Abstract
Background
Progesterone-induced dermatitis is a rare disorder. It typically occurs in females
due to an autoimmune phenomenon to endogenous progesterone production, but can also
be caused by exogenous intake of a synthetic progestin. Here, we present a case of
autoimmune progesterone dermatitis (AIPD) seen in an adolescent female.
Case
The patient is a 15-year-old Caucasian female with no significant past medical history
and no prior exogenous hormone use, who presented to her primary care physician complaining
of cyclic skin eruptions. She noted that her dermatologic symptoms occurred monthly,
just prior to her menses. An intradermal skin test using 0.1 cc of progesterone was
performed. The patient immediately developed a wheal, confirming the diagnosis of
AIPD. The patient was begun on a continuous regimen of an oral contraceptive pill
with 30 micrograms of ethinyl estradiol and 0.15 mg of levonorgestrel. The skin eruptions
have not returned since the initiation of this therapy.
Conclusion
Autoimmune progesterone dermatitis manifests via the occurrence of cyclic skin eruptions.
Women with the disorder commonly present with dermatologic lesions in the luteal phase
of the menstrual cycle. Diagnosis of AIPD is confirmed by performing a skin allergen
test using progesterone. Due to its rarity, AIPD should be considered a diagnosis
of exclusion.
In cases believed to be due to an endogenous production of progesterone, several methods
of therapy have been attempted. The ultimate goal of therapy is the suppression of
ovulation, which will prevent endogenous hormone production as progesterone is only
produced in ovulatory cycles. Currently, the first-line choice of therapy is a combination
oral contraceptive. If this treatment is ineffective, patients have been treated with
danazol, gonadotropin releasing hormone analogs, tamoxifen, and oophorectomy with
varying success.
Key Words
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Article info
Publication history
Section Editor: Robert K. Zurawin, MDBaylor College of Medicine, Houston, Texas, USA
Identification
Copyright
© 2006 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
