Whole course of treatment of autoimmune progesterone dermatitis that had spontaneously resolved during pregnancy: A case report and review of the literature

Abstract

Anaphylaxis due to autoimmune progesterone dermatitis is a rare but severe allergic disease in women. The clinical manifestations of APD are diverse, and a proper understanding of the disease can help even diagnose and treat it. A case of autoimmune progesterone dermatitis related in our department is reported as follows. She developed a rash with severe pruritus that was highly consistent with her menstrual cycle without any trigger 10 years ago. Laboratory tests were unremarkable. But all the symptoms disappeared during her pregnancy and resurfaced after the miscarriage. Two years ago, after a positive progesterone intradermal test confirmed the diagnosis of PH, she was given mifepristone, contraceptives(OCPs), and skin embedding treatment, and her symptoms improved.

Exogenous Progestogen Hypersensitivity and its Increasing Association with Assisted Reproductive Techniques (ART)/in vitro Fertilization (IVF)

“…[ 1 32 33 ] Pathogenesis through mechanisms such as delayed hypersensitivity (Type IV Gell and Coomb’s hypersensitivity reaction) through G protein-coupled receptor modulation of TH2 cells, through activation of progesterone membrane receptor a (PHR a) on CD8+ cells have also been suggested. [ 34 ] An immune complex-mediated (Type III Gell and Coomb’s hypersensitivity reaction) mechanism has also been proposed as one case report identified 17-hydroxyprogesterone-binding IgG immunoglobin in a patient’s serum experiencing cyclical perineal rashes. [ 18 35 ] A less accepted proposed mechanism for PH in patients with no prior exposure is progestogen sensitization developing after glucocorticoid exposure which shares similar chemical structure and hence may cause cross-sensitization.…”

“…Pathogenesis through mechanisms such as delayed hypersensitivity (Type IV Gell and Coomb’s hypersensitivity reaction) through G protein-coupled receptor modulation of TH2 cells, through activation of progesterone membrane receptor a (PHR a) on CD8+ cells have also been suggested. [ 34 ]…”

“…were the first to report their experience with effective treatment of progesterone-induced dermatitis with etonogestrel Implants (68 mg) skin embedding treatment while mifepristone tablets (25 mg) therapy for two months was considered not so effective. [ 34 ] Oophorectomy has been employed as a definitive treatment for patients with severe PH of endogenous or mixed aetiology, that cannot otherwise be managed medically although should be considered only in rare refractory cases or based on patient preference and not in women who still wish to conceive. [ 1 26 27 64 65 ]…”

Progesterone hypersensitivity: a cyclical history

“…The hypersensitivity reaction to progesterone was first described in 19211 and designated autoimmune progesterone dermatitis (AIPD) only in 1964 2 3. It is a rare pathology, with less than 200 reported cases 4.…”

“…It presents on a recurring basis, in temporal relation to the serum levels of progesterone and in a heterogeneous form with an expression that varies from limited cutaneous to systemic manifestation with anaphylaxis 3 8. Cutaneous lesions are usually characterised as vesicular, bullous, eczematous, urticarial or erythema multiforme and are most commonly found on the face, but also on the thorax, fingers, hands and oropharyngeal mucosa 9.…”