Objective:

A case of autoimmune progesterone dermatitis is presented.

Clinical case:

Twenty-eight years old woman who presented with a chronic itchy rash for approximately 2 years. The lesion appeared cyclically just before the menstrual cycle lasting 3-4 days and spontaneously disappeared 1-2 days after menstruation. Physical examination showed an erythematous plaque-like lesion of uniform color on the right shoulder. The biopsy showed dermatoepidermitis with interstitial dermal hemorrhage and infiltration of perivascular lymphocytes and the presence of eosinophils. Direct immunofluorescence analysis of the perilesional area was negative. The progesterone sensitivity test with intradermal injection showed a local erythematous reaction. The results obtained were considered as positive. All these findings allowed the diagnosis of progesterone autoimmune dermatitis to be made. Treatment with gonadotropin-releasing hormone agonists was indicated for 3 months with marked improvement.

Conclusion:

Progesterone autoimmune dermatitis is a condition in which the menstrual cycle is associated with a series of skin findings, such as erythema multiforme, eczema, urticaria, angioedema, and progesterone-induced anaphylaxis. These can often be confused with other forms of dermatosis. It occurs 3 to 10 days before the start of menstruation and disappears after 2 days. The pathogenesis is unknown. The diagnosis must be confirmed by skin tests to identify the characteristic inflammatory response. Treatment is inhibition of progesterone secretion by suppression of ovulation.

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