Table 2 Treatment options used in autoimmune progesterone dermatitis
Treatment Option | Advantages | Disadvantages |
|---|---|---|
Oral Contraceptives (OCPs) | - Usually tried as initial therapy | - Limited success due to the progesterone component of OCPs |
- Fewer side effects than other most other therapies | ||
Antihistamines | - Well tolerated, few side effects | - Rarely effective as monotherapy |
- Does not address underlying mechanism | ||
Conjugated Estrogens | - Avoids progesterone component of OCPs | - Increased risk of endometrial cancer, not commonly used today |
- Often require high doses | ||
Glucocorticoids | - Able to suppress multiple components of the immune system | - Usually not effective alone |
- Can be combined with other therapies | - Often require high doses | |
GnRH Agonists | - Often used if OCPs and glucocorticoids are not effective | - Can cause symptoms of estrogen deficiency (hot flashes, decreased bone mineral density) |
Alkaylated Steroids | - Can be combined with low dose steroids | - Can cause symptoms of excess androgens (facial hair, hepatic dysfunction, mood disorders) |
- Interferes with gonadal hormone receptors | ||
Tamoxifen | - Has been used successfully in patients unresponsive to conjugated estrogen | - Can cause symptoms of estrogen deficiency |
- Increased risk of venous thrombosis and cataract formation | ||
Bilateral oopherectomy | - Definitive treatment, used if medical options unsuccessful | - Surgical procedure, associated morbidity |
- Symptoms of estrogen deficiency |