Autoimmune Progesterone Dermatitis

Tami Maguire

Disclosures

Dermatology Nursing. 2009;21(4):190-192. 

In This Article

Description of APD

Autoimmune progesterone dermatitis is a treatable and potentially curable syndrome of dermatologic signs and symptoms associated with the menstrual cycle in women ranging from the onset of menarche to as late as 48 years of age. The disease represents an autoimmune hypersensitivity to endogenous progesterone. In some cases, it has occurred after hormone therapy or shortly after delivery (Rasi & Khatami, 2004). The condition presents with a variety of skin eruptions characterized by recurrent cyclical pre-menstrual exacerbation secondary to progesterone fluctuations during a woman's menstrual cycle. Skin eruptions include urticaria, erythema multiforme, eczema, and papulovesicular eruptions. These eruptions typically occur 5 to 8 days prior to menses and subside at the start of menarche.

APD must be differentiated from usual pre-menstrual flares and exacerbations of chronic dermatosis such as acne, dermatitis herpetiformis, erythema multiforme (a reaction to the progesterone), lupus, or psoriasis (Rodenas et al., 1998). The diagnosis of APD requires a recurrent eruption related to menses and progesterone sensitization by skin test with intradermal injection with progesterone or intramuscular injection as a challenge test (Rodenas et al., 1998).

The differential diagnosis of APD includes skin disorders such as contact dermatitis, drug eruption, insect bite reaction, urticaria, and erythema multiforme. The diagnosis of APD is confirmed by evidence of sensitivity to progesterone by intradermal skin testing.

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