What is the treatment for progesterone dermatitis?

Treatment of Progesterone Dermatitis

The most effective treatment for progesterone dermatitis is ovulation suppression using combined oral contraceptive pills (OCPs) as first-line therapy to prevent endogenous progesterone production.

Understanding Progesterone Dermatitis

Progesterone dermatitis, also known as autoimmune progesterone dermatitis (AIPD), is a rare autoimmune reaction to endogenous progesterone characterized by:

• Cyclical cutaneous eruptions that occur during the luteal phase of the menstrual cycle
• Symptoms typically beginning 3-10 days before menstruation and resolving 1-2 days after menstruation ceases 1, 2
• Various presentations including eczematous eruptions, urticaria, erythema multiforme, folliculitis, and angioedema 3

Diagnostic Approach

Diagnosis is confirmed through:

• Correlation of skin eruptions with the menstrual cycle
• Intradermal skin testing with progesterone (development of a wheal confirms diagnosis) 4, 1
• Exclusion of other cyclical dermatoses

Treatment Algorithm

First-Line Treatment:

• Combined oral contraceptive pills containing ethinyl estradiol and a progestin 4, 3
  • Example regimen: 30 mcg ethinyl estradiol with 0.15 mg levonorgestrel in a continuous regimen
  • Mechanism: Suppresses ovulation, preventing endogenous progesterone production

Second-Line Options (if OCPs fail or are contraindicated):

1. Gonadotropin-releasing hormone (GnRH) analogues 1, 5

   • Effectively suppresses ovulation
   • Limited by potential side effects (bone loss) and cost

2. Danazol 4, 2

   • Suppresses pituitary gonadotropins
   • Monitor for androgenic side effects

3. Tamoxifen 4

   • Less commonly used
   • Consider in patients with contraindications to hormonal therapy

Last Resort:

• Surgical intervention (oophorectomy) 4, 5
  • Reserved for severe, refractory cases
  • Permanent solution but carries surgical risks and induces menopause

Treatment Considerations

• Ineffective treatments to avoid:

  • Antihistamines and systemic corticosteroids frequently fail to provide relief 5
  • Topical steroids alone are insufficient for management 1

• Monitoring:

  • Evaluate response after 2-3 menstrual cycles
  • Adjust treatment if symptoms persist

Pitfalls and Caveats

• Progesterone dermatitis is frequently misdiagnosed as allergic contact dermatitis or other recurrent eczematous conditions 1
• Consider this diagnosis in women with treatment-refractory, cyclical skin eruptions
• The condition may first present or worsen after exposure to exogenous progesterone or during pregnancy 2
• Multiple subtypes likely exist, explaining variations in presentation and treatment response 2

Prognosis

With appropriate ovulation suppression therapy, most patients experience significant improvement or complete resolution of symptoms. Some patients may require long-term therapy until natural menopause occurs.