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Dermatology/Flaky patches on face between menstrual cycles


Every month, like clockwork, approximately 10 days after my period ends, I wake up with red, itchy patches all over the center of my face - nose, chin, and between my eyebrows.  It almost looks like hives.  By the next day, the redness fades and it stops itching, but the patches become extremely dry and flaky, and persist for a week or more, until shortly before my next period.  I have tried OTC hydrocortisone and clotrimazole, as well as eczema cream with colloidal oatmeal, moisturizers for sensitive skin, and straight vaseline, all with no effect.  Nor does exfoliation, either chemical or physical, reduce the flakiness.

I feel like it must be tied to my cycle because it happens every month at the same time, but I can't find any information about hormone-related skin conditions that occur around ovulation.  I am in my mid-30s, I don't take any hormones, I normally have combo/oily, sensitive skin, and my cycle is regular, but my skin seems to be its healthiest and most balanced during my period and I battle these impossibly flaky patches the rest of the time.  Have you ever heard of anything like this or have any ideas about how I could treat the patches?  

Thank you for your time and consideration.

You may have the following skin condition. I copied an article for you.

What is autoimmune progesterone dermatitis?

Autoimmune progesterone dermatitis (APD) is a rare skin condition in women that recurs in a cyclical manner corresponding to their menstrual cycles. It is thought to be a response of the skin to the hormonal changes that happen just before menses.

Characteristically, the skin eruptions occur during the luteal phase or the late pre-menstrual phase of the cycle. This is when the blood level of the sex-hormone progesterone rises. The skin rash happens as an autoimmune response to the body's own progesterone, hence its name.

Within a few days of menstruation when progesterone level falls, there is partial to complete resolution of the rash. It will recur during the next cycle.

Some patients have had previous exposure to external progesterone in the form of oral contraceptive pills. This is thought to pre-sensitize patients to react against their own internal progesterone. However, not all patients with APD are exposed to previous hormone therapy. It has been postulated that these patients produce an altered form of progesterone that incites an immunologic response against it. In another theory, progesterone is thought to heighten a patient's hypersensitivity response to another allergen.

How does progesterone dermatitis present?

A variety of rashes has been described. The most common are urticaria and erythema multiforme. Other presentations include:

Papulovesicles (eczema-like)
Annular erythema
Mouth erosions (stomatitis and aphthous ulcers)
Itch (the most common complaint)
Several other skin conditions may be more severe during the perimenstrual period, but these are not classified as autoimmune progesterone dermatitis. These include:

Herpes simplex infection (cold sores)
Acne and seborrhoea
Atopic dermatitis
Contact allergy to nickel
Lupus erythematosus
On average, the skin rash happens 7 days before onset of menstruation and lasts for 1-3 days after menstruation.

The age of onset is variable, the youngest case occurred at menarche and the disease can begin as late as 48 years of age.

Autoimmune progesterone dermatitis
Image provided by Sharon Morton
Autoimmune progesterone dermatitis
How is progesterone dermatitis diagnosed?

The diagnosis is usually made from the characteristic cyclical presentation.

A skin-prick test with intradermal progesterone is helpful. Positive tests with progesterone can be fairly rapid, usually developing as urticaria within 30 minutes of inoculation, or delayed with rashes peaking at 24-48 hours.

Provocative testing with intramuscular or oral progesterone can be performed as an alternative.

Skin biopsy alone is seldom diagnostic. A variety of histological features have been described. Superficial perivascular mixed inflammation is the most consistent finding.

How is progesterone dermatitis treated?

If the skin problem is mild, it may improve with topical steroids (for eczema) and antihistamines (for urticaria). Severe disease may be treated with systemic corticosteroids.

The production of progesterone can be suppressed with hormone-based therapy. This includes the use of conjugated oestrogen (American spelling estrogen), ethinyl oestradiol (estradiol), tamoxifen and danazol.

Women with autoimmune progesterone dermatitis should try to avoid medications containing progesterone including the combined oral contraceptive pill, minipill, depo injections. The specific drugs to avoid include norethindrone, norgestrel, levonorgestrel.

Surgical removal of ovaries or oophrectomy has been shown to be curative in refractory cases.

Related information


Walling HW, Scupham RK. Autoimmune progesterone dermatitis. Case report with histologic overlap of erythema multiforme and urticaria. Int J Dermatol 2008; 47: 380-382. Medline.
Rasi A, Khatami A. Autoimmune progesterone dermatitis. Int J Dermatol 2004; 43: 588-590. Medline.
Dedecker F, Graesslin O, Quereux C, Gabriel R. Autoimmune progesterone dermatitis: a rare pathology. Eur J Obs Gynae Repro Biol 2005; 123: 117-124. Medline.
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Michael S. Fisher, <B>Ph.D., M.D.</B>


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