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Autoimmune progesterone dermatitis: case report A 48-year-old woman developed autoimmune progesterone dermatitis (APD) while receiving estrogen/progesterone as an oral contraceptive (OCPs) [dosage and duration of treatment to reaction onset not stated]. The woman, who had a painful red rash on the bilateral malar cheeks for 2 years, presented to the clinic. She had daily flares of intense burning pain which deteriorated with heat and wind and disturbed her sleep and work. Additionally, she developed gastrointestinal distress, photosensitivity, body aches, depression and anxiety. Her symptoms improved moderately with cooling measures including ice packs, water spritzes and fans. She previously failed to tolerate or respond to pulsed-dye laser, metronidazole, hydrocortisone, propranolol, ivermectin and doxycycline. Her medical history included Raynaud phenomenon. During the admission, she was on estrogen/progesterone OCPs. Upon presentation, a physical examination was performed which showed minimal erythema on the bilateral malar cheeks and purple-red plaques on bilateral hands. Subsequent autoantibody test showed a positive result only for anticardiolipin IgM. Her symptoms were suspicious of erythromelalgia. Hence, she started receiving pentoxifylline and gabapentin. However, pentoxifylline was discontinued due to worsening of symptoms and she did not tolerate increased doses of gabapentin. At the same time, the woman’s estrogen/progesterone was discontinued. Following the discontinuation of estrogen/ progesterone, the frequency of her facial flushing decreased from daily to once in the month, a week prior to menses. During a flare, her progesterone level was 12.9 ng/mL (normal range for luteal phase of the menstrual cycle). The burning character of her facial rash was clinically consistent with erythromelalgia. However, the cyclical flaring of the rash during the luteal phase of menses raised suspicion for APD. After the gynaecologist and dermatologist consultation, she underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) for abnormal uterine bleeding as well as suspected APD. Her symptoms completely resolved following TAH-BSO procedure. She did not experience any symptoms 13 months after the surgery. Due to complete resolution of symptoms after TAH-BSO, the diagnosis of APD was confirmed. Whitt W, et al. Autoimmune progesterone dermatitis mimicking facial erythromelalgia successfully treated with hysterectomy and bilateral salpingo-oophorectomy. JAAD 803518055 Case Reports 6: 1104-1106, No. 10, Oct 2020. Available from: URL: http://doi.org/10.1016/j.jdcr.2020.08.026

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Reactions 28 Nov 2020 No. 1832