Autoimmune Progesterone Dermatitis: A Systematic Review

Abstract

Autoimmune progesterone dermatitis (AIPD) is a cyclical, cutaneous reaction to endogenous progesterone that occurs throughout the menstrual cycle. The cutaneous manifestations of AIPD vary greatly from patient to patient, ranging anywhere from urticaria to erythema multiforme to anaphylaxis. As such, recognition, diagnosis, and management of this condition are difficult for clinicians. In the present article, we conducted a systematic review of 112 articles and 132 individual cases to summarize the clinical features and presentation of AIPD while also summarizing the successes and failures of different treatment plans. Despite the great variety in clinical presentations, it is clear from the data that ovulation-suppressing medical therapies and surgery have the greatest success in treating AIPD, whereas more commonly used therapies such as antihistamines and systemic corticosteroids frequently fail in providing any relief. Further research is necessary to determine the exact pathogenesis of AIPD and allow for more targeted treatment.

A vasculitis mimic during pregnancy: autoimmune progesterone dermatitis

“…In our case, the withdrawal of progesterone confirmed the clinical suspicion of APD. In APD caused by vaginal progesterone, treatments, such as corticosteroids and antihistamines, frequently fail to provide any relief, as illustrated also in our case [ 4 ]. Cutaneous lesions resolve a few days after suspension of the progesterone pessaries [ 5 ]; therefore, the clinical suspicion of APD during pregnancy is paramount.…”

“…APD varies greatly from patient to patient and can present as urticaria, eczema or vesiculobullous eruptions [ 3 ]. It usually develops in the luteal phase of the menstrual cycle with spontaneous resolution after menstruation due to endogenous fluctuation of progesterone [ 4 ]. Confirmatory tests, such as skin prick testing with progesterone can be considered [ 3 ].…”

Athena Speciality Certificate Examination case for cutaneous allergy

“…Autoimmune progesterone dermatitis (APD) is a rare cyclical hypersensitivity reaction to endogenous progesterone, which increases during the luteal phase of the menstrual cycle 1 . A wide range of cutaneous presentations of APD have been described with variable morphology 2 (Table 1). The symptoms typically appear 3–10 days prior to menses and resolve within days of menstruation.…”

Diseases from the Spectrum of Dermatitis and Eczema: Can “Omics” Sciences Help with Better Systematics and More Accurate Differential Diagnosis?

“…The confirmed sensitizer here is progesterone—an endogenous steroid sex hormone whose molecular weight of 314 daltons places it among haptens. To date, more than a hundred cases diagnosed as AIPD have been reported throughout the medical literature; however, this number also includes cases of non-eczematous dermatoses, e.g., progesterone-triggered urticaria, which appears to comprise one-third of the reported cases [ 118 ]. The knowledge of AIPD pathomechanisms is limited.…”