Autoimmune progesterone dermatitis: a retrospective case series

Int J Womens Dermatol. 2022 Oct; 8(3): e009.

doi: 10.1097/JW9.0000000000000009

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Nessa Aghazadeh,a Nicholas A. Berry,b Rochelle R. Torgerson,a,c Miguel A. Park,d,e and Dawn Marie R. Davisa,d,*

Background:

Patient with APD presenting with diffuse urticaria.

Autoimmune progesterone dermatitis (APD) is a rare hypersensitivity disorder characterized by recurring dermatologic manifestations during the luteal phase of the menstrual cycle in women. Well-defined clinical and diagnostic criteria, outcomes measurements, and standard treatments are lacking.

Methods:

We performed a single-institution retrospective review of adult patients (older than 20 years at the time of diagnosis) with APD.

Results:

(A and B) Patient with APD presenting wit recurrent erythema multiforme-like eruption.

Fourteen patients were included with mean age of clinical onset of 34.3 ± 7.7 (range 24-54) years. There was a delay of 3.9 ± 5.5 (range 0.4-20) years between the onset of disease symptoms and diagnosis. The onset of APD was after exposure to exogenous progesterone in 9 of 14 patients. Progesterone skin test was performed in 9 patients and 6 were positive. Patients frequently presented with urticaria (9/14, 64.3%) and dermatitis (4/14, 28.6%). Continuous combined oral contraceptives (4/14, 28.6%), gonadotropin-releasing hormone agonist (3/14, 21.4%), and hysterectomy with bilateral salpingo-oophorectomy (2/14, 14.3%) were the most common attempted treatments with reliable outcomes.

Conclusions:

APD is a rare disorder which lacks universal diagnostic measures and criteria, contributing to a significant delay in diagnosis. Large-scale multicenter studies are needed to develop accurate tests, establish diagnostic criteria, and define treatment outcomes.

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