Autoimmune Progesterone Dermatitis Following Placement of a Progesterone-eluting IUD

A 26-year-old female with a history of Raynaud’s phenomenon and a family history of autoimmune disease presented with a cyclical facial rash for 10 months following placement of a progesterone-eluting IUD. The rash began 3-4 days before the onset of menses as a crusted, oozing, vesicular rash, and dried out and improved a few days following the onset of menses. The rash began around her eyes and progressively moved to her forehead, cheeks, jaw, and neck as the months on the IUD progressed. Physical exam revealed poorly-demarcated, pink scaly plaques with overlying crust on the mid-forehead, eyes, cheeks, nose, perioral region, and mid-chin. Patch testing and open application testing of personal skincare products at home were negative. ANA was marginally positive 1:40, although the rest of the rheumatologic workup was unrevealing. The patient’s history and exam were suggestive of autoimmune progesterone dermatitis and she planned to have her progesterone-eluting IUD exchanged for a copper IUD the following week. If no improvement, the patient planned to see a gynecologic endocrinologist for contraception with hormonal treatment that suppresses progesterone secretion rather than using progesterone to inhibit ovulation. The patient was lost to follow-up. Autoimmune progesterone dermatitis, also known as progesterone hypersensitivity, is a rare and under-recognized entity that may be triggered by endogenous (menses, pregnancy) or exogenous progesterone/progestin exposure (contraceptives, IVF).1 It may have a variety of clinical presentations and is thought to be IgE-mediated.1 Management may include reduction of exogenous progesterone and symptomatic control.