Autoimmune Progesterone Dermatitis

Tami Maguire

Disclosures

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

In This Article

Case Studies

Case 1. In a case reported by Baptist and Baldwin (2004), a 33-year-old woman with a history of endometriosis presented with complaints of chronic urticaria. The patient stated the urticaria began at age 12, and did not seem to have any obvious trigger. Each individual lesion would last from 12 to 24 hours, and the entire event lasted 5 to 10 days. The lesions usually started on the chest and then spread over her entire body. She was seen by many physicians, including an allergist and dermatologist, and was treated with a variety of medications, including certirizine, desloratadine, hydroxizine, ranitidine, and dyphenhydramine without relief. Prednisone at high doses would provide temporary relief, and she required multiple courses over the past 20 years. She also complained of occasional angioedema, usually at the same time as the hives. Multiple lab tests over the years had been unremarkable. Upon questioning the patient further, researchers found that due to the patient's endometriosis, she had very irregular menstrual cycles in terms of length and timing. Her physicians determined that the urticaria would begin approximately 4 days prior to the onset of menses, and would last about 2 days into her menses, although the symptoms did not occur with every episode of menses. The patient has two children, and during each pregnancy her hives and angioedema improved. Because of her endometriosis, she had been started on Depo-Provera® (medroxyprogesterone) in her 20s. After one injection, she developed severe urticaria that lasted over 2 months and required multiple courses of prednisone. Depo-Provera was discontinued.

When the patient was evaluated (after Depo-Provera), physical exam was essentially normal with exception of the presence of urticarial lesions. The patient was referred for allergy skin testing with progesterone 50 mg/ml. Full-strength intradermal test revealed a 7 mm wheal with erythema. The histamine control showed a 9 mm wheal with erythema, and saline control was negative. Based on the results of the allergy skin testing, the patient was diagnosed with autoimmune progesterone dermatitis. The patient was started on a GnRH agonist (nafarelin acetate nasal spray 200 mcg twice a day). Within a month, she noted dramatic improvement in her urticaria and angioedema.

Case 2. A 19-year-old woman presented with a 4-year history of premenstrual skin eruptions lasting for 3 or 4 days (Sharar, Bergman, & Pollack, 1997). Pruritic, erythematous, and edematous papules were noticed on the patient's elbows, lower abdomen, and scapular area. She had been treated with various antihistamines, short courses of oral steroids, and different types of contraceptive drugs with very poor response. Because the patient suffered severely from the eruptions, prophylactic treatment was attempted with the androgen danazol, 200 mg twice daily, to be taken 2 to 3 days before menstruation and for 3 days after. For 12 consecutive months during treatment, no skin lesions were observed. The patient eventually ceased treatment, and the eruptions reappeared. The same treatment regimen was resumed, with the same success and no side effects.

Both cases involve women who presented with a variety of skin manifestations that started during the luteal phase of their menstrual cycle. After being treated with medication to suppress ovulation, both women reported relief of their symptoms.

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