ACTA ENDOCRINOLOGICA (BUC)

Abstract Context. Autoimmune progesterone dermatitis (AIPD) is a rare, cyclical dermatosis, with variable clinical presentation, occurring exclusively or being aggravated during the luteal phase of the menstrual cycle, when levels of progesterone rise. Its pathogenesis is still unclear. AIPD is thought to occur as an autoimmune reaction to endogenous possibly modified progesterone, but it could also be triggered by exogenous progesterone exposure. AIPD is a diagnosis of exclusion. Usually there is no or limited response to oral H1 antihistamines and a partial response to steroids. Ovulation inhibitors represent the specific treatment. Case report. We report a case of AIPD in an 18-year-old nulliparous patient with no medical history of allergic diseases and no exposure to oral contraceptive pills. AIPD was suspected based on the clinical picture (recurrent cyclical eczematous eruption on the face and abdominal area) and confirmed by positive intradermal test and positive progesterone challenge. This diagnosis was supported by the result of the skin biopsy, which also helped to exclude other dermatoses with premenstrual aggravation. The rash responded satisfactorily to treatment with a combination of oral contraceptives, levonorgestrel and estrione, which is currently considered first line therapy. Conclusions. This case is of particular interest due to the lack of previous pregnancy or exposure to progesteron therapy. Recurrent, cyclical eruptions in fertile women should raise the suspicion of AIPD. If early recognized, the patient may benefit from non-invasive treatment that improves significantly the quality of life.

Context. Chronic idiopathic urticaria (CIU) is often associated with autoimmune thyroiditis (AT). Objective. The aim of this study was to analyze the clinical particularities of patients with CIU associated with AT and to evaluate the efficacy of dapsone in such patients. Design. We performed an observational study of patients hospitalized in our clinic between January 2010 - December 2013 for moderate/severe chronic urticaria (CU). Subjects and Methods. Data regarding medical history, clinical, paraclinical findings, coexistence of AT and response to treatment were compared between patients with CU and AT and those without AT. Patients continued oral H1 antihistamines. Severe flares required systemic corticotherapy. 11 patients with refractory CIU associated with AT received dapsone treatment. Levothyroxine was administered in patients with hypothyroidism. Results. Among the 210 patients admitted for CU, 39 (92% female) were diagnosed with CIU associated with AT. Patients with CIU associated with AT had a slightly longer disease duration, a higher prevalence of angioedema (25.6% vs. 16.7%) and a more frequent need of systemic corticotherapy for urticaria exacerbations (46.2% vs. 30.4%). All 39 patients achieved significant clinical improvement after a mean period of 4 weeks based on urticaria activity score (UAS) 7 (p<0.0001). Conclusions. Assays for thyroid autoantibodies and thyroid function should be part of the workup in patients with CU, enabling the diagnosis of autoimmune urticaria. Without correction of the underlying autoimmune mechanisms, CU may persist regardless of conventional treatment. Dapsone represents a therapeutic option in autoimmune CU.