Abstract

PIP: This paper presents the 1st reported case of progesterone-induced cyclical erythema multiforme. The patient, 33 years of age, suffered from recurrent pruritic annular and target lesions on the hands, feet, and trunk and oral laceration from 1977-83. She had taken oral contraceptives in 1972 without adverse effects. The eruptions began in the 2nd half of the menstrual cycle, worsened through the luteal phase, and were at their most florid on days 2-4 of menstrution. There was no relationship to estrogen levels; however, the postovulatory progesterone peak, as indicated by serial serum progesterone levels, corresponded to the initiation of eruptions. Erythema multiforme was induced within 48 hours by intramuscular injection of 10 mg progesterone or 10 mg medroxyprogesterone; this further evoked a rise in circulating immune complexes for 48 hours. There was no indication that the erythema multiforme was associated with menstrual-linked herpes simplex or the use of analgesics during menstruation. Autoimmune progesterone dermatitis is often associated with prior exposure to synthetic progesterones, as in this case. It has been suggested that the synthetic progesterone acts as a stimulus for antibodies which cross-react with natural progesterone. The antiestrogen tamoxifern was used successfully in this case and is a valuable alternative to treatment with oophorectomy.