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Autoimmune Progesterone Dermatitis Treatment

Autoimmune progesterone dermatitis (APD) is a condition that causes the skin to become inflamed and irritated in response to the hormone progesterone. 
APD is most commonly seen in women of childbearing age though it can occur at any age. 
The condition is thought to be caused by an autoimmune reaction in which the body’s immune system mistakenly attacks healthy tissue.
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What Is Autoimmune Progesterone Dermatitis, And How Does It Happen ?

  • Autoimmune progesterone dermatitis is an uncommon cyclical mucocutaneous hypersensitivity reaction to the highest levels of endogenous progesterone seen during the luteal phase of the menstrual cycle.

What Are The Symptoms Of Autoimmune Progesterone Dermatitis ?

  • Autoimmune progesterone dermatitis affects mostly young adult women, with a mean starting age of 27.3 years. However, it has also been recorded in teenagers following menarche and older premenopausal women. 
  • It is more common, but not always, in women who have taken exogenous progestogens like the oral contraceptive pill or reproductive therapies. It might appear during pregnancy or during the post-partum period. There is no danger from a genetic mutation.

What Is Autoimmune Progesterone Dermatitis And What Causes It?

  • It is unknown what causes autoimmune progesterone dermatitis. The following are some hypotheses:
  • Exogenous progestogens can cause a type 1 (immediate) hypersensitivity reaction, resulting in the production of progesterone-specific immunoglobulin E (IgE) antibodies and a mast cell-mediated response, which can target progesterone receptors on keratinocytes above the basal layer.
  • Progestogens may cause a type 4 (delayed) hypersensitivity reaction.
  • Due to a continuing immunological reaction to the high amounts of progesterone seen in the luteal phase of the menstrual cycle, sensitized patients develop cyclical symptoms.
  • The reason is unknown in patients who have never been exposed to exogenous progestogens.

What Do The Symptoms Of Autoimmune Progesterone Dermatitis Look Like?

  • Autoimmune progesterone dermatitis usually manifests as a rash 3–4 days before menstruation, when progesterone levels are at their highest. The rash disappears a few days after menstruation begins as progesterone levels drop, only to reappear right before the next period. Women who have irregular menses may not notice this cyclical pattern.
  • A variety of rashes can be found in autoimmune progesterone dermatitis, but the majority of patients have:
  • dermatitis with urticaria, angioedema, and anaphylaxis.

Other eruptions that have been documented include:

  • Morbilliform rash, papules and plaques, vesiculobullous and vesiculopustular lesions, petechiae, and purpura are non-specific skin alterations.
  • Eruption of a fixed medication
  • Vulvovaginitis with a cyclic pattern
  • Erythema multiforme, Stomatitis
  • An annular erythema is a type of erythema that appears on the
  • A necrolytic erythema-like eruption that is migrating
  • Skin changes are more common on the trunk and limbs, but they can also occur on the face, oral mucosa, lips, and genitalia.

What Are The Risks Associated With Autoimmune Progesterone Dermatitis?

Abortion on the spur of the moment has been documented.

How Can You Know Whether You Have Autoimmune Progesterone Dermatitis?

  • If you have APD, you should see a doctor.
  • The rash is reproducible following intramuscular progesterone injection—oral or intravaginal challenge tests may be options. There is a constant and recurring premenstrual flare of a rash.
  • The rash can be avoided if ovulation is suppressed.
  • Intradermal progesterone testing is possible and may cause local or systemic responses. However, it may be difficult to find suitable reagents, the tests are not standardized, and irritating reactions may occur.
  • Lymphocytic transformation tests, interferon gamma release assays, and ELISA demonstration of progesterone-specific IgE are examples of non-standard procedures.
  • There are no diagnostic skin biopsy results that distinguish progesterone-induced illness from other causes.

What's The Difference Between Autoimmune Progesterone Dermatitis And Other Skin Conditions?

  • A drug accident
  • Urticaria that appears out of nowhere
  • atopic dermatitis or other dermatoses that flare up around the time of menstruation.
  • Dermatitis caused by oestrogen

What Are The Symptoms Of Autoimmune Progesterone Dermatitis And How Can You Cure It?

  • Corticosteroids, both oral and topical
  • Antihistamines
  • Omalizumab
  • The oral contraceptive pill is a type of contraception that is taken orally.
  • Hormones that release gonadotrophins
  • Tamoxifen
  • Oophorectomy
  • Desensitization to progesterone via injection or intravaginal topical application

How Can Autoimmune Progesterone Dermatitis Turn Out?

  • Without treatment, autoimmune progesterone dermatitis progresses unchecked. The treatment's effectiveness varies. Some women have fewer symptoms throughout pregnancy, which is thought to be due to a natural desensitization process that happens when progesterone levels rise gradually; others have more symptoms during pregnancy. 
  • Progesterone-containing hormone replacement therapy should not be provided since autoimmune progesterone dermatitis disappears with menopause.


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