Autoimmune progesterone dermatitis of pregnancy

Late prurigo of pregnancy

“…We believe that the patients described in the present study as well as those described as toxaemic rash of pregnancy (Bourne, 1962), latetypeof prurigo of pregnancy (Nurse, 1968) and pruritic urticarial papules and plaques of pregnancy (Lawley et al^ 1979) have the same condition. The clinical features of the patients described as prurigo of pregnancy of Besnier by Costello (1941) are more compatible with the early type of prurigo of pregnancy as reported by Nurse (1968), although Costello states that in his cases the eruption started in the later months of pregnancy.…”

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 Intradermal testing can be useful in the differential diagnosis with other forms of dermatitis such as PUPPP or pemphigoid gestationis. Bierman 8 presented a patient who developed APD secondary to endogenous hormone production during the first trimester of two successive pregnancies, both of which ended in spontaneous abortion. Skin biopsy revealed an intense infiltration of eosinophils in the epidermis, within the hair follicles as well as within the dermis extending into the subcutaneous tissue.…”

“…Intradermal injection with aqueous progesterone produced a delayed hypersensitivity reaction which was identical to the histopathological features present in the naturally occurring lesion. 8 The biopsy findings of tissue eosinophilia may be a response to a progesterone/anti-progesterone anti-body complex formation.…”

Autoimmune progesterone dermatitis: treatment with oophorectomy

“…The pathogenesis of this condition remains obscure, although it has been hypothesized that an allergy to progesterone may occur by exposure to exogenous hormone (contraceptive pill) 1 or to an endogenous one during menarche or pregnancy. 3 It has also been discussed whether progesterone sensitivity might occur as a cross-reaction in patients sensitized to topical corticosteroids. [22][23][24] Autoimmune phenomena are another possibility, as the problem has been demonstrated in some cases of women affected by premature ovarian failure (menopause prior to the age of 40) with synthesis of antiprogesterone antibodies (IgE class or IgG4 subclass).…”