Autoimmune progesterone urticaria

Abstract

Autoimmune progesterone dermatitis is a rare cutaneous disorder characterized by recurrent and cyclic skin eruption with variable morphology, occurring during the luteal phase. A case of autoimmune progesterone urticaria in a 47-year-old woman is reported. An intradermal progestin test revealed a strong reactivity against this hormone. Treatment with tamoxifen and leuprolide acetate induced only a partial remission of urticaria. Bilateral oophorectomy was performed with absolute clearing of cutaneous lesions.

Sex hormones and urticaria

“…The mechanism of such autoimmune reaction to progesterone is unknown. In some patients, the onset of the disorder occurs after the hormonal therapy (containing progesterone), suggesting that synthetic progesterone may induce cross-reaction against the endogenous hormone [34][35][36][37]. This disorder can also appear or aggravate during pregnancy, possibly because the increasing progesterone levels occurring during such period may promote the immunological imbalance responsible for progesterone hypersensitivity.…”

“…On one hand, hypersensitivity to progesterone may be a causal factor of urticaria symptoms in patients suffering from autoimmune progesterone dermatitis [34][35][36][37], while on other hand, endogenous and exogenous progesterone may lead to improvement in urticaria symptoms [28].…”

“…This disorder can also appear or aggravate during pregnancy, possibly because the increasing progesterone levels occurring during such period may promote the immunological imbalance responsible for progesterone hypersensitivity. The diagnosis is made using intradermal skin test or intramuscular and oral challenge with progesterone [34][35][36][37]. Treatment strategies base generally on drugs suppressing ovulation and hence the postovulatory rise in progesterone concentration [38].…”

Autoimmune Progesterone Dermatitis: Potential Role of Cutaneous Angiogenin Expression?

“…Estroprogestative contraception is the most commonly used therapy [1,2,5,7,26] . Other treatments include danazol [27] , a synthetic steroid analog that inhibits LH and FSH surge, azathioprin [5] , tamoxifen [9,28] as well as oophorectomy [4,6,14] . However, LH-RH analogs which induce reversible menopause are often preferred [1,29] .…”

“…AIPD is a rare but characteristic entity, of which at least 70 cases have been described so far [1] . Its clinical presentation is extremely variable with erythematous, macular, papular and/or vesicular rashes [7][8][9] , palmoplantar dyshidrosis [2, 10] , erythemamultiforme-like lesion [2-4, 11, 12] , stomatitis [9] as well as urticaria [13,14] , angioedema [6] and anaphylactic-like shock [7,10,15] . The lesions typically and constantly relapse during the luteal phase of the menstrual cycle.…”