Autoimmune progesterone dermatitis of pregnancy

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).…”

“…4,25 Oestrogen dermatitis, a recently characterized entity which also presents as significant premenstrual flares of skin lesions, 26 was in the past misdiagnosed as autoimmune progesterone dermatitis. 27 Nowadays, the diagnosis of autoimmune progesterone dermatitis requires a recurrent eruption related to the menses and the demonstration of progesterone sensitization by means of skin tests with intradermal injection of progesterone, 1,3,6,7,10,15,16,28,29 the oral 11,12,14 or intramuscular administration of progesterone 1,6,13,14,19 as challenge tests, basophil degranulation tests 2,12 or the detection of circulating serum antibodies to progesterone (antibodies to the luteinizing cells of the corpus luteum). 1,2,7,9 Although the relief of symptoms has occasionally been obtained with systemic corticosteroids, 10,14,29 the goal of the treatment is to inhibit the secretion of endogenous progesterone by the suppression of ovulation.…”

“…1,2,7,9 Although the relief of symptoms has occasionally been obtained with systemic corticosteroids, 10,14,29 the goal of the treatment is to inhibit the secretion of endogenous progesterone by the suppression of ovulation. Pharmacological treatment with ethinyloestradiol, 8,12 conjugated oestrogens [1][2][3]6,15,17,18 or tamoxifen 13,14,30 is of value in most cases. Nevertheless, due to the low incidence of this disease, there is no experience in long-term treatment.…”

“…Autoimmune progesterone dermatitis is an unusual manifestation of allergy to progesterone. It occurs in fertile women with a previous history of exogenous progesterone intake 1,2 and sometimes in association with pregnancy, 3 although it may also appear without such a background. 4,5 It is characterized by cyclical premenstrual flares of cutaneous manifestations, such as urticaria, 1,6-11 erythema multiforme, 2,12,13 eczema 1,14 and papulovesicular eruptions.…”

“…4,5 It is characterized by cyclical premenstrual flares of cutaneous manifestations, such as urticaria, 1,6-11 erythema multiforme, 2,12,13 eczema 1,14 and papulovesicular eruptions. 3,15,16 The lesions typically recur in the days before the menses, with the postovulation rise in serum progesterone levels. Diagnosis requires further confirmation of progesterone sensitivity and treatment is based on suppression of ovulation.…”