Autoimmune progesterone dermatitis mimicking facial erythrom
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A 48-year-old female presented with a two-year history of a painful red rash on the bilateral malar cheeks. Daily flares of intense burning pain, exacerbated by heat and wind had become associated with gastrointestinal distress, photosensitivity, body aches, depression, and anxiety. Past medical history was significant for Raynaud phenomenon.

Physical examination revealed minimal erythema on the bilateral malar cheeks and purple-red plaques on bilateral hands. Extensive autoantibody testing was positive only for anti-cardiolipin IgM. Patient discontinued oral contraceptive pills and the frequency of her facial flushing decreased from daily to a cluster once monthly, a week prior to menses. During a flare, her progesterone level was 12.9ng/mL, within the normal range for luteal phase of the menstrual cycle. Although the burning character of her facial rash was clinically consistent with erythromelalgia, the cyclical flaring of the rash during the luteal phase of menses raised suspicion for autoimmune progesterone dermatitis.

Between dermatology visits, under the guidance of her gynecologist, she underwent a total abdominal hysterectomy with bilateral salpingo oophorectomy (TAH-BSO) for the indication of abnormal uterine bleeding as well as suspected APD. In the 13 months since her hysterectomy she has had no flares of her painful facial rash and remains symptom-free with only residual faint pink patches on the cheeks.

source: https://www.jaadcasereports.org/action/showPdf?pii=S2352-5126(20)30626-3
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