D3.39 - Autoimmune Progesterone Dermatitis Case Report

Introduction: Autoimmune progesterone dermatitis (PD) is a rare hypersensitivity reaction characterized by skin lesions in women in their third decade that is exacerbated by high progesterone levels in the luteal phase of the menstrual cycle. Urticaria and dermatitis are the most common lesions, but asthma, anaphylaxis are also reported. Diagnosis is based on a history of cyclic recurrent dermatitis and intradermal skin tests with progesterone.

Case Report

Thirty seven y-F patient admitted to allergy clinic with complaints of eczematous skin rash on her right wrist and neck for the last 7 months. Lesions had recurrence in every month which started 7 days before menstruation and gradually regressed in the days following menstruation (Figures 1 and 2). She had a history with allergic rhinitis. Her skin lesions were partly resolved by topical corticosteroids (CS) and oral antihistamines (AH1), but reccured in the next month. The standard European patch test result was found to be negative. The lesions seemed to have a relationship with the menstrual cycle. With a preliminary diagnosis of PD, skin prick test (SPT) with 1/10 dilution and intradermal test (IDT) was performed by a 50 mg/ml progesterone ampoule. The patient's SPT was negative, but the IDT result was found to be positive (8x5mm induration) (Figure 3). Skin tests with PG were negative in three healthy volunteers. Patient diagnosed PD and topical pimecrolimus was prescribed that decreased the severity and reccurence of lesions.

Discussion Conclusion

This report of PD is important to keep in mind in cases like middle-aged female patient who have skin lesions that occur in the luteal phase and relieved with menstrual cycle. Diagnostic criteria of PD are exacerbation of skin lesions in the premenstrual period, and positive skin tests with PG. In resistant cases oral contraceptive (OC) is recommended after treatment with topical KS, oral AH1, and topical calcineurin inhibitors. In our patient topical treatments were preferred since she refused to use OC.