D. Maor, H. Rajgopal Bala,, R.L. Nixon
Autoimmune progesterone dermatitis (AIPD) is a rare skin disorder resulting from a hypersensitivity to endogenous progesterone. The condition is characterised by cyclical cutaneous or mucosal eruptions occurring in response to elevated progesterone levels during the luteal phase of the menstrual cycle. There are a range of cutaneous manifestations, including eczematous eruptions, urticaria, erythema multiforme, vesiculopustular eruptions, ﬁxed drug eruptions, stomatitis and apthous ulcers. Angioedema and anaphylaxis may also occur. Diagnosis is traditionally conﬁrmed with intradermal skin testing or intramuscular challenge with progesterone or its derivatives.
We present a case of a 31-year-old woman with suspected AIPD who underwent intradermal skin testing to progesterone. Ten healthy female controls without symptoms of AIPD were also tested. The patient’s test was positive at 15 min, and at 24-h she developed an urticarial rash on her back, right eye swelling and mild throat swelling, requiring oral antihistamines and prednisolone. Of note, nine of ten controls also had positive skin reactions to intradermal progesterone at 15 min, 24-h and 48-h. Whilst we believe our patient’s symptoms and skin test result are consistent with AIPD, the results in the control group call into question the validity of using intradermal progesterone testing to make a diagnosis of AIPD. This area requires further research, particularly as a diagnosis of AIPD has signiﬁcant consequences and impacts for treatment modalities.