Dermatology

Dermatology questions? Ask an online dermatologist.

Ask a Doctor,
Get an Answer ASAP!

I have a severe skin disoreder that can be debiltating. I…

Customer Question
I have a severe skin...
I have a severe skin disoreder that can be debiltating. I have been to a dermotologist and my OB/GYN. I was diagnosed with anxiety related dermatitis. I believe the diagnosis was based on previous records and not through the rule out process. It has been suggested to me that I may have Autoimmune Progesterine Dermatitus which is a rare condition and difficult to diagnose.
My skin is so irratated and feels as if it is burning mostly my arms, neck and crotch area. I get little blisters or pimple like lesions on my arms, neck , and noticed I got one on my genital area that really itched and hurt. I am diagnosed with HPV and do take medication for depression and ADHD.
It is so bad that I can't stand it and it makes it hard to concentrate or function and really upsets me because I get know relief. In the meantime my arms look terrible and the face breakouts have increased. Can you help and guide me in the right direction?
Submitted: 8 years ago.Category: Dermatology
Show More
Show Less
Ask Your Own Dermatology Question
Answered in 22 minutes by:
6/29/2010
Dermatologist: Dr. Lori, Family Physician replied 8 years ago
Dr. Lori
Dr. Lori, Family Physician
Category: Dermatology
Satisfied Customers: 1,209
Experience: Board Certified Family Physician for 12+ yrs, Extensive Derm exper. & wound care
Verified

Jeni--

Yes, this is a VERY rare condition with only 50 reported cases. There isn't much to go on, but the artcle I amattaching explains all the screening questions, and different forms of therapy, if in fact this is what you have.

Therapy is aimed at treating the skin, which is not successful.

Therapy that is aimed at blocking the body's production of progesterone seems to be what works best.

These are antiestrogen drugs, danazol and high dose steroids.

To do this, you need to be in the care of a derm and Gyne at a university setting.

Look at this article, and register if you must at the site. I will cut and paste some info in case you cannot get access.

http://www.medscape.com/viewarticle/712365_6

Diagnostic Screening

When a patient presents with signs and symptoms suggestive of APD, it is extremely important to obtain a thorough history. Pertinent questions are extremely important:

  1. How often do symptoms appear? Monthly, every other month, a few times a year?
  2. Is your menstrual cycle regular or irregular?
  3. When do the symptoms appear related to your menstrual cycle, and when do they resolve?
  4. Have you been treated for this condition in the past? Did it relieve the symptoms?
  5. Have you ever taken birth control pills or any medications related to female infertility?
  6. Did you have any symptoms during pregnancy?

These patients may have suffered with this condition for many years, and thought it was a normal manifestation of menstruation. Obtaining a detailed gynecological history will provide data on which to base a probable diagnosis.

Autoimmune Progesterone Dermatitis and the Menstrual Cycle

In a small group of women, the menstrual cycle has been associated with the spectrum of dermatologic diseases including eczema, erythema multiforme, folliculitis, angioedema, urticaria, and others (Baptist & Baldwin, 2004). The lesions may appear as typical urticaria or erythema multiforme in various stages of healing. The lesions may be present in the oral mucosa, lips, palms of hands, trunk, or feet. The patient may describe pruritus, severe pain (especially oral lesions), or angioedema.

Autoimmune progesterone dermatitis is usually considered an auto-allergic (autoimmune) reaction to endogenous progesterone. Some cases have reported women affected by premature ovarian failure (menopause prior to the age of 40) with synthesis of antiprogesterone antibodies. The age of onset is variable, with the youngest reported case occurring at menarche, but the initiation of the disease may be as late as 48 years of age. Risk factors for APD include fertile women with previous history of exogenous progesterone intake, sometimes in association with pregnancy. Erythema-multiforme, urticaria, and eczematous lesions are the most common findings which occur a few days prior to menses with the post ovulation rise in progesterone and end at the beginning of menstruation (Cristaudo et al., 2007). The hallmarks for diagnosis are premenstrual flare, reproducibility of rash with intramuscular progesterone, and prevention of rash with inhibition of ovulation (Warin, 2001).

TREATMENTS

Evidence shows that various possible treatments exist for the different types of progesterone sensitivity. Symptomotology varies in each case, requiring separate courses of treatment according to the level of manifestation of progesterone sensitivity (Snyder & Krishnaswamy, 2003). Definitive treatment of APD involves using anovulatory agents to suppress progesterone secretion. In mild cases, the skin eruptions may be controlled with topical steroids and oral histamines, but is sometimes resistant to this conventional therapy (Baptist & Baldwin, 2004). Systemic glucocorticoids in high doses have been reported to control the cutaneous lesions of APD, but not in all studies. Although symptom relief has been attained with the use of systemic corticosteroids, the goal of treatment is to inhibit the secretion of endogenous progesterone by suppression of ovulation (Rodenas et al., 1998).

The 17-a-alkylated steroids such as danazol or the later generation stanozolol have been used to suppress ovulation in simple dermatologic cases. This can be complicated by elevations in liver function tests (Baptist & Baldwin, 2004). Severe cases of APD have been treated prohylactically with danazol before the expected onset of menses and continued 3 days after menses ended (Snyder & Krishnaswamy, 2003). By using this treatment regimen, there was no interference with the menstrual cycle, and the adverse effects (elevated liver function tests and masculine side effects) with danazol are avoided.

Tamoxifen, a nonsteriodal anti-estrogen agent, has also been used as a treatment modality, which has induced remission of APD. Side effects include amenorrhea and negative bone metabolism effects (Snyder & Krishnaswamy, 2003). Tamoxifen has also been associated with increased risk of deep vein thrombosis and cataract formation. Conjugated estrogens have also been used in the treatment of APD. Some improvement has been shown, although this required high doses (Baptist & Baldwin, 2004). This treatment is not commonly used today due to the increased risk of endometrial carcinoma.

Different gonadotropin-releasing hormone (GnRH)/LH - RH) agonists such as buserelin and triptore have also been used to induce remission by causing ovarian suppression (Baptist & Baldwin, 2004). Side effects include symptoms of estrogen deficiency (hot flashes, vaginal dryness, decreased bone mineral density), so estrogen supplements may be necessary. The negative effects of GnRH therapy are its expense and that estrogen supplementation is often necessary. For patients in whom these conservative therapeutic measures do not control the disease, definitive treatment appears to be surgical management with oophorectomy (Snyder & Krishnaswamy, 2003).

All in all- it seems ther drug Danazol has the best response, but you want to make sure this is what you have--

The scientists best known for this work, and the one who wrote the article is:

Authors and Disclosures

Tami Maguire

Tami Maguire, ARNP, is ER Team Leader, Lakeland Regional Medical Center, Lakeland, FL

If you are thought to have APD, I would contact this provider and start a conversation....

Or your doctors can......

Best of Luck,

This is RARE so you want to go to the ONE that knows the most.

Be well and Godspeed.

I am happy to answer other questions, but I do not know about APD until now, and I have not seen any cases. So--- my knowledge is limited.

But I will help in any way I can!

Sincerely-

Ask Your Own Dermatology Question
Was this answer helpful?

How JustAnswer works

step-image
Describe your issueThe assistant will guide you
step-image
Chat 1:1 with a dermatologistLicensed Experts are available 24/7
step-image
100% satisfaction guaranteeGet all the answers you need
Ask Dr. Lori Your Own Question
Dr. Lori
Dr. Lori
Dr. Lori, Family Physician
Category: Dermatology
Satisfied Customers: 1,209
1,209 Satisfied Customers
Experience: Board Certified Family Physician for 12+ yrs, Extensive Derm exper. & wound care

Dr. Lori is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me.

Susan O.USA

I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much

Corrie MollPretoria, South Africa

I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well!

ClaudiaAlbuquerque, NM

Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion.

KevinBeaverton, OR

Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
I feel better already! Thank you.

ElanorTracy, CA

Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem.

JulieLockesburg, AR

You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions.

John and StefanieTucson, AZ

< Previous | Next >

Meet the Experts:

dermdoc19

dermdoc19

Dermatologist

4,069 satisfied customers

30 years practice in general and cosmetic dermatology

Dr. Nair

Dr. Nair

Dermatologist

9,189 satisfied customers

MBBS, MD (Dermatology, Venereology & Leprology)

Dr. Shahz

Dr. Shahz

Dermatologist

243 satisfied customers

MBBS, MCPS, MD

Dr. Skinner

Dr. Skinner

Dermatologist

1,548 satisfied customers

MD , DNB ( D &V), FAAD

Dr. Hanish Babu, MD

Dr. Hanish Babu, MD

Dermatologist

261 satisfied customers

MBBS; MD 26 years Experience.

Dr. S. Attili

Dr. S. Attili

Dermatologist & Dermatopathologist

5,170 satisfied customers

MRCP (Dermatology), Int. Board Certification in Dermatopathology

Dr. Pravin

Dr. Pravin

Dermatologist

1,705 satisfied customers

Senior Consultant MBBS DNB (DVD)

< Previous | Next >

Related Dermatology Questions
I broke out in fluid filled itchy blisters about quarter
I broke out in fluid filled itchy blisters about quarter inch or smaller following my work in a gift shop Sept 17. Originally that evening I had 10 to 15 blisters on wrists arms elbows legs (from knee… read more
Christopher Palmer
Christopher Palmer
DO
124 satisfied customers
I have a legion/rash/blister on different areas on my face.
I have a legion/rash/blister on different areas on my face. The first area began about 2 years ago above my lip. It generally does not itch, is not accompanied by fever or other symptoms. have been ex… read more
Dr. Thomas, MD
Dr. Thomas, MD
2,227 satisfied customers
I have been experiencing what seems like a cyclical rash.
I have been experiencing what seems like a cyclical rash. This happened last year, every 3-4 weeks for several months, and it started up again in January. (I am female, with functioning ovaries but no… read more
Dr. Phil, MD
Dr. Phil, MD
Internal Medicine Physician
Doctoral Degree
2,863 satisfied customers
I have never had acne before or any serious breakouts.
Hi! I have never had acne before or any serious breakouts. However 3 weeks ago i had a few very small pimples appear on my chin. Normally a small pimple will go away in a few days. I had Lasik eye sur… read more
Dr. Nair
Dr. Nair
Dermatologist
MD (Dermatology, Venereology, Lepro
9,189 satisfied customers
My husband has an itchy rash on his back, shoulders and
My husband has an itchy rash on his back, shoulders and neck. The rash looks like small blisters in clusters. It flares up and recedes, but never goes away entirely. This has been going on since last … read more
dermdoc19
dermdoc19
Dermatologist
Doctoral Degree
4,069 satisfied customers
I have been having red patches that seems to be growing on
Hello Dr. I have been having red patches that seems to be growing on my face, arms, and thighs. The red patches (rash) are mildly red with approx. 4cmx4cm wide. The skin where the rashes are located m… read more
Dr. Nair
Dr. Nair
Dermatologist
MD (Dermatology, Venereology, Lepro
9,189 satisfied customers
What is Perivascular dermatitis with eosinophils and how do
What is Perivascular dermatitis with eosinophils and how do you treator cure it. This condition is in conjunction with Porokeratosis.… read more
Dr. S. Attili
Dr. S. Attili
Dermatologist & Dermatopathologist
MRCP (Dermatology), Dip. Dermatopathology
5,170 satisfied customers
I have a red itchy blotchy rash that appears on my neck,
I have a red itchy blotchy rash that appears on my neck, arms, hands, legs and feet. It will completely go away. Will reappear on my skin hot burning itch. I have used Cortizone 10 for poison Ivy and … read more
Anthony Bray, MD
Anthony Bray, MD
Doctoral Degree
9,226 satisfied customers
I have had an itchy skin rash for almost a year. my left
hi i have had an itchy skin rash for almost a year. my left gland swells and is painful when i have bad rash breakouts. The rash looks like tiny blisters with really nothing in them. it is all over my… read more
Dr. Nair
Dr. Nair
Dermatologist
MD (Dermatology, Venereology, Lepro
9,189 satisfied customers
Got a breakout of little blistery bumps all over body even
Got a breakout of little blistery bumps all over body even on lips and face...extremely itchy and oozes lite yellow substance. Dermatologist said it was eczema but I feel like it may be an infection o… read more
dermdoc19
dermdoc19
Dermatologist
Doctoral Degree
4,069 satisfied customers
I have had a seriously itchy rash that covered my legs arms
I have had a seriously itchy rash that covered my legs arms and head. My neck and the neck lymphnodes were swollen but have since gone down. The MD doctor gave me benadryl and allegra plus creams. Did… read more
Dermadoc
Dermadoc
Consultant Dermatologist
Post-Doctoral Degree
308 satisfied customers
I have been diagnosed with Graves Disease. Currently I have
I have been diagnosed with Graves Disease. Currently I have a blistering skin condition on my hands and arms, extrememly itchy and peeling skin. I cant tolerate any sort of cream on theis areas as it … read more
Dermadoc
Dermadoc
Consultant Dermatologist
Post-Doctoral Degree
308 satisfied customers
My wife has had a skin desease for 16 years and has been to
My wife has had a skin desease for 16 years and has been to every dermatologist that is in the area. We have had no results. She is on the verge of doing something disasterous and I can't blame her. S… read more
Dermadoc
Dermadoc
Consultant Dermatologist
Post-Doctoral Degree
308 satisfied customers
I have a breakout of spots on my skin. I am female, aged 35
I have a breakout of spots on my skin. I am female, aged 35 and this does not normally happen. The spots are mostly along my jawline and I have two blisters on the top and bottom of my right cheek. Th… read more
Dr Owen
Dr Owen
Ob/Gyn Doctor
Doctoral Degree
406 satisfied customers
I‘ve recently return from a two year assignment in Eastern
I‘ve recently return from a two year assignment in Eastern Africa where I developed a rash that that resembles a fungus or mold on varies parts on my body, i.e. stomach, outer areas of armpits, neckli… read more
Dr  Jones
Dr Jones
Medical consultant
Post-Doctoral Degree
3,829 satisfied customers
I am a 45 year old female and have recently had breakouts on
I am a 45 year old female and have recently had breakouts on both checks and nose area. I had switched to a different cleanser/moisterizer a few months a go and thought this could be the issue but aft… read more
Dr. Chip
Dr. Chip
M.D.
13,138 satisfied customers
A few months back i started getting really small, itchy
Hi, a few months back i started getting really small, itchy blisters around the tops of my legs where they met my body. when scratched it would remove a fine layer of skin and the skin would ooze clea… read more
Dr. Muneeb Ali
Dr. Muneeb Ali
Senior Registrar Critical Care Medicine
Doctoral Degree
8,856 satisfied customers
I am trying to find out if my recent skin breakouts are
I am trying to find out if my recent skin breakouts are stress related or something else. I normally have pretty healthy skin but about a week ago I started getting these very small blister like pimpl… read more
Dr. Sophie :: Medicine &amp; Neurology
Dr. Sophie :: Medicine & Neurology
Neurologist
Post-Doctoral Degree
1,832 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Show MoreShow Less

Ask Your Question

x