Autoimmune progesterone dermatitis

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

References

1. "Monarch Initiative".
2. (2011). "Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization". Elsevier BV.
3. (October 5, 1964). "Autoimmune Progesterone Dermatitis". American Medical Association (AMA).
4. (2018). "Exogenous progesterone hypersensitivity associated with recurrent pregnancy loss". Elsevier BV.
5. (2004). "Autoimmune progesterone dermatitis presenting with purpura and petechiae". Oxford University Press (OUP).
6. (November 26, 2009). "Case of autoimmune progesterone dermatitis presenting as fixed drug eruption". Wiley.
7. (August 1, 2006). "Chronic vulvovaginal pruritus treated successfully with GnRH analogue". Oxford University Press (OUP).
8. (2003). "Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review". Elsevier BV.
9. (2004). "Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature". Springer Science and Business Media LLC.
10. (1992). "Corticosteroid or steroid allergy?". Wiley.
11. (1994). "The significance of positive patch tests to 17-hydroxyprogesterone". Wiley.
12. (2016). "Autoimmune progesterone dermatitis: Update and insights". Elsevier BV.
13. (April 1977). "Autoimmune progesterone dermatitis". Archives of Dermatology.
14. (August 2002). "Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro interferon-gamma release". Academy of Dermatology.
15. (October 5, 1964). "Autoimmune Progesterone Dermatitis Cure by Oophorectomy". JAMA.