Autoimmune Progesterone Dermatitis

Tami Maguire

Disclosures

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

In This Article

Autoimmune Progesterone Dermatitis and the Menstrual Cycle

In a small group of women, the menstrual cycle has been associated with the spectrum of dermatologic diseases including eczema, erythema multiforme, folliculitis, angioedema, urticaria, and others (Baptist & Baldwin, 2004). The lesions may appear as typical urticaria or erythema multiforme in various stages of healing. The lesions may be present in the oral mucosa, lips, palms of hands, trunk, or feet. The patient may describe pruritus, severe pain (especially oral lesions), or angioedema.

Autoimmune progesterone dermatitis is usually considered an auto-allergic (autoimmune) reaction to endogenous progesterone. Some cases have reported women affected by premature ovarian failure (menopause prior to the age of 40) with synthesis of antiprogesterone antibodies. The age of onset is variable, with the youngest reported case occurring at menarche, but the initiation of the disease may be as late as 48 years of age. Risk factors for APD include fertile women with previous history of exogenous progesterone intake, sometimes in association with pregnancy. Erythema-multiforme, urticaria, and eczematous lesions are the most common findings which occur a few days prior to menses with the post ovulation rise in progesterone and end at the beginning of menstruation (Cristaudo et al., 2007). The hallmarks for diagnosis are premenstrual flare, reproducibility of rash with intramuscular progesterone, and prevention of rash with inhibition of ovulation (Warin, 2001).

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