Autoimmune progesterone dermatitis: Difference between revisions

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{{Infobox medical condition (new)
{{Infobox medical condition
| name = Autoimmune progesterone dermatitis
|name = Autoimmune progesterone dermatitis
|synonyms = APD, Autoimmune progesterone urticaria, Progesterone dermatitis.<ref name="Monarch Initiative r376">{{cite web | title=Monarch Initiative | website=Monarch Initiative |url=https://monarchinitiative.org/MONDO:0021952 | access-date=December 23, 2023}}</ref>
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| field = dermatology
|specialty = [[Dermatology]]
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'''Autoimmune progesterone dermatitis''' may appear as [[urticarial]] [[papules]], deep gyrate [[skin lesion|lesions]], [[papulovesicular]] lesions, an [[eczema]]tous eruption, or as targetoid lesions.<ref name="Andrews">{{cite book | vauthors = James WD, Berger T, Elston D |title=Andrews' diseases of the skin : clinical dermatology. |date=2006 |publisher=Saunders Elsevier |location=Philadelphia |isbn=978-0-7216-2921-6 |edition=10th}}</ref>{{rp|82}} Autoimmune progesterone dermatitis initially manifests with eye symptoms, e.g. burning, and progresses into [[rashes]]. Its relapsing-remitting pattern in women correspond to the [[progesterone]] levels during the [[menstrual cycle]], which spike twice a month. It is an extremely rare disease.{{Citation needed|date=October 2022}}


'''Autoimmune progesterone dermatitis''' '''(APD)''' occurs during the [[luteal phase]] of a woman's [[menstrual cycle]] and is an uncommon cyclic premenstrual reaction to [[progesterone]]. It can present itself in several ways, including [[eczema]], [[erythema multiforme]], [[urticaria]], [[angioedema]], and progesterone-induced [[anaphylaxis]].<ref name="progesterone desensitization">{{cite journal | last=Prieto-Garcia | first=Alicia | last2=Sloane | first2=David E. | last3=Gargiulo | first3=Antonio R. | last4=Feldweg | first4=Anna M. | last5=Castells | first5=Mariana | title=Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization | journal=Fertility and Sterility | publisher=Elsevier BV | volume=95 | issue=3 | year=2011 | issn=0015-0282 | doi=10.1016/j.fertnstert.2010.10.038 | pages=1121.e9–1121.e13}}</ref> The first case of autoimmune progesterone dermatitis was identified in 1964.<ref name="Shelley Preucel Spoont 1964">{{cite journal | last=Shelley | first=Walter B | last2=Preucel | first2=Robert W. | last3=Spoont | first3=Stanley S. | title=Autoimmune Progesterone Dermatitis | journal=JAMA | publisher=American Medical Association (AMA) | volume=190 | issue=1 | date=October 5, 1964 | issn=0098-7484 | doi=10.1001/jama.1964.03070140041004 | page=}}</ref> Reproductive function may be impacted by APD.<ref name="recurrent pregnancy loss">{{cite journal | last=Kuruvilla | first=Merin | last2=Vanijcharoenkarn | first2=Kristine | last3=Wan | first3=Justin | last4=Pereira | first4=Nigel | last5=Chung | first5=Pak | title=Exogenous progesterone hypersensitivity associated with recurrent pregnancy loss | journal=The Journal of Allergy and Clinical Immunology: In Practice | publisher=Elsevier BV | volume=6 | issue=4 | year=2018 | issn=2213-2198 | doi=10.1016/j.jaip.2017.11.041 | pages=1412–1413}}</ref>
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==See also==
*[[Skin lesion]]


== Signs and symptoms ==
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==References==
Skin lesions can present as [[purpura]],<ref name="purpura and petechiae">{{cite journal | last=Wintzen | first=M. | last2=Goor-van Egmond | first2=M. B. T. | last3=Noz | first3=K. C. | title=Autoimmune progesterone dermatitis presenting with purpura and petechiae | journal=Clinical and Experimental Dermatology | publisher=Oxford University Press (OUP) | volume=29 | issue=3 | year=2004 | issn=0307-6938 | doi=10.1111/j.1365-2230.2004.01516.x | pages=316–316}}</ref> [[urticaria]], [[erythema multiforme]], [[folliculitis]], [[eczema]], [[papulovesicular]] eruptions, [[Fixed drug eruption|fixed drug eruptions]],<ref name="fixed drug eruption">{{cite journal | last=ASAI | first=Jun | last2=KATOH | first2=Norito | last3=NAKANO | first3=Mayu | last4=WADA | first4=Makoto | last5=KISHIMOTO | first5=Saburo | title=Case of autoimmune progesterone dermatitis presenting as fixed drug eruption | journal=The Journal of Dermatology | publisher=Wiley | volume=36 | issue=12 | date=November 26, 2009 | issn=0385-2407 | doi=10.1111/j.1346-8138.2009.00723.x | pages=643–645}}</ref> or vulvovaginal [[pruritus]].<ref name="vulvovaginal pruritus">{{cite journal | last=Banerjee | first=A K | last2=de Chazal | first2=R | title=Chronic vulvovaginal pruritus treated successfully with GnRH analogue | journal=Postgraduate Medical Journal | publisher=Oxford University Press (OUP) | volume=82 | issue=970 | date=August 1, 2006 | issn=0032-5473 | doi=10.1136/pgmj.2005.043950 | pages=e22–e22 | doi-access=free}}</ref> There are also reports of [[anaphylaxis]].<ref name="anaphylaxis">{{cite journal | last=Snyder | first=Joy L. | last2=Krishnaswamy | first2=Guha | title=Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review | journal=Annals of Allergy, Asthma &amp; Immunology | publisher=Elsevier BV | volume=90 | issue=5 | year=2003 | issn=1081-1206 | doi=10.1016/s1081-1206(10)61838-8 | pages=469–477}}</ref> Symptoms start to show up three to ten days before the onset of [[menstruation]].<ref name="endometriosis">{{cite journal | last=Baptist | first=Alan P | last2=Baldwin | first2=James L | title=Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature | journal=Clinical and Molecular Allergy | publisher=Springer Science and Business Media LLC | volume=2 | issue=1 | year=2004 | issn=1476-7961 | doi=10.1186/1476-7961-2-10 | page=10}}</ref> APD may affect [[fertility]].<ref name="recurrent pregnancy loss"/>

== Mechanism ==
It is unknown exactly what causes APD. The use of exogenous progesterones (OCPs) at the beginning of a patient's treatment may increase the possibility that the antigen will be absorbed by antigen-presenting cells and presented to [[Th2|TH2]] cells, which may lead to the subsequent synthesis of [[Immunoglobulin E|IgE]]. However, this mechanism would not account for the pathogenesis in patients whose APD began before this treatment.<ref name="endometriosis"/> Although not all studies have shown it, some authors have proposed that [[hydrocortisone]]<ref name="Corticosteroid">{{cite journal | last=Schoenmakers | first=A. | last2=Vermorkkn | first2=A. | last3=Degreef | first3=H. | last4=Dooms‐Goossens | first4=A. | title=Corticosteroid or steroid allergy? | journal=Contact Dermatitis | publisher=Wiley | volume=26 | issue=3 | year=1992 | issn=0105-1873 | doi=10.1111/j.1600-0536.1992.tb00286.x | pages=159–162}}</ref> or [[17α-Hydroxyprogesterone|17-α-hydroxyprogesterone]] may cause initial sensitization due to their cross-sensitivity with [[progesterone]].<ref name="17‐hydroxyprogesterone">{{cite journal | last=Wilkinson | first=S. M. | last2=Beck | first2=M. H. | title=The significance of positive patch tests to 17‐hydroxyprogesterone | journal=Contact Dermatitis | publisher=Wiley | volume=30 | issue=5 | year=1994 | issn=0105-1873 | doi=10.1111/j.1600-0536.1994.tb00606.x | pages=302–303}}</ref>

== Diagnosis ==
An intradermal [[progesterone]] injection test is performed in conjunction with a clinical history to confirm the diagnosis of APD.<ref name="Nguyen Razzaque Ahmed 2016 pp. 191–197">{{cite journal | last=Nguyen | first=Tegan | last2=Razzaque Ahmed | first2=A. | title=Autoimmune progesterone dermatitis: Update and insights | journal=Autoimmunity Reviews | publisher=Elsevier BV | volume=15 | issue=2 | year=2016 | issn=1568-9972 | doi=10.1016/j.autrev.2015.11.003 | pages=191–197}}</ref>

A delayed or immediate hypersensitivity reaction could be the cause of APD. As a result, intradermal testing might not show a positive result for 24 to 48 hours.<ref>{{cite journal |last1=Hart |first1=Roland |title=Autoimmune progesterone dermatitis |journal=Archives of dermatology |date=April 1977 |volume=133 |issue=4 |pages=426–430 |doi=10.1001/archderm.1977.01640040034003 |pmid=192155}}</ref> Furthermore, [[progesterone]] patch testing has been recommended by some authors to further assess for a hypersensitivity reaction.<ref>{{cite journal |last1=Halevy |first1=Sima |last2=Cohen |first2=Arnon D |last3=Lunenfeld |first3=Eitan |last4=Grossman |first4=Nili |title=Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro interferon-gamma release |journal=Academy of Dermatology |date=August 2002 |volume=47 |issue=2 |pages=311–313 |pmid=12140482}}</ref> Notably, certain individuals with typical clinical symptoms of APD who improved after treatment for the disorder did not test negative for intradermal [[Growth factor|growth factors]].<ref>{{cite journal |last1=Shelley |first1=Walter B |last2=Preucel |first2=Robert W |last3=Spoont |first3=Stanley S |title=Autoimmune Progesterone Dermatitis Cure by Oophorectomy |journal=JAMA |date=October 5, 1964 |volume=190 |issue=1 |pages=35–38 |doi=10.1001/jama.1964.03070140041004 |pmid=14197141}}</ref>

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== See also ==
* [[Autoimmune estrogen dermatitis]]
* [[Fixed drug reaction]]

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== References ==
{{reflist}}
{{reflist}}

== Further reading ==
* {{cite journal | last=Irshad | first=Shahmeen | last2=Haider | first2=Muhammad S | last3=Master | first3=Madiha F | last4=Asif | first4=Nasir | last5=Khalil | first5=Ambreen | title=Autoimmune Progesterone Dermatitis | journal=Cureus | publisher=Cureus, Inc. | date=November 2, 2021 | issn=2168-8184 | doi=10.7759/cureus.19217 | doi-access=free | ref=none}}
* {{cite journal | last=Huang | first=Yepei | last2=Ye | first2=Sha | last3=Bao | first3=Xiaoyan | last4=Yang | first4=Ru | last5=Huang | first5=Jian | title=Whole course of treatment of autoimmune progesterone dermatitis that had spontaneously resolved during pregnancy: A case report and review of the literature | journal=Frontiers in Immunology | publisher=Frontiers Media SA | volume=13 | date=September 7, 2022 | issn=1664-3224 | doi=10.3389/fimmu.2022.939083 | doi-access=free | ref=none}}


== External links ==
== External links ==
* [https://dermnetnz.org/topics/autoimmune-progesterone-dermatitis DermNet]
* [https://autoimmune.org/disease-information/progesterone-dermatitis/ The Autoimmune Association]

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| OMIM =
| ICD9 = {{ICD9|692.9}}
| DiseasesDB =
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| MeshID = C535299
| eMedicineSubj = article
| DiseasesDB = 33845
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| eMedicineTopic = 712365
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| SNOMED CT = 838551007
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{{Cutaneous-condition-stub}}
{{dermatitis and eczema}}
{{dermatitis and eczema}}

[[Category:Eczema]]
[[Category:Eczema]]

Revision as of 17:23, 23 December 2023

Autoimmune progesterone dermatitis
Other namesAPD, Autoimmune progesterone urticaria, Progesterone dermatitis.[1]
SpecialtyDermatology

Autoimmune progesterone dermatitis (APD) occurs during the luteal phase of a woman's menstrual cycle and is an uncommon cyclic premenstrual reaction to progesterone. It can present itself in several ways, including eczema, erythema multiforme, urticaria, angioedema, and progesterone-induced anaphylaxis.[2] The first case of autoimmune progesterone dermatitis was identified in 1964.[3] Reproductive function may be impacted by APD.[4]

Signs and symptoms

Skin lesions can present as purpura,[5] urticaria, erythema multiforme, folliculitis, eczema, papulovesicular eruptions, fixed drug eruptions,[6] or vulvovaginal pruritus.[7] There are also reports of anaphylaxis.[8] Symptoms start to show up three to ten days before the onset of menstruation.[9] APD may affect fertility.[4]

Mechanism

It is unknown exactly what causes APD. The use of exogenous progesterones (OCPs) at the beginning of a patient's treatment may increase the possibility that the antigen will be absorbed by antigen-presenting cells and presented to TH2 cells, which may lead to the subsequent synthesis of IgE. However, this mechanism would not account for the pathogenesis in patients whose APD began before this treatment.[9] Although not all studies have shown it, some authors have proposed that hydrocortisone[10] or 17-α-hydroxyprogesterone may cause initial sensitization due to their cross-sensitivity with progesterone.[11]

Diagnosis

An intradermal progesterone injection test is performed in conjunction with a clinical history to confirm the diagnosis of APD.[12]

A delayed or immediate hypersensitivity reaction could be the cause of APD. As a result, intradermal testing might not show a positive result for 24 to 48 hours.[13] Furthermore, progesterone patch testing has been recommended by some authors to further assess for a hypersensitivity reaction.[14] Notably, certain individuals with typical clinical symptoms of APD who improved after treatment for the disorder did not test negative for intradermal growth factors.[15]

See also

References

  1. ^ "Monarch Initiative". Monarch Initiative. Retrieved December 23, 2023.
  2. ^ Prieto-Garcia, Alicia; Sloane, David E.; Gargiulo, Antonio R.; Feldweg, Anna M.; Castells, Mariana (2011). "Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization". Fertility and Sterility. 95 (3). Elsevier BV: 1121.e9–1121.e13. doi:10.1016/j.fertnstert.2010.10.038. ISSN 0015-0282.
  3. ^ Shelley, Walter B; Preucel, Robert W.; Spoont, Stanley S. (October 5, 1964). "Autoimmune Progesterone Dermatitis". JAMA. 190 (1). American Medical Association (AMA). doi:10.1001/jama.1964.03070140041004. ISSN 0098-7484.
  4. ^ a b Kuruvilla, Merin; Vanijcharoenkarn, Kristine; Wan, Justin; Pereira, Nigel; Chung, Pak (2018). "Exogenous progesterone hypersensitivity associated with recurrent pregnancy loss". The Journal of Allergy and Clinical Immunology: In Practice. 6 (4). Elsevier BV: 1412–1413. doi:10.1016/j.jaip.2017.11.041. ISSN 2213-2198.
  5. ^ Wintzen, M.; Goor-van Egmond, M. B. T.; Noz, K. C. (2004). "Autoimmune progesterone dermatitis presenting with purpura and petechiae". Clinical and Experimental Dermatology. 29 (3). Oxford University Press (OUP): 316–316. doi:10.1111/j.1365-2230.2004.01516.x. ISSN 0307-6938.
  6. ^ ASAI, Jun; KATOH, Norito; NAKANO, Mayu; WADA, Makoto; KISHIMOTO, Saburo (November 26, 2009). "Case of autoimmune progesterone dermatitis presenting as fixed drug eruption". The Journal of Dermatology. 36 (12). Wiley: 643–645. doi:10.1111/j.1346-8138.2009.00723.x. ISSN 0385-2407.
  7. ^ Banerjee, A K; de Chazal, R (August 1, 2006). "Chronic vulvovaginal pruritus treated successfully with GnRH analogue". Postgraduate Medical Journal. 82 (970). Oxford University Press (OUP): e22–e22. doi:10.1136/pgmj.2005.043950. ISSN 0032-5473.
  8. ^ Snyder, Joy L.; Krishnaswamy, Guha (2003). "Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review". Annals of Allergy, Asthma & Immunology. 90 (5). Elsevier BV: 469–477. doi:10.1016/s1081-1206(10)61838-8. ISSN 1081-1206.
  9. ^ a b Baptist, Alan P; Baldwin, James L (2004). "Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature". Clinical and Molecular Allergy. 2 (1). Springer Science and Business Media LLC: 10. doi:10.1186/1476-7961-2-10. ISSN 1476-7961.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  10. ^ Schoenmakers, A.; Vermorkkn, A.; Degreef, H.; Dooms‐Goossens, A. (1992). "Corticosteroid or steroid allergy?". Contact Dermatitis. 26 (3). Wiley: 159–162. doi:10.1111/j.1600-0536.1992.tb00286.x. ISSN 0105-1873.
  11. ^ Wilkinson, S. M.; Beck, M. H. (1994). "The significance of positive patch tests to 17‐hydroxyprogesterone". Contact Dermatitis. 30 (5). Wiley: 302–303. doi:10.1111/j.1600-0536.1994.tb00606.x. ISSN 0105-1873.
  12. ^ Nguyen, Tegan; Razzaque Ahmed, A. (2016). "Autoimmune progesterone dermatitis: Update and insights". Autoimmunity Reviews. 15 (2). Elsevier BV: 191–197. doi:10.1016/j.autrev.2015.11.003. ISSN 1568-9972.
  13. ^ Hart, Roland (April 1977). "Autoimmune progesterone dermatitis". Archives of dermatology. 133 (4): 426–430. doi:10.1001/archderm.1977.01640040034003. PMID 192155.
  14. ^ Halevy, Sima; Cohen, Arnon D; Lunenfeld, Eitan; Grossman, Nili (August 2002). "Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro interferon-gamma release". Academy of Dermatology. 47 (2): 311–313. PMID 12140482.
  15. ^ Shelley, Walter B; Preucel, Robert W; Spoont, Stanley S (October 5, 1964). "Autoimmune Progesterone Dermatitis Cure by Oophorectomy". JAMA. 190 (1): 35–38. doi:10.1001/jama.1964.03070140041004. PMID 14197141.

Further reading

External links

Retrieved from "https://en.wikipedia.org/w/index.php?title=Autoimmune_progesterone_dermatitis&oldid=1191454660"