A thirty-eight-year-old married Caucasian female was referred to our reproductive endocrinology clinic by her gynecologist secondary to cyclical urticaria. Patient has a gynecologic history of menarche at the age of 12 and reports 28 day menstrual cycles. Patient states she gets an erythema multiforme, urticaria, and dermatographism one week prior to menses that resolve after menses since one year after menarche. Patient reports no history of joint swelling. Patient as an adolescent was seen by an allergy specialist and dermatologists for evaluation. Allergy testing was done and was reported negative. Patient was placed on antihistamines for treatment, which she reports did not help her symptoms. Patient was told her symptoms were due to stress.
The patient's obstetrical history consists of two pregnancies resulting in two full-term cesarean deliveries. She has not had any issues with infertility. The patient reports during pregnancy and while breast feeding that she did not have any episodes of a rash and/or hives. Patient also states that she was on oral contraceptives for one year at age 23 where she noticed her symptoms decreased. She reports multiple drug allergies resulting in a rash.
Our patient was diagnosed with autoimmune progesterone dermatitis based on history and physical exam and was treated with oral contraceptives which was successful in controlling her outbreaks.