Three Cases of Autoimmune Progesterone Dermatitis

Autoimmune progesterone dermatitis is a rare cyclic premenstrual reaction to progesterone produced during the luteal phase of the menstrual cycle. The clinical symptoms of autoimmune progesterone dermatitis overlap with other forms of dermatosis such as erythema multiforme, eczema, fixed drug eruption, urticaria, and angioedema. We experienced 3 cases of autoimmune progesterone dermatitis. All patients had a recurrent history of monthly skin eruptions. Skin lesions normally began a few days before menstruation and resolved a few days later. Patients were confirmed to have autoimmune progesterone dermatitis by the results of the progesterone intradermal test. All three patients had different clinical findings such as erythema annulare centrifugum, urticaria, contact dermatitis, and rosacea. Because patients presented with variable clinical manifestations, they could have been easily misdiagnosed. The patients were treated with oral contraceptive, antihistamine and steroids for symptom control. We propose that dermatologists should consider autoimmune progesterone dermatitis in cases of recurrent cyclic skin eruptions in female patients. Further, if this condition is suspected, thorough history taking including that on menstrual cycle and intradermal progesterone test should be performed.

A Case of Autoimmune Progesterone Dermatitis Presenting as Erythema Multiforme / 대한피부과학회지

Autoimmune progesterone dermatitis is a rare disorder involving hypersensitivity to progesterone. It is most frequently characterized by recurrent erythema multiforme, eczematous or urticarial eruptions during the luteal phase of the menstrual cycle. It resolves or partially improves after menstruation. Sensitivity is demonstrated by a challenge test with medroxyprogesterone acetate. The therapeutic goal for autoimmune progesterone dermatitis is the suppression of ovulation. Currently, the first-line choice of therapy is a combination oral contraceptive. Here, we report a case of autoimmune progesterone dermatitis that manifested as cyclic bullous erythema multiforme. A reactive intradermal progesterone test confirmed the diagnosis.

A Case of Autoimmune Progesterone Dermatitis Misdiagnosed as Allergic Contact Dermatitis

Autoimmune progesterone dermatitis is a rare autoimmune response to endogenous progesterone that usually occurs in fertile females. Cutaneous or mucosal lesions develop cyclically during the luteal phase of the menstrual cycle when progesterone levels are elevated. Symptoms usually start 3-10 days before menstruation and resolve 1-2 days after menstruation ceases. We report the case of a 48-year-old woman with intermittent eczematous skin lesions of the legs, forearms, and buttocks. She was diagnosed with allergic contact dermatitis, and topical steroids were prescribed. Her skin eruptions waxed and waned for 6 years and were associated with her menstrual cycle. We performed an intradermal test using progesterone, which was positive, and prescribed gonadotropin-releasing hormone analogues monthly for 3 months. The patient's skin lesions improved, confirming the diagnosis. Autoimmune progesterone dermatitis should be included in the differential diagnosis of recurrent eczema that is refractory to treatment in women of child-bearing age.

A Case of the Autoimmune Progesterone Dermatitis / 대한피부과학회지

Autoimmune progesterone dermatitis is a rare cyclic premenstrual reaction to a variety of progesterone produced during the luteal phase of a woman's menstrual cycle, including urticaria, urticarial papule, papulovesicle, eczematous lesion, erythema multiforme, and progesterone-induced anaphylaxis. A 23-year-old woman presented with brown colored hyperpigmented reticular patches on the chest and abdomen. Since the age of 20, she had been recurrently suffering from pruritic eruption that appeared regularly 5 to 10 days prior to menstruation and persisted for several days. Intradermal skin test reaction to progesterone was positive. These features were consistent with the diagnosis of autoimmune progesterone dermatitis.

Autoimmune progesterome dermatitis / 대한피부과학회지

Autoimmune progesterorie dermatitis describes an eruption which is influenced by the hormonal changes of the menstrual cycle. Recurrent premenstrual eruptions occur which correspond to the postovulation rise in serum prrigesterone. A 32-year-old women feveloped cyclic hives premenstrually and followed by spontaneous regression. Intradermal skin testing with crystal progesterone produced a generalized urticarial response after eight hours. The patient was treated with systemic corticostirod and antihistamine.