Autoimmune progesterone dermatitis

Abstract

Autoimmune progesterone dermatitis (APD) is an exceptional condition affecting young women of childbearing age with a high prevalence during the third decade of life. The diagnosis should be confirmed using an intradermal skin test to progesterone, during the follicular phase of the menstrual cycle. APD represents an early manifestation of autoimmune disease. A case of APD is presented who after curative treatment did not develop other autoimmune diseases during a 6-year follow-up. Dermatologists, gynecologists and obstetricians should be aware of this rare but highly invalidating entity.

Case of autoimmune progesterone dermatitis presenting as necrotic migratory erythema successfully controlled by danazol

“…It is proposed that the immune complex of immunoglobulin G and progesterone lead to erythema multiforme-type skin lesions and the intermittent eruption of the disease during the menstrual period. 6 Various therapies had been reported to treat APD, such as conjugated estrogens, oral contraceptives, corticosteroids, antihistamines, progesterone, tamoxifen, antiestrogen, danazol, gonadotropin-releasing hormone (GnRH) analogs and oophorectomy. 5 There are three pathogenetic hypotheses: (i) exogenous progesterone induced progesterone hypersensitivity by stimulating T-helper cells; (ii) higher level of endogenous progesterone during pregnancy may be another triggering factor; and (iii) alike hormones, such as glucocorticoids and mineralocorticoids, may cross-react.…”

“…4 Recurrent anaphylaxis resulting from ovarian hormone-related exacerbation in some patients indicates that it may be caused by gonadotropins or progesterone. 3,6 Antihistamines and corticosteroids can be used for symptomatic relief. 6 Various therapies had been reported to treat APD, such as conjugated estrogens, oral contraceptives, corticosteroids, antihistamines, progesterone, tamoxifen, antiestrogen, danazol, gonadotropin-releasing hormone (GnRH) analogs and oophorectomy.…”

“…6 Danazol, an isoxazole derivative of ethisterone with mild progestational and androgenic activities, can promote the clearance of progesterone by competing with hormone-binding proteins. 6 Danazol, an isoxazole derivative of ethisterone with mild progestational and androgenic activities, can promote the clearance of progesterone by competing with hormone-binding proteins.…”

“…5 There are three pathogenetic hypotheses: (i) exogenous progesterone induced progesterone hypersensitivity by stimulating T-helper cells; (ii) higher level of endogenous progesterone during pregnancy may be another triggering factor; and (iii) alike hormones, such as glucocorticoids and mineralocorticoids, may cross-react. 6 Various therapies had been reported to treat APD, such as conjugated estrogens, oral contraceptives, corticosteroids, antihistamines, progesterone, tamoxifen, antiestrogen, danazol, gonadotropin-releasing hormone (GnRH) analogs and oophorectomy. 3,6 Antihistamines and corticosteroids can be used for symptomatic relief.…”

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“…APD is an uncommon, poorly recognized, and under-diagnosed catamenial dermatoses associated with hypersensitivity reactions to progestagens (Detrixhe, Nikkels, & Dezfoulian, 2017). Skin lesions (urticaria, eczema or erythema multiforme-like) occur during the luteal phase of the menstrual cycle.…”