Autoimmune progesterone dermatitis (APD) is a rare autoimmune condition, considered to be an endocrine system abnormality, that is thought to be a reaction caused by woman’s hypersensitivity to her own (endogenous) progesterone.
What Causes APD?
The exact cause of APD is unknown. There is however speculation that APD occurs in some women who have used exogenous progesterone, namely oral hormonal birth control pills, which may sensitize them to their own progesterone, though not all women with APD have used oral contraceptives, and likewise, not all women who use oral contraceptives are subjecting themselves to getting APD.
Symptoms of APD
Presentation of APD can range from “subcutaneous and mucosal lesions” to the extremely rare anaphylaxis, a severe life-threatening allergic reaction. It can be hard to diagnose based on presentation alone because it can be nearly any rash-like abnormality of the skin such as:
- small, red, raised itchy bumps on the skin
- eczema-like rash
- swelling or sores within the mouth
- ring-shaped red skin eruptions
- angioedema which is swelling under the skin (versus externally like hives)
- multiple symmetrical skin lesions that have a central sore surrounded by rings, that may itch, be painful, and come and go quickly
- utricaria or hives
These skin issues can appear around mouth, on lips, upper body, legs, arms (elbows), palms, hands, or feet. Pimples and acne are not considered signs or symptoms of APD.
APD is exacerbated by the natural increase of progesterone after ovulation late in the luteal phase, anywhere from three days to a week prior to menstruation, and often disappears when menstruation begins, or shortly after menstruation begins. APD is cyclic, meaning it follows this pattern from cycle to cycle. This is key in diagnosing APD. Any of the aforementioned skin issues come and go within a week prior to and onset of menstruation.
APD is often diagnosed by allergy skin testing. APD primarily subsides on its own upon the onset of menstruation, but for many women with APD it returns each cycle. Medical treatment for the symptoms may include topical anti-itch medications, corticosteroids and hormone therapy to inhibit ovulation and the production of progesterone. For women with severe APD, surgical removal of the ovaries (oophorectomy) may be suggested. Most resources share that medications containing any progesterone (such as oral contraceptives) should be avoided as treatment. Conventional antihistamines have not been found to be effective.
When considering natural options for APD, a woman would want to help her body by addressing hormone imbalance, immune system function and fertility issues first. Case studies have shown that women with preexisting fertility issues, especially those often treated with oral contraceptives, are more likely to experience APD. Because this is such a rare condition, we feel it is best for women who suspect this issue to first get a diagnosis from a medical doctor and then if interested in natural treatment options, seek the care of a naturopathic doctor.
Will APD Affect A Woman’s Ability to Conceive?
There is little information available about trying to conceive with APD. Some sources suggest finding a healthcare provider who has had success “desensitizing” women to endogenous progesterone without suppressing ovulation, if you have had trouble conceiving with APD. Some women have conceived naturally and either experienced relief from APD, or had to deal with it into pregnancy, while others have struggled to conceive.
APD affects a woman’s quality of life. Many doctors don’t yet fully understand autoimmune health issues including APD. While rare, if you suspect a rash or skin issue you are experiencing may be APD, consider contacting your healthcare provider who may refer you to a specialist in dermatology, allergens, immunology, or reproductive endocrinology for further testing and to help create a treatment plan.
Note From the Author About APD and Natural Progesterone Cream:
You may be wondering about topical natural progesterone cream use and APD. Through the entirety of my research for this article, there were no references to this.
If you are using natural progesterone cream, which is bioidentical, meaning the hormones in the cream are chemically identical to those your body produces, and you experience a cyclical skin rash or skin issue, one could speculate it may be a cause. Some women have allergic reactions to ingredients in natural progesterone creams, as well, so it can be difficult to determine what may be the true cause of the rash. As always, if you develop any type of skin issue while using natural progesterone cream, discontinue application of the cream and speak with your healthcare provider.
1. Dedecker F, Graesslin O, Quereux C and Gabriel R. Autoimmune progesterone dermatitis. DermNet NZ. December 9, 2009; http://dermnetnz.org/reactions/progesterone-dermatitis.html
2. Ikbal Kaygusuz, Ilknur Inegol Gumus and Evren Sarifakioglu, et al. Autoimmune progesterone dermatitis. Taiwanese Journal of Obstetrics and Gynecology Volume 53, Issue 3, Pages 420–422, September 2014. DOI: http://dx.doi.org/10.1016/j.tjog.2013.12.007. http://www.tjog-online.com/article/S1028-4559%2814%2900141-7/abstract
3. Tami Maguire. Autoimmune Progesterone Dermatitis. Dermatology Nursing. 2009; 21(4):190-192. http://www.medscape.com/viewarticle/712365
4. US Dept. of Health & Human Services; National Institutes of Health; Genetic and Rare Diseases Information Center (GARD). Autoimmune progesterone dermatitis. http://rarediseases.info.nih.gov/gard/9139/autoimmune-progesterone-dermatitis/case/33524/case-questions