By Gary M. White, MD
Autoimmune progesterone dermatitis (APD) is a rare skin condition affecting women and caused by autoimmunity to endogenous progesterone. The rash is cyclical, flaring premenstrually.
The symptoms typically start 3-7 days prior to the menses and skin lesions may be observed 1 or 2 days before the flow. Reported skin lesions are extremely varied and may be erythematous, maculopapular, urticarial, annular, vesicobullous, or resemble erythema multiforme or fixed drug. In women with irregular menses, the diagnosis may not be as obvious. In some cases, anaphylaxis has been associated. One woman had multiple fixed drug eruption lesions that flared monthly as a manifestation of her APD Dermatology Online Journal 23(6).
Sensitivity can be demonstrated by intradermal skin testing with progesterone or challenge test with intramuscular progesterone acetate. Alternatively, an intradermal test with the administration of 0.5 mg/mL of medroxyprogesterone acetate may be done [Australas J Dermatol. 2016 Aug 4.].
The goal of treatment is to suppress progesterone secretion through anovulation. Usually, an oral contraceptive or conjugated estrogen is prescribed. In severe cases, oophorectomy can be curative. The condition spontaneously resolves after menopause.
In one study [Eur J Obs Gyn Rep Bio 1997;72;97], tamoxifen 10 mg BID for 7 days premenstrually prevented the skin eruption in 9 of 9 women. None of the women, most of whom were in their 20's, experienced menstrual irregularity.
A 39-year-old multiparous Caucasian woman with generalized, self-limited urticaria in her perimenstrual period. An intradermal test with the administration of 0.5 mg/mL of medroxyprogesterone acetate was positive. An oral combined contraceptive was initiated with complete resolution of symptoms. Australas J Dermatol. 2016 Aug 4
A 20-year-old woman presented with a 6-year history of recurrent erythematous papules and plaques on the trunk. The eruption would begin 5 days before menses and resolving 1 to 2 days after the menstrual period. An intradermal progesterone test read at 20 minutes was positive (progesterone, 50 mg/mL at a dilution of 1:10 in aqueous solution elicited a 10-mm wheal vs a 4-mm wheal for the glycerine control). Levonorgestrel/ethinyl estradiol, 0.1 mg to 20 μg daily cleared her lesions within 3 months. JAAD Case Rep. 2015 Sep; 1(5): 319–320
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