Autoimmune progesterone dermatitis

{{Infobox medical condition

|name = Autoimmune progesterone dermatitis

|synonyms = APD, Autoimmune progesterone urticaria, Progesterone dermatitis.{{cite web | title=Monarch Initiative | website=Monarch Initiative |url=https://monarchinitiative.org/MONDO:0021952 | access-date=December 23, 2023}}

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Autoimmune progesterone dermatitis (APD) occurs during the luteal phase of a woman's menstrual cycle and is an uncommon cyclic premenstrual reaction to progesterone. It can present itself in several ways, including eczema, erythema multiforme, urticaria, angioedema, and progesterone-induced anaphylaxis.{{cite journal | last1=Prieto-Garcia | first1=Alicia | last2=Sloane | first2=David E. | last3=Gargiulo | first3=Antonio R. | last4=Feldweg | first4=Anna M. | last5=Castells | first5=Mariana | title=Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization | journal=Fertility and Sterility | publisher=Elsevier BV | volume=95 | issue=3 | year=2011 | issn=0015-0282 | doi=10.1016/j.fertnstert.2010.10.038 | pages=1121.e9–1121.e13| pmid=21092951 | doi-access=free }} The first case of autoimmune progesterone dermatitis was identified in 1964.{{cite journal | last1=Shelley | first1=Walter B | last2=Preucel | first2=Robert W. | last3=Spoont | first3=Stanley S. | title=Autoimmune Progesterone Dermatitis | journal=JAMA | publisher=American Medical Association (AMA) | volume=190 | issue=1 | date=October 5, 1964 | issn=0098-7484 | doi=10.1001/jama.1964.03070140041004 | page=}} Reproductive function may be impacted by APD.{{cite journal | last1=Kuruvilla | first1=Merin | last2=Vanijcharoenkarn | first2=Kristine | last3=Wan | first3=Justin | last4=Pereira | first4=Nigel | last5=Chung | first5=Pak | title=Exogenous progesterone hypersensitivity associated with recurrent pregnancy loss | journal=The Journal of Allergy and Clinical Immunology: In Practice | publisher=Elsevier BV | volume=6 | issue=4 | year=2018 | issn=2213-2198 | doi=10.1016/j.jaip.2017.11.041 | pages=1412–1413| pmid=29339132 | s2cid=42650500 }}

Signs and symptoms

Skin lesions can present as purpura,{{cite journal | last1=Wintzen | first1=M. | last2=Goor-van Egmond | first2=M. B. T. | last3=Noz | first3=K. C. | title=Autoimmune progesterone dermatitis presenting with purpura and petechiae | journal=Clinical and Experimental Dermatology | publisher=Oxford University Press (OUP) | volume=29 | issue=3 | year=2004 | issn=0307-6938 | doi=10.1111/j.1365-2230.2004.01516.x | pages=316| pmid=15115523 | s2cid=26356147 }} urticaria, erythema multiforme, folliculitis, eczema, papulovesicular eruptions, fixed drug eruptions,{{cite journal | last1=ASAI | first1=Jun | last2=KATOH | first2=Norito | last3=NAKANO | first3=Mayu | last4=WADA | first4=Makoto | last5=KISHIMOTO | first5=Saburo | title=Case of autoimmune progesterone dermatitis presenting as fixed drug eruption | journal=The Journal of Dermatology | publisher=Wiley | volume=36 | issue=12 | date=November 26, 2009 | issn=0385-2407 | doi=10.1111/j.1346-8138.2009.00723.x | pages=643–645| pmid=19958448 | s2cid=39416529 }} or vulvovaginal pruritus.{{cite journal | last1=Banerjee | first1=A K | last2=de Chazal | first2=R | title=Chronic vulvovaginal pruritus treated successfully with GnRH analogue | journal=Postgraduate Medical Journal | publisher=Oxford University Press (OUP) | volume=82 | issue=970 | date=August 1, 2006 | issn=0032-5473 | doi=10.1136/pgmj.2005.043950 | pages=e22 | pmid=16891434 | doi-access=free| pmc=2585717 }} There are also reports of anaphylaxis.{{cite journal | last1=Snyder | first1=Joy L. | last2=Krishnaswamy | first2=Guha | title=Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review | journal=Annals of Allergy, Asthma & Immunology | publisher=Elsevier BV | volume=90 | issue=5 | year=2003 | issn=1081-1206 | doi=10.1016/s1081-1206(10)61838-8 | pages=469–477| pmid=12775127 }} Symptoms start to show up three to ten days before the onset of menstruation.{{cite journal | last1=Baptist | first1=Alan P | last2=Baldwin | first2=James L | title=Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature | journal=Clinical and Molecular Allergy | publisher=Springer Science and Business Media LLC | volume=2 | issue=1 | year=2004 | issn=1476-7961 | doi=10.1186/1476-7961-2-10 | page=10 | pmid=15287986 | doi-access=free | pmc=509283 }} 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{{cite journal | last1=Schoenmakers | first1=A. | last2=Vermorkkn | first2=A. | last3=Degreef | first3=H. | last4=Dooms-Goossens | first4=A. | title=Corticosteroid or steroid allergy? | journal=Contact Dermatitis | publisher=Wiley | volume=26 | issue=3 | year=1992 | issn=0105-1873 | doi=10.1111/j.1600-0536.1992.tb00286.x | pages=159–162| pmid=1505180 | s2cid=43398231 }} or 17-α-hydroxyprogesterone may cause initial sensitization due to their cross-sensitivity with progesterone.{{cite journal | last1=Wilkinson | first1=S. M. | last2=Beck | first2=M. H. | title=The significance of positive patch tests to 17-hydroxyprogesterone | journal=Contact Dermatitis | publisher=Wiley | volume=30 | issue=5 | year=1994 | issn=0105-1873 | doi=10.1111/j.1600-0536.1994.tb00606.x | pages=302–303| pmid=8088149 | s2cid=5939298 }}

Diagnosis

An intradermal progesterone injection test is performed in conjunction with a clinical history to confirm the diagnosis of APD.{{cite journal | last1=Nguyen | first1=Tegan | last2=Razzaque Ahmed | first2=A. | title=Autoimmune progesterone dermatitis: Update and insights | journal=Autoimmunity Reviews | publisher=Elsevier BV | volume=15 | issue=2 | year=2016 | issn=1568-9972 | doi=10.1016/j.autrev.2015.11.003 | pages=191–197| pmid=26554933 }}

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.{{cite journal |last1=Hart |first1=Roland |title=Autoimmune progesterone dermatitis |journal=Archives of Dermatology |date=April 1977 |volume=133 |issue=4 |pages=426–430 |doi=10.1001/archderm.1977.01640040034003 |pmid=192155}} Furthermore, progesterone patch testing has been recommended by some authors to further assess for a hypersensitivity reaction.{{cite journal |last1=Halevy |first1=Sima |last2=Cohen |first2=Arnon D |last3=Lunenfeld |first3=Eitan |last4=Grossman |first4=Nili |title=Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro interferon-gamma release |journal=Academy of Dermatology |date=August 2002 |volume=47 |issue=2 |pages=311–313 |pmid=12140482}} Notably, certain individuals with typical clinical symptoms of APD who improved after treatment for the disorder did not test negative for intradermal growth factors.{{cite journal |last1=Shelley |first1=Walter B |last2=Preucel |first2=Robert W |last3=Spoont |first3=Stanley S |title=Autoimmune Progesterone Dermatitis Cure by Oophorectomy |journal=JAMA |date=October 5, 1964 |volume=190 |issue=1 |pages=35–38 |doi=10.1001/jama.1964.03070140041004 |pmid=14197141}}

References

External links

[https://dermnetnz.org/topics/autoimmune-progesterone-dermatitis DermNet]
[https://autoimmune.org/disease-information/progesterone-dermatitis/ The Autoimmune Association]

{{Medical resources

| ICD11 = {{ICD11|EA8Y}}

| ICD10 = {{ICD10|L30.8}}

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| ICD9 = {{ICD9|692.9}}

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| MeshID = C535299

| DiseasesDB = 33845

| SNOMED CT = 838551007

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Category:Eczema