Autoimmune progesterone dermatitis

Medical condition

Autoimmune progesterone dermatitis
Other names	APD, Autoimmune progesterone urticaria, Progesterone dermatitis.
Specialty	Dermatology

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. The first case of autoimmune progesterone dermatitis was identified in 1964. Reproductive function may be impacted by APD.

Signs and symptoms

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

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. Although not all studies have shown it, some authors have proposed that hydrocortisone or 17-α-hydroxyprogesterone may cause initial sensitization due to their cross-sensitivity with progesterone.

Diagnosis

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

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. Furthermore, progesterone patch testing has been recommended by some authors to further assess for a hypersensitivity reaction. Notably, certain individuals with typical clinical symptoms of APD who improved after treatment for the disorder did not test negative for intradermal growth factors.

References

"Monarch Initiative". Monarch Initiative. Retrieved December 23, 2023.
Prieto-Garcia, Alicia; Sloane, David E.; Gargiulo, Antonio R.; Feldweg, Anna M.; Castells, Mariana (2011). "Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization". Fertility and Sterility. 95 (3). Elsevier BV: 1121.e9–1121.e13. doi:10.1016/j.fertnstert.2010.10.038. ISSN 0015-0282. PMID 21092951.
Shelley, Walter B; Preucel, Robert W.; Spoont, Stanley S. (October 5, 1964). "Autoimmune Progesterone Dermatitis". JAMA. 190 (1). American Medical Association (AMA). doi:10.1001/jama.1964.03070140041004. ISSN 0098-7484.
^ Kuruvilla, Merin; Vanijcharoenkarn, Kristine; Wan, Justin; Pereira, Nigel; Chung, Pak (2018). "Exogenous progesterone hypersensitivity associated with recurrent pregnancy loss". The Journal of Allergy and Clinical Immunology: In Practice. 6 (4). Elsevier BV: 1412–1413. doi:10.1016/j.jaip.2017.11.041. ISSN 2213-2198. PMID 29339132. S2CID 42650500.
Wintzen, M.; Goor-van Egmond, M. B. T.; Noz, K. C. (2004). "Autoimmune progesterone dermatitis presenting with purpura and petechiae". Clinical and Experimental Dermatology. 29 (3). Oxford University Press (OUP): 316. doi:10.1111/j.1365-2230.2004.01516.x. ISSN 0307-6938. PMID 15115523. S2CID 26356147.
ASAI, Jun; KATOH, Norito; NAKANO, Mayu; WADA, Makoto; KISHIMOTO, Saburo (November 26, 2009). "Case of autoimmune progesterone dermatitis presenting as fixed drug eruption". The Journal of Dermatology. 36 (12). Wiley: 643–645. doi:10.1111/j.1346-8138.2009.00723.x. ISSN 0385-2407. PMID 19958448. S2CID 39416529.
Banerjee, A K; de Chazal, R (August 1, 2006). "Chronic vulvovaginal pruritus treated successfully with GnRH analogue". Postgraduate Medical Journal. 82 (970). Oxford University Press (OUP): e22. doi:10.1136/pgmj.2005.043950. ISSN 0032-5473. PMC 2585717. PMID 16891434.
Snyder, Joy L.; Krishnaswamy, Guha (2003). "Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review". Annals of Allergy, Asthma & Immunology. 90 (5). Elsevier BV: 469–477. doi:10.1016/s1081-1206(10)61838-8. ISSN 1081-1206. PMID 12775127.
^ Baptist, Alan P; Baldwin, James L (2004). "Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature". Clinical and Molecular Allergy. 2 (1). Springer Science and Business Media LLC: 10. doi:10.1186/1476-7961-2-10. ISSN 1476-7961. PMC 509283. PMID 15287986.
Schoenmakers, A.; Vermorkkn, A.; Degreef, H.; Dooms-Goossens, A. (1992). "Corticosteroid or steroid allergy?". Contact Dermatitis. 26 (3). Wiley: 159–162. doi:10.1111/j.1600-0536.1992.tb00286.x. ISSN 0105-1873. PMID 1505180. S2CID 43398231.
Wilkinson, S. M.; Beck, M. H. (1994). "The significance of positive patch tests to 17-hydroxyprogesterone". Contact Dermatitis. 30 (5). Wiley: 302–303. doi:10.1111/j.1600-0536.1994.tb00606.x. ISSN 0105-1873. PMID 8088149. S2CID 5939298.
Nguyen, Tegan; Razzaque Ahmed, A. (2016). "Autoimmune progesterone dermatitis: Update and insights". Autoimmunity Reviews. 15 (2). Elsevier BV: 191–197. doi:10.1016/j.autrev.2015.11.003. ISSN 1568-9972. PMID 26554933.
Hart, Roland (April 1977). "Autoimmune progesterone dermatitis". Archives of Dermatology. 133 (4): 426–430. doi:10.1001/archderm.1977.01640040034003. PMID 192155.
Halevy, Sima; Cohen, Arnon D; Lunenfeld, Eitan; Grossman, Nili (August 2002). "Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro interferon-gamma release". Academy of Dermatology. 47 (2): 311–313. PMID 12140482.
Shelley, Walter B; Preucel, Robert W; Spoont, Stanley S (October 5, 1964). "Autoimmune Progesterone Dermatitis Cure by Oophorectomy". JAMA. 190 (1): 35–38. doi:10.1001/jama.1964.03070140041004. PMID 14197141.

External links

Classification	D ICD-11: EA8Y ICD-10: L30.8 ICD-9-CM: 692.9 MeSH: C535299 DiseasesDB: 33845 SNOMED CT: 838551007
External resources	Scholia: Q4826347

v t e Dermatitis and eczema
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Other	substances taken internally: Bromoderma Fixed drug reaction Nummular dermatitis Pityriasis alba Papuloerythroderma of Ofuji

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