Autoimmune progesterone dermatitis (APD) occurs during the

luteal phase The menstrual cycle is on average 28 days in length. It begins with Menstruation, menses (day 1–7) during the follicular phase (day 1–14), followed by ovulation (day 14) and ending with the luteal phase (day 14–28). While historically, medi ...

of a woman's

menstrual cycle The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that makes pregnancy possible. The ovarian cycle controls the production and release of eg ...

and is an uncommon cyclic premenstrual reaction to

progesterone Progesterone (; P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the ma ...

. It can present itself in several ways, including

eczema Dermatitis is a term used for different types of skin inflammation, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened ...

erythema multiforme Erythema multiforme (EM) is an immune-mediated inflammatory skin condition associated with several viral infections, that appears with red patches evolving into target lesions, typically on both hands. It is typically associated with infection ...

urticaria Hives, also known as urticaria, is a kind of skin rash with red or flesh-colored, raised, itchy bumps. Hives may burn or sting. The patches of rash may appear on different body parts, with variable duration from minutes to days, and typically ...

angioedema Angioedema is an area of swelling (edema) of the lower layer of skin and tissue just under the skin or mucous membranes. The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs. Often it is associated with hives, which are ...

, and progesterone-induced

anaphylaxis Anaphylaxis (Greek: 'up' + 'guarding') is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of the use of emergency medication on site. It typicall ...

. The first case of autoimmune progesterone dermatitis was identified in 1964. Reproductive function may be impacted by APD.

Signs and symptoms

Skin lesions can present as

purpura Purpura () is a condition of red or purple discolored spots on the skin that do not blanch on applying pressure. The spots are caused by bleeding underneath the skin secondary to platelet disorders, vascular disorders, coagulation disorders, ...

folliculitis Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head. A ...

, papulovesicular eruptions, fixed drug eruptions, or vulvovaginal

pruritus An itch (also known as pruritus) is a sensation that causes a strong desire or reflex to scratch. Itches have resisted many attempts to be classified as any one type of sensory experience. Itches have many similarities to pain, and while both ...

. There are also reports of

. Symptoms start to show up three to ten days before the onset of

menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and Mucous membrane, mucosal tissue from the endometrium, inner lining of the uterus through the vagina. The menstrual cycle is characterized ...

. APD may affect

fertility Fertility in colloquial terms refers the ability to have offspring. In demographic contexts, fertility refers to the actual production of offspring, rather than the physical capability to reproduce, which is termed fecundity. The fertility rate ...

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 Immunoglobulin E (IgE) is a type of antibody (or immunoglobulin (Ig) " isoform") that has been found only in mammals. IgE is synthesised by plasma cells. Monomers of IgE consist of two heavy chains (ε chain) and two light chains, with the ε ...

. 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 Hydrocortisone is the name for the hormone cortisol when supplied as a medication. It is a corticosteroid and works as an anti-inflammatory and by immune suppression. Uses include conditions such as adrenocortical insufficiency, adrenogenit ...

or 17-α-hydroxyprogesterone may cause initial sensitization due to their cross-sensitivity with

Diagnosis

An intradermal

injection test is performed in conjunction with a clinical history to confirm the diagnosis of APD. 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. Furthermore,

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

growth factors A growth factor is a naturally occurring substance capable of stimulating cell proliferation, wound healing, and occasionally cellular differentiation. Usually it is a secreted protein or a steroid hormone. Growth factors are important for regu ...

References

External links

DermNet

The Autoimmune Association
{{dermatitis and eczema Eczema

Signs and symptoms

Mechanism

Diagnosis

See also

References

Further reading

External links