Autoimmune progesterone dermatitis

December 31, 2014

Synonyms

Overview

Autoimmune progesterone dermatitis (APD) is primarily characterized by a recurrent skin rash that varies in severity depending on the phase of the menstrual cycle. The rash generally appears during the second half of the cycle when levels of the hormone, progesterone, begin to rise and it subsides shortly after menstruation. As progesterone production is linked to menstrual cycles, the rash occurs usually in the week before menstruation until a few days after menstruation starts.

Symptoms

Autoimmune progesterone dermatitis (APD) is primarily characterized by a recurrent skin rash that varies in severity depending on the phase of the menstrual cycle. The rash generally appears during the second half of the cycle when levels of the hormone, progesterone, begin to rise. Following menstruation, when the levels of progesterone naturally fall, the rash typically improves and may even completely resolve until the next cycle.

A variety of skin rashes are associated with APD, including:

Hives
Erythema multiforme
Swelling beneath the skin (angioedema)
Eczema-like rash
Annular erythema
Mouth sores
Cyclic skin rash
Urticaria

Rarely, APD may progress to progesterone-induced anaphylaxis.

Causes

The exact underlying cause of autoimmune progesterone dermatitis is not completely understood. Most scientists believe that the cyclic rash occurs when an abnormal immune reaction (autoimmune response) is triggered by rising levels of the hormone, progesterone. A second proposed theory speculates that high levels of progesterone may lead to a heightened response to another allerg

Diagnosis

The diagnosis of APD is typically made based on clinical history (including timing of symptoms around the menstrual cycle) and evidence of a skin reaction to progesterone. In most cases, progesterone is introduced by a skin prick or needle injection into either the skin (intradermal) or muscle (intramuscular). Testing is considered positive when a skin reaction called a 'wheal-and-flare' develops and persists within a 24-48 hour period.

Other diagnostic studies described in the medical literature include: eosinophil count, quantitative measurements of immunoglobulin and complement as well as analysis of hormonal factors including luteinizing hormone, , progesterone, and estradiol.

Treatment

The treatment or control of symptoms of autoimmune progesterone dermatitis (APD) varies. Mild cases might be successfully managed with use of antihistamines and/or corticosteroids.

Most methods of treatment focus on temporarily suppressing ovulation. This might be achieved through varying medications including: conjugated estrogen, ethinyl estradiol, tamoxifen, and danazol. Gonadotropin releasing hormone agonists have additionally had reported success in the literature; however as these medications can prompt symptoms of menopause, they might not be recommended for pre-menopausal patients. Progesterone desensitization, in which increasing doses of progesterone are administered via vaginal suppository, has been reported as a successful treatment in one case in the literature.

For severe cases in which the above treatment options are not successful, surgical removal of ovaries or oophorectomy is curative.