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Q?: "... every month just hours after my period starts, my face breaks out in hives. ...By the next morning, my lips are swollen. By day three, my mouth, tongue and gums are sore and rough. (gums aren't smooth feeling) I'm free of all symptoms in 10 - 14 days... My doctors are calling it either Autoimmune progesterone (or estrogen) dermatosis"....I can't find any information on this condition...Is there any information out there on this topic??? ...Thanks for your help!"

Dr. Keti:
17 January, 2003

It looks as if you are experiencing some kind of allergic reaction. Although the cause of allergy cannot always be identified, there are tests that are used to try and identify some of the allergens that cause inflammatory reactions in the skin or elsewhere.

Allergic contact dermatitis is an itchy skin condition caused by an allergic reaction to material in contact with the skin.

Allergic diseases, affect both sexes. Some allergens (substances that cause allergic reaction) are responsible more frequently for dermatitis (skin involvement) in females. The increased use of cosmetics and fragrance, are examples of such cases that cause numerous contact dermatitis symptoms. Nickel allergy is the most frequent contact allergy in women with a rate of 20-40% of female population and only 3-5% of male population.(1) Allergy such as autoimmune progesterone dermatitis is on the other hand exceptional (1)

Autoimmune Progesterone Dermatitis (APD) This rare dermatitis may be mild to severe. The dermatitis, which is inflammation of the upper layers of the skin, can assume a variety of manifestations such as blisters, including pompholyx, (a form of hand eczema ), urticaria, (wealing in the skin), occurring because of released chemicals such as histamine from cells, that cause small blood vessels to leak and cause tissue swelling, erythema multiforme, (a characteristic rash and often blisters in the mouth and elsewhere), or as erythema annulare centrifugum, a type of scaling or nonscaling, pruritic (itchy) or nonpruritic, annular (ring like) or arcuate, erythematous (redish) skin manifestation. (2)(3)

APD is an uncommon dermatitis, characterized by exacerbations during the second or luteal phase of the menstrual cycle. In autoimmune disease the body's normal immune system loses its ability to recognize its own cells and attacks itself. (4)

In APD, the skin eruptions recur periodically in association with the menstrual cycle. Sensitivity to progesterone is studied in vivo by means of intradermal and patch tests. In some cases in addition to a positive reaction to administered progesterone, sensitivity to progesterone is further confirmed in vitro(in lab), by results of an interferon-gamma release test, and some doctors consider that as a proof of a possible role for T(H)1-type cytokines, natural cell chemicals, released in autoimmune progesterone dermatitis, (4: Study by Halevy S, Cohen AD, Lunenfeld E, Grossman N.)


Causes
The mechanism that causes these signs is unclear, but it's been shown (Hart) that prior exposure to synthetic progesterone preparations are strongly associated with the symptoms of some women. However, some women tested positive to progesterone or estrogen sensitivity test without prior exposure to progesterone.(6)


Diagnosis: Tests to aid the diagnosis include intradermal and intramuscular test injection of progesterone, the former generally results in delayed hypersensitivity reactions or an urticarial reaction, while the latter usually evokes immediate reactions.

According to the article in the European Journal of Dermatology, vol.12. issue 6, of December 2000: "Autoimmune reaction to estrogen has been described as a recurrent itchy eruption involving the face and trunk in a 56-year-old woman, which appeared 3 days before menstruation and improved 5-10 days after cessation. ....Intradermal skin test reaction to progesterone was positive. Progesterone sensitivity was also demonstrated by challenge test with intramuscular progesterone acetate. These features were consistent with the diagnosis of APD."(5)

Treatment

This dermatologic condition should be thought of when taking patient's history. The clinician must be able to rule out other more common causes of dermatitis and at the same time relate the symptoms to the menstrual cycle.

Identifying this treatable condition is important for at least two reasons: firstly, to improve the patient's quality of life and secondly, to prevent the progression (although rarely occurring) of the APD to life-threatening anaphylaxis (allergic shock).

Therapy for autoimmune progesterone dermatitis centers on the suppression of ovulation and therefore suppression of the luteal phase production of progesterone. Suppression of ovulation can be achieved either pharmacologically or surgically.

With respect to available therapy approach, consult your doctors for what suits your circumstances best.

Some patients have been successfully treated with the cyclic administration of conjugated estrogens, luteinizing hormone-releasing hormone agonists (which may initially exacerbate the condition before providing relief), tamoxifen, and danazol.

Some doctors would advocate removal of the ovaries or oophorectomy as a definitive therapy.

Monitoring of this disease is advocated as the course of the Autoimmune Progesterone Dermatitis ranges from spontaneous remission to the occurrence of anaphylactic shock.

 


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