What are the other Names for this Condition? (Also known as/Synonyms)

• APD (Autoimmune Progesterone Dermatitis)
• Progesterone Dermatitis
• Progestogen Hypersensitivity

What is Autoimmune Progesterone Dermatitis? (Definition/Background Information)

• Autoimmune Progesterone Dermatitis (APD) is an uncommon hormonal condition only observed in women during their reproductive/child-bearing phase. It is characterized by skin eruptions that may resemble urticaria, occurring cyclically around menstruation
• This autoimmune condition develops due to an abnormal response of the body to the progesterone hormone during menstrual cycles. Autoimmune Progesterone Dermatitis is known to recur during each menstrual cycle causing emotional and psychological stress
• A management of the condition involves symptomatic treatment of the skin symptoms and avoidance of progesterone-based medications. The prognosis of Progesterone Dermatitis is generally good for mild cases

Who gets Autoimmune Progesterone Dermatitis? (Age and Sex Distribution)

• Autoimmune Progesterone Dermatitis are exclusively observed in women during their reproductive period i.e., typically between 12 and 50 years of age (between menarche and menopause)
• Worldwide, there is no racial or ethnic preference observed, although it is a rare condition

What are the Risk Factors for Autoimmune Progesterone Dermatitis? (Predisposing Factors)

The risk factors for Autoimmune Progesterone Dermatitis include:

• Women in their active reproductive years have a high risk for developing the condition
• According to some medical literature, an earlier intake of oral contraceptives may induce the condition, although this is unproven

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Autoimmune Progesterone Dermatitis? (Etiology)

The cause of development of Autoimmune Progesterone Dermatitis is not well-established. The role of a prior exposure to hormonal therapy is under debate within the scientific community.

• Some experts feel that the body gets pre-sensitized to (external or exogenous) progesterone contained in oral contraceptives resulting in an autoimmune reaction
• Others believe that this external progesterone induces a hypersensitivity reaction in the woman to another (unidentified) allergen, leading to the symptoms

However, it was observed that not all women who develop Progesterone Dermatitis were under hormonal therapies.

What are the Signs and Symptoms of Autoimmune Progesterone Dermatitis?

The signs and symptoms of Autoimmune Progesterone Dermatitis may include:

• Presence of itchy red skin rashes
• The rashes are mostly in the form of hives and erythema multiforme
• Eczema-like blisters and ring-shaped red lesions have also been noted
• The rashes may appear on any part of the body such as the trunk, including abdomen and back, face, arms, and legs
• Mouth ulcers

The rashes almost always appear a few days to a week before the start of each menstrual cycle (luteal phase) and recede following the end of menstruation (after about 3 days). A recurrence is observed in the next/subsequent cycle.

The presence of Autoimmune Progesterone Dermatitis is known to exacerbate the symptoms of other skin conditions, such as cold sores, acne, atopic eczema, and psoriasis, among others, during the premenstrual period.

How is Autoimmune Progesterone Dermatitis Diagnosed?

A diagnosis of Autoimmune Progesterone Dermatitis is generally challenging due to its resemblance to many common skin conditions with wide skin presentations. The diagnosis may be frequently delayed, partly because if its rarity. However, the recurrence of skin rashes aligned with the menstrual cycle can help the healthcare provider in diagnosing Progesterone Dermatitis.

The diagnosis may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Blood tests, analysis of pus, and culture of the fluid being drained (for causative pathogen), as needed
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Provocative test/study: A minute amount of dilute progesterone in injected into the superficial dermis. If the typical lesion develops at the site, the diagnosis can be made
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. A skin tissue biopsy is not helpful in establishing the diagnosis

A differential diagnosis is very important to exclude diseases/conditions that present similar signs and symptoms. These may include:

• Allergic contact dermatitis
• Angioedema
• Eczema
• Erythema multiforme
• Fixed drug eruption
• Rosacea
• Urticaria

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Autoimmune Progesterone Dermatitis?

The possible complications due to Autoimmune Progesterone Dermatitis include:

• Emotional stress due to recurring skin rashes during each menstrual cycle
• Cosmetic issues
• Superimposed bacterial and fungal skin infections

How is Autoimmune Progesterone Dermatitis Treated?

The treatment measures available for Autoimmune Progesterone Dermatitis may include:

• Mild conditions may be symptomatically treated using topical steroid creams and antihistamine therapy
• Avoidance of medications containing progesterone hormone including oral contraceptive pills
• Hormone therapy may be administered in some women to suppress production of progesterone
• In case the condition is severe, recurrent, and does not respond well to therapy, a surgery to remove the ovaries (oophorectomy) may be advised

How can Autoimmune Progesterone Dermatitis be Prevented?

• Currently, there are no available guidelines to prevent Autoimmune Progesterone Dermatitis
• However, avoiding medications or contraceptives containing progesterone may be beneficial in women with Progesterone Dermatitis

What is the Prognosis of Autoimmune Progesterone Dermatitis? (Outcomes/Resolutions)

The prognosis of Autoimmune Progesterone Dermatitis is generally good in mild cases. However, severe conditions can become a chronic problem during each menstrual cycle.

Additional and Relevant Useful Information for Autoimmune Progesterone Dermatitis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/womens-health/