January - March 2015, Volume 11, Issue 1

Bumbacea RS, Ghiordanescu IM, Tudose I, Popa LG, Badiu C, Giurcaneanu C

Autoimmune Progesterone Dermatitis in a Patient with no Medical History of Hormonal Contraception or Pregnancy

Acta Endo (Buc) 2015, 11 (1): 99-102
doi: 10.4183/aeb.2015.99

Abstract Context. Autoimmune progesterone dermatitis (AIPD) is a rare, cyclical dermatosis, with variable clinical presentation, occurring exclusively or being aggravated during the luteal phase of the menstrual cycle, when levels of progesterone rise. Its pathogenesis is still unclear. AIPD is thought to occur as an autoimmune reaction to endogenous possibly modified progesterone, but it could also be triggered by exogenous progesterone exposure. AIPD is a diagnosis of exclusion. Usually there is no or limited response to oral H1 antihistamines and a partial response to steroids. Ovulation inhibitors represent the specific treatment. Case report. We report a case of AIPD in an 18-year-old nulliparous patient with no medical history of allergic diseases and no exposure to oral contraceptive pills. AIPD was suspected based on the clinical picture (recurrent cyclical eczematous eruption on the face and abdominal area) and confirmed by positive intradermal test and positive progesterone challenge. This diagnosis was supported by the result of the skin biopsy, which also helped to exclude other dermatoses with premenstrual aggravation. The rash responded satisfactorily to treatment with a combination of oral contraceptives, levonorgestrel and estrione, which is currently considered first line therapy. Conclusions. This case is of particular interest due to the lack of previous pregnancy or exposure to progesteron therapy. Recurrent, cyclical eruptions in fertile women should raise the suspicion of AIPD. If early recognized, the patient may benefit from non-invasive treatment that improves significantly the quality of life.

Keywords: progesterone dermatitis, immunological reaction, progesterone challenge

Correspondence: Roxana Silvia Bumbacea MD, Str. Capitan Vijelie nr 24, Ap 1, Sector 5, Bucharest, 050672, Romania, E-mail: roxana.bumbacea@gmail.com