๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
AUTOIMMUNE PROGESTERONE DERMATITIS
Although autoimmune progesterone dermatitis is not a specific dermatosis of pregnancy, it can first appear during pregnancy or postpartum. Classically, there are recurrent cyclic flares of dermatitis that correspond to the luteal phase of the menstrual cycle, when progesterone levels increase. In addition to eczematous changes, lesions can vary
from urticaria to papulovesicles to erythema multiforme-like. Some patients have primarily pruritus or oral erosions. At sites of intra-dermal injection of progesterone (e.g. 50โmg/ml), the vast majority of affected patients develop a cutaneous reaction characterized by urticaria (immediate [30โmin]) and/or erythema and induration (delayed [24โ48โh]). Injections of saline and estrogen (e.g. estrone [1โmg/ml]) are often done concurrently, to serve as a control and to examine for
Adapted from Kroumpouzos G, Cohen LM. Dermatoses of pregnancy. J Am Acad Dermatol 2001;45:1โ19.
evidence of estrogen dermatitis, respectively. Both oral and intramuscular progesterone have been used as a challenge test in patients with delayed reactions. Treatment consists primarily of inhibiting ovulation via estrogen-containing preparations. Anecdotally, additional reported therapies include tamoxifen and danazol, each possibly suppressing ovulation via interaction with the hypothalamicโpituitary axis. Of note, some patients have had remissions during pregnancy.
The author and editors are grateful to Drs Heidi Bai and Jenny Murase for their help in creating the table of dermatologic drugs in pregnancy and lactation featured in the online version of this chapter.
Additional figures and table on An overview of the use of dermatologic drugs during pregnancy and lactation available in our eBook (see inside front cover for access code).
Fig. 27.10 Approach to the pregnant woman with pruritus. Patients with refractory gestational pemphigoid may benefit from plasmapheresis during pregnancy. See Table 27.3 for special considerations regarding the use of corticosteroids (topical and oral) and antihistamines during pregnancy.
Fig. 27.11 Physiologic changes during pregnancy.A Well-demarcated linea nigra in a patient with polymorphic eruption of pregnancy. B Palmar erythema. C Gingival pyogenic granuloma.
Table 27.5 Physiologic changes during pregnancy.