Autoimmune progesterone dermatitis (APD) is an immune reaction to endogenous progesterone that can follow exposure to exogenous progesterone. Skin eruption develops cyclically during the luteal phase of the menstrual cycle when progesterone levels are elevated. Patients present with a variety of skin eruptions, including erythema multiforme, eczema, urticaria, angioedema, and progesterone-induced anaphylaxis. The resultant clinical symptoms are frequently confused with other forms of dermatosis. The diagnostic criteria of APD include recurrent cyclical worsening of skin lesions and symptomatic improvement after inhibition of progesterone secretion by suppression of ovulation. The pathogenesis is unclear. Diagnosis is confirmed by skin testing for inflammatory responses to small doses of the hormone, and desensitization with small doses of the hormone is the most appropriate form of management. Keywords Autoimmune progesterone dermatitis. Sex hormones. Estradiol. Progesterone. Hypersensitivity Female Sex Hormones Throughout the Menstrual Cycle and Life The hormonal status of women is controlled by the hypothalamic-hypophyseal-ovarian axis and involves the release of gonadotrophins and ovarian hormones,
Recurrent pregnancy loss may be associated with inappropriate local immune responses to sex hormones. Further research is necessary into the mechanisms of hypersensitivity to estrogen and progesterone and their interactions with other systems.
The aim of this study was to determine whether women with recurrent pregnancy loss (RPL) and concurrent premenstrual syndrome (PMS) who underwent desensitization with sex hormones had an improved obstetric outcome. This manuscript summarizes a 10 year open label prospective follow up study of 26 women with RPL, aged 25-42 with 3-8 previous miscarriages and PMS, who had hormone hypersensitivity on skin testing. Skin testing was positive to estradiol in 23 women, progesterone in 20 women and to both estrogen and progesterone in 17 women. Amelioration of the symptoms of PMS (according to the VAS) was seen in 21 of 26 patients after desensitization with small doses of sex hormones intradermally. There was long term and stable reduction of severe PMS in 21 of 26 patients after desensitization. Five women conceived after skin testing, prior to desensitization. Sixteen of 26 women (61%) had subsequent live births. Five women had two subsequent live births in the subsequent pregnancy. There were no obstetric complications. Five women had two subsequent pregnancies with live births. It seems that correction of sex hormone hypersensitivity was accompanied by relief of persistent PMS, may have a positive effect on the chances of a successful pregnancy.
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