Autoimmune Progesterone Dermatitis: an under-diagnosed allergy phenomenon

Abstract

Autoimmune Progesterone Dermatitis (AIPD) is a NIH classified rare condition in which allergic dermatitis to endogenous progesterone manifests in a wide spectrum of cyclic cutaneous eruptions. Rashes or even systemic anaphylaxis, begin in the premenstrual period during the luteal phase when progesterone levels peak. The rash subsides a few days into menses, with the decline of progesterone levels or with suppression of ovulation by medical intervention. We present three cases of AIPD, each with unique clinical presentations and medical history of the disease. All three patients tested positive on a controlled intradermal injection test of progesterone, which is the standard method of AIPD diagnosis to date since clinical history alone can be equivocal. In this case report, we propose an approach and clinical considerations for any woman of reproductive age presenting with cyclic dermatitis related to menses. Most recent documentation states that only 70 cases of Autoimmune Progesterone Dermatitis have ever been reported. We propose that AIPD is a heavily under-diagnosed disease due the uncertainty of its pathogenesis and vague clinical presentations. However, with a standard diagnosis procedure and available treatment options for this relatively debilitating disease, AIPD should be a differential diagnosis in the minds of every physician in a primary care or emergency setting.