Lymphocytic infiltration is a rare chronic form dermatosis, which is characterized by benign skin lymphocyte infiltration. Pathology has a wave-like course and a tendency to self-resolution. Clinically, it is manifested by rashes on the unchanged skin of smooth, flat, cyanotic pink papules or plaques that merge together into foci about the size of a palm.
Primary elements have clear boundaries, can 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 hormonal therapy, NSAIDs, and local drugs.
Description of this pathology
Lymphocytic infiltration is a benign pseudolymphoma of the skin with a chronic recurring 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.
The first mention of the disease
This disease was first described in the medical literature in 1953, when N. Kanof and M. Jessner considered it as an independent pathological process with end-to-end lymphocyte infiltration of all skin structures. The name "pseudolymphoma" was introduced by C. 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 somewhat later, clinicians began to consider this disease as T-pseudolymphoma, since it is the T-lymphocytes that ensure the benign course of the pathology and the possibility of involuntary involution of the initial elements. Subsequent studies have shown that immunity plays a significant role in the development of lymphocytic infiltration, which is probably due to the fact that immune cells are located in the gastrointestinal tract, and its damage is observed in 70% of cases. The study of pathology continues to this day. Understanding the reasons for the development of the T-lymphoid process is important in the development of pathogenetic therapy with pseudolymph.
The stages of this disease
This disease has several stages of development, which are characterized by the severity of the pathological process. Thus, stand out:
- Broken lymphoplasmacytic infiltration. With it, 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 is it? It is characterized by the formation of multiple lesions and lesions.
The causes of the disease
The most possible reasons for 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 that are externally represented by infiltrative disorders in the skin.
The mechanism of development of lymphocytic infiltration is as follows: the intact epidermis provides T-lymphocytes with the ability to infiltrate the deep layers of the skin, located around the vascular plexuses and in the papillary outgrowths throughout the thickness of the skin. Pathology triggers trigger an inflammatory process to which skin and immune cells respond directly. In the process of eliminating such inflammation, T-lymphocytes are included, which provide a benign immune response in the form of proliferation of skin epithelial cells.
Stages of the inflammatory process
At the same time, inflammation develops, which goes through three stages: alteration, exudation and proliferation with the participation of reticular tissue cells (histiocytes). These cells group together and form islands that resemble lymphoid follicles. At the last stage of stopping the inflammatory reaction, two simultaneous proliferation processes reinforce and complement each other. Thus, foci of pathology arise.
Since lymphocytes are heterogeneous, the assessment of their histochemical properties using monoclonal antibodies and immunological markers formed the basis of immunophenotyping. This analysis has significant diagnostic value in dermatology.
Many people are interested in the fact that this is lymphoplasmacytic infiltration of the stomach and intestines?
Gastrointestinal Disorders
The disease can be expressed in varying degrees. In this case, the glands are shortened, their density is significantly reduced. With lymphoplasmacytic infiltration in the stroma, a marked increase in reticulin fibers and smooth muscle hyperplasia are observed. Chronic gastritis can be considered reversible if, after the treatment, the infiltration disappears, restoration of atrophied glands and cell renewal are noted.
The exact mechanisms for the onset of type B gastritis with lymphomasmazocytic gastric infiltration are still not clear enough. Etiological factors that contribute to the development of chronic gastritis are usually divided into endogenous and exogenous.
Intestinal infiltration
With this disease, infiltrates in the connective tissue and disruptions of not only the stomach, but also other digestive organs are noted. These 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 intestinal microflora.
Symptomatology
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 ring-shaped islands with areas of peeling. The resolution of such pathological elements begins, as a rule, from the center, as a result of which the drainage foci may have sagging in the central parts. Typical localization is the face, neck, parotid spaces, nape, cheeks, forehead and cheekbones. In some cases, rashes can be observed on the skin of the limbs and trunk. Typically, the primary element is single, a less common tendency to spread the pathological process.
Stroma
Often stroma are formed in the stomach, colon , intestines, which are reticular connective tissue (interstitium), a three-dimensional finely looped network. In the stroma pass the lymphatic and blood vessels.
Lymphocytic infiltration is characterized by a recurring undulating course. This disease is resistant to ongoing treatment, can spontaneously self-heal. Relapses usually occur in places of previous localization, but they can also capture new areas of the epidermis. Despite the prolonged chronic course, internal organs are not involved in the pathological process.
Diagnosis of the disease
This disease is diagnosed by dermatologists on the basis of clinical symptoms, medical history, luminescent microscopy (the characteristic glow at the border of dermoepidermal compounds is not determined) and histology with the obligatory consultation of an oncologist and immunologist. Histologically, with lymphocytic infiltration, unchanged superficial skin is determined. In the thickness of all dermal layers, a grouping of connective tissue cells and lymphocytes around the vessels is observed.
Other diagnostic methods
In more complex cases, tumor immunotyping, molecular and histochemical testing are performed. K. Fan et al recommend a diagnosis based on the results of DNA cytofluorimetry with a study of the number of normal cells (in this pathological process - more than 97%). Differential diagnosis is carried out with systemic lupus erythematosus, sarcoidosis, annular granuloma, Beett 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 intervals. Therapy of this pathology is non-specific. There is a high therapeutic efficacy in the appointment of antimalarial medicines ("Hydroxychloroquine", "Chloroquine") and anti-inflammatory non-steroid drugs ("Diclofenac", "Indomethacin") after preliminary treatment of concomitant digestive tract pathologies. If the condition of the gastrointestinal system allows, enterosorbents are used. Locally shown the use of hormonal corticosteroid ointments and creams, as well as injection blockade of skin rashes "Betamethasone" and "Triamcinolone".
With resistance, plasmapheresis is connected to the treatment (up to 10 sessions). The treatment of the digestive system with lymphoplasmacytic infiltration of the intestine and stomach is closely associated with diseases of the gastrointestinal tract - gastritis, inflammation in the large intestine, etc., which can be characterized by mucosal damage. To identify them, the patient needs to undergo appropriate diagnostics and therapy, which consists in taking antidiarrheal, antibacterial and anti-inflammatory drugs, as well as observing the diet (fractional meals, refusing foods that provoke fermentation, smoked, spicy and fatty foods).