A case of autoimmune progesterone dermatitis misdiagnosed as allergic contact dermatitis

Abstract

Autoimmune progesterone dermatitis is a rare autoimmune response to endogenous progesterone that usually occurs in fertile females. Cutaneous or mucosal lesions develop cyclically during the luteal phase of the menstrual cycle when progesterone levels are elevated. Symptoms usually start 3-10 days before menstruation and resolve 1-2 days after menstruation ceases. We report the case of a 48-year-old woman with intermittent eczematous skin lesions of the legs, forearms, and buttocks. She was diagnosed with allergic contact dermatitis, and topical steroids were prescribed. Her skin eruptions waxed and waned for 6 years and were associated with her menstrual cycle. We performed an intradermal test using progesterone, which was positive, and prescribed gonadotropin-releasing hormone analogues monthly for 3 months. The patient's skin lesions improved, confirming the diagnosis. Autoimmune progesterone dermatitis should be included in the differential diagnosis of recurrent eczema that is refractory to treatment in women of child-bearing age.

Keywords: Autoimmune progesterone dermatitis; allergic contact dermatitis; eczema; gonadotropin-releasing hormone analogues; intradermal test.

Fig. 1

(A) The biopsy specimen from the left lower leg consisted of an ellipsoid skin sample with underlying subcutaneous tissue. The hematoxylin and eosin stained histologic section was consistent with acute to subacute eczematous dermatitis (H&E stain, ×40). (B) The histologic section shows an inflammatory cell infiltration around follicular and perivascular tissues with increased dermal eosinophils (H&E stain, ×200).

Fig. 2

(A) Fixed, nummular eczematous dermatitis was present on both lower legs. (B) The previously observed dermatitis improved after 3 months of GnRH analogue treatment.

Fig. 3

Intradermal testing with progesterone (1: 10, 1: 1) was positive after 15 min.