The phenotype of hormone-related allergic and autoimmune diseases in the skin: annular lesions that lateralize

Abstract

Introduction. Sexual dimorphism with an increased prevalence in women has long been observed in various autoimmune, allergic, and skin diseases. Recent research has attempted to correlate this female predilection to physiologic changes seen in the menstrual cycle in order to more effectively diagnose and treat these diseases. Cases. We present five cases of cutaneous diseases in women with annular morphology and distributive features that favor one side over the other. In all cases, skin disease improved with ovarian suppression. Conclusion. Sexual dimorphism in the innate and adaptive immune systems has long been observed, with females demonstrating a more vigorous immune response compared to males. Female sex hormones promote T and B lymphocyte autoreactivity and favor the humoral arm of adaptive immunity. In addition to ovarian steroidogenesis and immunity, intricate pathways coexist in order to engage a single oocyte in each cycle, while simultaneously sustaining the ovarian reserve. Vigorous proinflammatory, vasoactive, and pigment-related cytokines emerge during the demise of the corpus luteum, influencing peripherical sex hormone metabolism of the level of the macrophage and fibroblast. We propose that annular and lateralizing lesions are important manifestations of hormone-related inflammation and recognition of this linkage can lead to improved immune and reproductive health.

Figure 1

(a) 40-year-old female with abrupt onset of palmoplantar pustulosis. (b) Significant improvement occurred after three months of therapy with norethindrone-based oral contraceptive pills.

Figure 2

(a) A 23-year-old Indian female presented with a single patch of alopecia areata. (b) Hair regrowth is evident after 3 months of therapy with norethindrone and metformin.

Figure 3

(a) A 19-year-old Caucasian female presented with a large temporal patch of alopecia areata. (b) Significant hair regrowth is evident after three months of therapy with norethindrone and metformin.

Figure 4

(a) A 25-year-old female with type I DM and onset of necrobiosis lipoidica at puberty. (b) A reduction in peripheral erythema and active border ensued after one year of therapy with norethindrone-based oral contraceptive pills.

Figure 5

(a) A 20-year-old Caucasian female presented with vitiligo on the knees, with the right knee involved more than the left knee. (b) Repigmentation occurred after one year of norethindrone-based oral contraceptive therapy.

Figure 6

McLaughlin and McIver [14].