Autoimmune progesterone dermatitis explained

Autoimmune progesterone dermatitis
Synonyms:	APD, Autoimmune progesterone urticaria, Progesterone dermatitis.^[1]

Autoimmune progesterone dermatitis (APD) occurs during the luteal phase of a woman's menstrual cycle and is an uncommon cyclic premenstrual reaction to progesterone. It can present itself in several ways, including eczema, erythema multiforme, urticaria, angioedema, and progesterone-induced anaphylaxis.^[2] The first case of autoimmune progesterone dermatitis was identified in 1964.^[3] Reproductive function may be impacted by APD.^[4]

Signs and symptoms

Skin lesions can present as purpura,^[5] urticaria, erythema multiforme, folliculitis, eczema, papulovesicular eruptions, fixed drug eruptions,^[6] or vulvovaginal pruritus.^[7] There are also reports of anaphylaxis.^[8] Symptoms start to show up three to ten days before the onset of menstruation.^[9] APD may affect fertility.^[4]

Mechanism

It is unknown exactly what causes APD. The use of exogenous progesterones (OCPs) at the beginning of a patient's treatment may increase the possibility that the antigen will be absorbed by antigen-presenting cells and presented to TH2 cells, which may lead to the subsequent synthesis of IgE. However, this mechanism would not account for the pathogenesis in patients whose APD began before this treatment.^[9] Although not all studies have shown it, some authors have proposed that hydrocortisone^[10] or 17-α-hydroxyprogesterone may cause initial sensitization due to their cross-sensitivity with progesterone.^[11]

Diagnosis

An intradermal progesterone injection test is performed in conjunction with a clinical history to confirm the diagnosis of APD.^[12]

A delayed or immediate hypersensitivity reaction could be the cause of APD. As a result, intradermal testing might not show a positive result for 24 to 48 hours.^[13] Furthermore, progesterone patch testing has been recommended by some authors to further assess for a hypersensitivity reaction.^[14] Notably, certain individuals with typical clinical symptoms of APD who improved after treatment for the disorder did not test negative for intradermal growth factors.^[15]

See also

• Autoimmune estrogen dermatitis
• Fixed drug reaction

Further reading

• Irshad . Shahmeen . Haider . Muhammad S . Master . Madiha F . Asif . Nasir . Khalil . Ambreen . Autoimmune Progesterone Dermatitis . Cureus . Cureus, Inc. . November 2, 2021 . 13 . 11 . e19217 . 2168-8184 . 10.7759/cureus.19217 . 34877200 . 8642151 . free . none.
• Huang . Yepei . Ye . Sha . Bao . Xiaoyan . Yang . Ru . Huang . Jian . Whole course of treatment of autoimmune progesterone dermatitis that had spontaneously resolved during pregnancy: A case report and review of the literature . Frontiers in Immunology . Frontiers Media SA . 13 . September 7, 2022 . 1664-3224 . 10.3389/fimmu.2022.939083 . free . 36159858 . none. 9490548 .

External links

• DermNet
• The Autoimmune Association

Notes and References

1. Web site: Monarch Initiative . Monarch Initiative . December 23, 2023.
2. Prieto-Garcia . Alicia . Sloane . David E. . Gargiulo . Antonio R. . Feldweg . Anna M. . Castells . Mariana . Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization . Fertility and Sterility . Elsevier BV . 95 . 3 . 2011 . 0015-0282 . 10.1016/j.fertnstert.2010.10.038 . 1121.e9–1121.e13. 21092951 . free .
3. Shelley . Walter B . Preucel . Robert W. . Spoont . Stanley S. . Autoimmune Progesterone Dermatitis . JAMA . American Medical Association (AMA) . 190 . 1 . October 5, 1964 . 0098-7484 . 10.1001/jama.1964.03070140041004 .
4. Kuruvilla . Merin . Vanijcharoenkarn . Kristine . Wan . Justin . Pereira . Nigel . Chung . Pak . Exogenous progesterone hypersensitivity associated with recurrent pregnancy loss . The Journal of Allergy and Clinical Immunology: In Practice . Elsevier BV . 6 . 4 . 2018 . 2213-2198 . 10.1016/j.jaip.2017.11.041 . 1412–1413. 29339132 . 42650500 .
5. Wintzen . M. . Goor-van Egmond . M. B. T. . Noz . K. C. . Autoimmune progesterone dermatitis presenting with purpura and petechiae . Clinical and Experimental Dermatology . Oxford University Press (OUP) . 29 . 3 . 2004 . 0307-6938 . 10.1111/j.1365-2230.2004.01516.x . 316. 15115523 . 26356147 .
6. ASAI . Jun . KATOH . Norito . NAKANO . Mayu . WADA . Makoto . KISHIMOTO . Saburo . Case of autoimmune progesterone dermatitis presenting as fixed drug eruption . The Journal of Dermatology . Wiley . 36 . 12 . November 26, 2009 . 0385-2407 . 10.1111/j.1346-8138.2009.00723.x . 643–645. 19958448 . 39416529 .
7. Banerjee . A K . de Chazal . R . Chronic vulvovaginal pruritus treated successfully with GnRH analogue . Postgraduate Medical Journal . Oxford University Press (OUP) . 82 . 970 . August 1, 2006 . 0032-5473 . 10.1136/pgmj.2005.043950 . e22 . 16891434 . free. 2585717 .
8. Snyder . Joy L. . Krishnaswamy . Guha . Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review . Annals of Allergy, Asthma & Immunology . Elsevier BV . 90 . 5 . 2003 . 1081-1206 . 10.1016/s1081-1206(10)61838-8 . 469–477. 12775127 .
9. Baptist . Alan P . Baldwin . James L . Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature . Clinical and Molecular Allergy . Springer Science and Business Media LLC . 2 . 1 . 2004 . 1476-7961 . 10.1186/1476-7961-2-10 . 10 . 15287986 . free . 509283 .
10. Schoenmakers . A. . Vermorkkn . A. . Degreef . H. . Dooms-Goossens . A. . Corticosteroid or steroid allergy? . Contact Dermatitis . Wiley . 26 . 3 . 1992 . 0105-1873 . 10.1111/j.1600-0536.1992.tb00286.x . 159–162. 1505180 . 43398231 .
11. Wilkinson . S. M. . Beck . M. H. . The significance of positive patch tests to 17-hydroxyprogesterone . Contact Dermatitis . Wiley . 30 . 5 . 1994 . 0105-1873 . 10.1111/j.1600-0536.1994.tb00606.x . 302–303. 8088149 . 5939298 .
12. Nguyen . Tegan . Razzaque Ahmed . A. . Autoimmune progesterone dermatitis: Update and insights . Autoimmunity Reviews . Elsevier BV . 15 . 2 . 2016 . 1568-9972 . 10.1016/j.autrev.2015.11.003 . 191–197. 26554933 .
13. Hart . Roland . Autoimmune progesterone dermatitis . Archives of Dermatology . April 1977 . 133 . 4 . 426–430 . 10.1001/archderm.1977.01640040034003 . 192155.
14. Halevy . Sima . Cohen . Arnon D . Lunenfeld . Eitan . Grossman . Nili . Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro interferon-gamma release . Academy of Dermatology . August 2002 . 47 . 2 . 311–313 . 12140482.
15. Shelley . Walter B . Preucel . Robert W . Spoont . Stanley S . Autoimmune Progesterone Dermatitis Cure by Oophorectomy . JAMA . October 5, 1964 . 190 . 1 . 35–38 . 10.1001/jama.1964.03070140041004 . 14197141.