Three Cases of Autoimmune Progesterone Dermatitis

Abstract

Autoimmune progesterone dermatitis is a rare cyclic premenstrual reaction to progesterone produced during the luteal phase of the menstrual cycle. The clinical symptoms of autoimmune progesterone dermatitis overlap with other forms of dermatosis such as erythema multiforme, eczema, fixed drug eruption, urticaria, and angioedema. We experienced 3 cases of autoimmune progesterone dermatitis. All patients had a recurrent history of monthly skin eruptions. Skin lesions normally began a few days before menstruation and resolved a few days later. Patients were confirmed to have autoimmune progesterone dermatitis by the results of the progesterone intradermal test. All three patients had different clinical findings such as erythema annulare centrifugum, urticaria, contact dermatitis, and rosacea. Because patients presented with variable clinical manifestations, they could have been easily misdiagnosed. The patients were treated with oral contraceptive, antihistamine and steroids for symptom control. We propose that dermatologists should consider autoimmune progesterone dermatitis in cases of recurrent cyclic skin eruptions in female patients. Further, if this condition is suspected, thorough history taking including that on menstrual cycle and intradermal progesterone test should be performed.

Keywords: Autoimmune progesterone dermatitis; Menstrual cycle; Progesterone.

Fig. 1. (A, B) Clearly marked erythematous patches with edema on both cheeks (patient 1). (C) Intradermal progesterone test was performed in patient 1. Within 3 minutes, a 2-cm-sized erythema at the progesterone injection site. After 20 minutes, erythema remained.

Fig. 2. (A, B) Pruritic erythematous patches with edema on the chest and back (patient 2). (C) Histological examination of the chest lesion showed patchy infiltration of lymphocytes and a few eosinophils (H&E; ×40, inset: ×400). (D) Positive intradermal progesterone test in patient 2. After 30 minutes, 1.5-cm sized erythema and wheal is distinctly seen (left). After 48 hours, erythema persists at the progesterone injection site right). P: progesterone, S: saline.

Fig. 3. (A, B) Pruritic and stingy erythematous polycyclic patches on the trunk (patient 3). (C) A 0.5-cm-sized wheal is observed after 30 minutes. Further, gyrated patches on the face, neck, hands appeared after 24 hours.