone and Triamcinolone.
In case of resistance to the treatment, plasmapheresis is connected (up to 10 sessions). Therapy of the digestive system with lymphoplasmacytic infiltration of the intestines and stomach is closely related to diseases of the gastrointestinal tract - gastritis, inflammation in the large intestine, etc., which can be characterized by damage to the mucous membranes. To identify them, the patient must undergo appropriate diagnostics and therapy, which consists in taking antidiarrheal, antibacterial and anti-inflammatory drugs.medicines, as well as adherence to a diet (fractional meals, avoidance of products that provoke fermentation, smoked, spicy and fatty foods).
