Autoimmune Progesterone Dermatitis

Abstract

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,

Female sex as an independent prognostic factor in the development of oral mucositis during autologous peripheral stem cell transplantation

“…The adverse effect of decreased serum estrogen on the mucosa is well known: the oral epithelium becomes thin and atrophic, accompanied by a deterioration of mucosal integrity and immunity 27 , whereas estrogen supplementation and HRT improves mucosal integrity 28 – 30 . The oral mucosa also responds to progesterone 31 , high levels being detrimental, especially in immuno-compromised patients 32 – 34 . There were elevated serum and salivary progesterone levels in our patients during APSCT (Fig.…”

Autoimmune progesterone dermatitis following vaginal progesterone exposure in pregnancy

“…7 Although the pathogenesis is still unclear, it is believed that after exposure to exogenous progestin, sensitized antigen presenting cells and T lymphocytes generate specific immunoglobulin E antibodies that give rise to the skin lesions as progesterone levels increase during the luteal phase of the menstrual cycle or during pregnancy. 7,8 The cutaneous eruptions typical of APD are usually pruritic with chronic urticarial reaction, eczema, erythema multiforme, stomatitis and vesiculobullous eruptions, although some cases of purpura and petechiae have been reported. 7,9,10 Cases associated with anaphylaxis have been described as well.…”

“…7,8 The cutaneous eruptions typical of APD are usually pruritic with chronic urticarial reaction, eczema, erythema multiforme, stomatitis and vesiculobullous eruptions, although some cases of purpura and petechiae have been reported. 7,9,10 Cases associated with anaphylaxis have been described as well. All skin surfaces may be involved including oral, extremities, and genitals.…”

“…[1][2][3][4][5][6] Outside of pregnancy, exogenous as well as endogenous fluctuations of progesterone have been demonstrated to cause a rare type I immediate and type IV delayed hypersensitivity reaction known as autoimmune progesterone dermatitis (APD). 7,8 APD manifests itself primarily with cutaneous eruptions and rarely causes anaphylaxis. APD following the administration of vaginal progesterone in pregnancy has not been described to date.…”

Effect of Omalizumab for Autoimmune Progesterone Dermatitis Refractory to Bilateral Oophorectomy: a case report

“…If APD is IgE-mediated, the diagnosis is con rmed by a positive wheal and are response to skin testing with progesterone [6]. Various treatment options have been described for APD, including gonadotrophinreleasing hormone (GnRH) agonists (suppressing progesterone production), oral contraceptives, tamoxifen, prednisone, dapsone, thalidomide, azathioprine and danazol [7][8][9].…”