Autoimmune progesterone dermatitis is a response of the skin to the hormonal changes that happen just before menses. This rare disorder is characterised by recurrent skin manifestations such as rashes, which generally subsides shortly after menstruation. The exact cause of APD is not clear, but it is thought to involve an abnormal immune reaction or autoimmune response, triggered by a woman’s own progesterone.
One of the most common symptoms of APD is recurrent skin rash that varies in severity, depending on the phase of the menstrual cycle. The rashes usually appears during the second half of the cycle when progesterone begins to rise. Other symptoms include hives, erythema multiforme, swelling beneath the skin (angioediema), eczema-like rash, annular erythema, mouth sores. APD may also progress to progesterone-induced anaphylaxis, but is very rare.
Other conditions may be more severe during the perimenstrual period, but these are not classified as ADP. These include:
- Herpes simplex infection (cold sores)
- Acne and seborrhoea
- Nickel allergy
- Atopic dermatitis
- Lupus erythomasus
Diagnosing APD is made based on clinical history, including timing of symptoms around the menstrual cycle and evidence of a skin reaction to progesterone. A skin prick test is usually performed, wherein progesterone is introduced to the skin (intradermal) or muscle (intramuscular). Testing is considered positive when a skin reaction called a wheal-and-flare develops and persists within 24-48 hours.
Controlling symptoms of APD varies. Mild cases might be managed with the use of antihistamines and/or corticosteroids.
In some cases, methods of treatment focus on suppressing progesterone, which may be done through the use of medications including conjugated estrogen, ethinyl estradiol, tamoxifen, and danazol. However for severe cases, surgical removal of ovaries or oophrectomy is curative.
Women with APD should try to avoid medications containing progesterone, including the combined oral contraceptive pill, minipill, and depo injections. Specific drugs to avoid include nrethindrone, norgestrel, and leveonorgestrel.