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Autoimmune progesterone dermatitis
Other namesAPD, Autoimmune progesterone urticaria, Progesterone dermatitis. [1]
Specialty Dermatology

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. [2] The first case of autoimmune progesterone dermatitis was identified in 1964. [3] Reproductive function may be impacted by APD. [4]

Signs and symptoms

Skin lesions can present as purpura, [5] urticaria, erythema multiforme, folliculitis, eczema, papulovesicular eruptions, fixed drug eruptions, [6] or vulvovaginal pruritus. [7] There are also reports of anaphylaxis. [8] Symptoms start to show up three to ten days before the onset of menstruation. [9] APD may affect fertility. [4]

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. [9] Although not all studies have shown it, some authors have proposed that hydrocortisone [10] or 17-α-hydroxyprogesterone may cause initial sensitization due to their cross-sensitivity with progesterone. [11]

Diagnosis

An intradermal progesterone injection test is performed in conjunction with a clinical history to confirm the diagnosis of APD. [12]

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. [13] Furthermore, progesterone patch testing has been recommended by some authors to further assess for a hypersensitivity reaction. [14] Notably, certain individuals with typical clinical symptoms of APD who improved after treatment for the disorder did not test negative for intradermal growth factors. [15]

See also

References

  1. ^ "Monarch Initiative". Monarch Initiative. Retrieved December 23, 2023.
  2. ^ Prieto-Garcia, Alicia; Sloane, David E.; Gargiulo, Antonio R.; Feldweg, Anna M.; Castells, Mariana (2011). "Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization". Fertility and Sterility. 95 (3). Elsevier BV: 1121.e9–1121.e13. doi: 10.1016/j.fertnstert.2010.10.038. ISSN  0015-0282. PMID  21092951.
  3. ^ Shelley, Walter B; Preucel, Robert W.; Spoont, Stanley S. (October 5, 1964). "Autoimmune Progesterone Dermatitis". JAMA. 190 (1). American Medical Association (AMA). doi: 10.1001/jama.1964.03070140041004. ISSN  0098-7484.
  4. ^ a b Kuruvilla, Merin; Vanijcharoenkarn, Kristine; Wan, Justin; Pereira, Nigel; Chung, Pak (2018). "Exogenous progesterone hypersensitivity associated with recurrent pregnancy loss". The Journal of Allergy and Clinical Immunology: In Practice. 6 (4). Elsevier BV: 1412–1413. doi: 10.1016/j.jaip.2017.11.041. ISSN  2213-2198. PMID  29339132. S2CID  42650500.
  5. ^ Wintzen, M.; Goor-van Egmond, M. B. T.; Noz, K. C. (2004). "Autoimmune progesterone dermatitis presenting with purpura and petechiae". Clinical and Experimental Dermatology. 29 (3). Oxford University Press (OUP): 316. doi: 10.1111/j.1365-2230.2004.01516.x. ISSN  0307-6938. PMID  15115523. S2CID  26356147.
  6. ^ ASAI, Jun; KATOH, Norito; NAKANO, Mayu; WADA, Makoto; KISHIMOTO, Saburo (November 26, 2009). "Case of autoimmune progesterone dermatitis presenting as fixed drug eruption". The Journal of Dermatology. 36 (12). Wiley: 643–645. doi: 10.1111/j.1346-8138.2009.00723.x. ISSN  0385-2407. PMID  19958448. S2CID  39416529.
  7. ^ Banerjee, A K; de Chazal, R (August 1, 2006). "Chronic vulvovaginal pruritus treated successfully with GnRH analogue". Postgraduate Medical Journal. 82 (970). Oxford University Press (OUP): e22. doi: 10.1136/pgmj.2005.043950. ISSN  0032-5473. PMC  2585717. PMID  16891434.
  8. ^ Snyder, Joy L.; Krishnaswamy, Guha (2003). "Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review". Annals of Allergy, Asthma & Immunology. 90 (5). Elsevier BV: 469–477. doi: 10.1016/s1081-1206(10)61838-8. ISSN  1081-1206. PMID  12775127.
  9. ^ a b Baptist, Alan P; Baldwin, James L (2004). "Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature". Clinical and Molecular Allergy. 2 (1). Springer Science and Business Media LLC: 10. doi: 10.1186/1476-7961-2-10. ISSN  1476-7961. PMC  509283. PMID  15287986.
  10. ^ Schoenmakers, A.; Vermorkkn, A.; Degreef, H.; Dooms-Goossens, A. (1992). "Corticosteroid or steroid allergy?". Contact Dermatitis. 26 (3). Wiley: 159–162. doi: 10.1111/j.1600-0536.1992.tb00286.x. ISSN  0105-1873. PMID  1505180. S2CID  43398231.
  11. ^ Wilkinson, S. M.; Beck, M. H. (1994). "The significance of positive patch tests to 17-hydroxyprogesterone". Contact Dermatitis. 30 (5). Wiley: 302–303. doi: 10.1111/j.1600-0536.1994.tb00606.x. ISSN  0105-1873. PMID  8088149. S2CID  5939298.
  12. ^ Nguyen, Tegan; Razzaque Ahmed, A. (2016). "Autoimmune progesterone dermatitis: Update and insights". Autoimmunity Reviews. 15 (2). Elsevier BV: 191–197. doi: 10.1016/j.autrev.2015.11.003. ISSN  1568-9972. PMID  26554933.
  13. ^ Hart, Roland (April 1977). "Autoimmune progesterone dermatitis". Archives of Dermatology. 133 (4): 426–430. doi: 10.1001/archderm.1977.01640040034003. PMID  192155.
  14. ^ Halevy, Sima; Cohen, Arnon D; Lunenfeld, Eitan; Grossman, Nili (August 2002). "Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro interferon-gamma release". Academy of Dermatology. 47 (2): 311–313. PMID  12140482.
  15. ^ Shelley, Walter B; Preucel, Robert W; Spoont, Stanley S (October 5, 1964). "Autoimmune Progesterone Dermatitis Cure by Oophorectomy". JAMA. 190 (1): 35–38. doi: 10.1001/jama.1964.03070140041004. PMID  14197141.

Further reading

External links

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