Track

Abstract

Autoimmune progesterone dermatitis (APD) is a rare, hormonally mediated dermatosis characterized by cyclical cutaneous eruptions in response to endogenous or exogenous progesterone. A 22-year-old female with no significant past medical history presented with recurrent, pruritic papules localized to her elbows. The lesions flared predictably one week prior to menses. Symptom resolution was observed with the onset of menses. High-dose second generation antihistamine therapy and high-potency topical steroids failed to provide relief. Notably, she was trialed on estrogen containing oral contraceptive therapy with resolution of her monthly rash. 

A punch biopsy of one of the papules revealed subacute spongiotic and vacuolar interface dermatitis with dermal edema and a lymphophistiocytic perivascular infiltrate with scattered neutrophils and rare eosinophils. Histopathology was consistent with previously described cases of APD and when correlated with the patient’s cyclical symptoms and hormonal response, confirm the diagnosis. 

APD can present with a broad clinical spectrum ranging from eczematous papules and urticaria to vesiculobullous lesions and anaphylaxis. The hallmark feature is symptom onset in the luteal phase of the menstrual cycle, driven by the natural rise in progesterone. Although a progesterone intradermal test can aid in diagnosis, clinical correlation remains essential. Estrogen-containing oral contraceptives are the mainstay of treatment, aimed at suppressing ovulation and progesterone production. This case highlights the importance of recognizing cyclical dermatologic symptoms in young women and considering APD in the differential diagnosis.