Pustular autoimmune progesterone dermatitis in pregnancy: a rare presentation

Abstract

Autoimmune progesterone dermatitis (AIPD) is a rare, hormonally mediated dermatosis characterized by recurrent premenstrual skin eruptions caused by hypersensitivity to endogenous or exogenous progesterone. Although symptoms often subside during pregnancy due to hormonal adaptation, re-exposure to progesterone can trigger disease flares. A 30-year-old woman presented with complains of generalized erythematous and itchy eruption with few pustular lesions on the face for 5 days. Upon enquiring she revealed that she is 2 months pregnant and started on oral micronized progesterone prescribed for obstetric support. Laboratory investigations were normal, and histopathology showed a perivascular lymphocytic infiltrate with dermal edema, suggestive of hypersensitivity. Based on the temporal association between progesterone exposure and lesion recurrence, a diagnosis of autoimmune progesterone dermatitis was established. The withdrawal of progesterone, along with treatment using antihistamines and a short course of corticosteroids, resulted in complete resolution. The patient remained symptom-free throughout pregnancy and postpartum, with no recurrences during 18 months of follow-up. This case underscores the diagnostic significance of exogenous progesterone induced autoimmune progesterone dermatitis. Awareness of this rare condition is essential, particularly during pregnancy, for prevention and effective management.