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ISSN 0210-5187 (Electronic)

2018, Number 2

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Med Cutan Iber Lat Am 2018; 46 (2)

Autoimmune progesterone dermatitis or hypersensitivity to progesterone. A new case with clinical response to sulfona and review of the literature

Sánchez OA, Albizuri PMF, Lecumberri SB, Beato MM, Hernández CN

Language: Spanish
References: 19
Page: 137-141
PDF size: 346.50 Kb.


ABSTRACT

Introduction: Autoimmune progesterone dermatitis (APD) is a rare syndrome associated with hypersensitivity to progestogens. Its clinic may be heterogeneous, and its diagnosis complicated, although it must be suspected if the symptoms appear in the premenstrual phase and are repeated in each cycle. Clinical case: This is a 44-year-old female patient who consulted for outbreaks of pruritic skin lesions, which began after her second child was born and resurfaced in the second half of each menstrual cycle. Later, during her third pregnancy, they disappeared, reappearing after childbirth once more. Since then, every month, there were new skin lesions before menstruation. The appearance of lesions ranged from erythematous and edematous papules to erythema multiforme-like plaques. They improved with oral corticosteroid cycles, but not with antihistamines or oral contraceptives. The clinical course was determinant to diagnose PAD. The skin prick tests with medroxyprogesterone were negative, so provocation was performed by intradermal inoculation of autologous serum that was positive confirming the diagnosis. Taking into account therapeutic options without adverse effects acceptable to the patient, treatment with dapsone was initiated, with great improvement of the lesions in the absence of side effects. In our case, the striking response to dapsone, not previously described in autoimmune progesterone dermatitis, may be due to the anti-inflammatory effect exerted by inhibiting the activity of eosinophils and polymorphonuclear neutrophils; therefore, we believe it should be considered a good therapeutic alternative in this disease.


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