250: Progesterone Sensitivity Rash

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Did you know that progesterone can trigger rashes?

Usually estrogen is more commonly the “sex hormone problem child” when it comes to skin, but when progesterone is the culprit, it’s causes A LOT of trouble.

If you’ve never heard of progesterone triggering rashes or Progesterone Hypersensitivity, you’ll want to check out this episode.

Now to be clear, this is NOT a common problem as progesterone reactivity like this is considered to be rare (though I’m willing to bet that a lot of cases are left undiagnosed if you don’t know what to even look for).

And if you know someone dealing with progesterone sensitivity rashes, please share this with them because there is a lot of great research linked up in the citations section below that could be helpful for them!

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In this episode:

  • What is progesterone hypersensitivity?
  • Is it an autoimmune disease or an allergic reaction?
  • Tips for figuring out if you have progesterone hypersensitivity
  • Fascinating signs + symptoms
  • Potential triggers that prime your body to react to progesterone
  • Treatment options to discuss with your doctor

Quotes:

A consistent flare-up that starts around the progesterone spike in your cycle around day 20 or 21 of a 28-day cycle is an important clue.

Progesterone hypersensitivity may be linked to a higher rate of pregnancy loss.

 

Woman thinking about Progesterone Sensitivity Rashes

Progesterone Sensitivity Rash (FULL TRANSCRIPT)

Welcome back to episode #250 of the Healthy Skin Show!

In today’s episode, I want to talk about a curious and extremely frustrating situation where your body could actually develop progesterone sensitivity rashes – also more formally called Autoimmune Progesterone Dermatitis and even Progesterone Hypersensitivity.

Over the years, I’ve received a bunch of emails from women who are desperately looking for  more information on this type of rash that tends to flare like clockwork a few days before the onset of menstruation when progesterone spikes.

As of the date of this episode hitting the airwaves, I’ve worked with one client who struggled with a progesterone sensitivity rash.

I’ve done quite a bit of research on this topic seeking some answers for her and others interested in this topic.

And I’ve asked colleagues who are “in the know” in terms of hormones about ways to address this.

What I can tell you is that options are still very limited.

I’m hoping in time to have a guest on the show to talk about her personal experience with this and what she found helpful, but for now, I felt it worthwhile to share the basics of Progesterone Hypersensitivity to hopefully help even one listener seeking answers.

 

Woman wondering what a progesterone sensitivity rash is

What is Progesterone Sensitivity Rash?

Progesterone hypersensitivity is considered to be a rare condition that impacts a small number of mostly women who are still experiencing a menstrual cycle (though there has been one case affecting a man who was supplementing with progestin reported in the literature).(1)

Though it was previously coined Autoimmune Progesterone Dermatitis back in 1964, it is generally not considered an autoimmune condition – and thus the name Progesterone Hypersensitivity was suggested as a better alternative.(1)

Essentially what happens is that your body becomes reactive to progesterone, and it’s not exactly clear why this would happen.

Some have pointed to the introduction of man-made progesterone in the form of progestin as a culprit, though hormonal birth control is also sometimes attempted as an option to control the flares.

My client with progesterone hypersensitivity did not see or feel any big improvement in symptoms when hormonal birth control pills were prescribed by her doctor.

What’s also interesting is that some women seemed to tolerate progestin (found in hormonal birth control) just fine and only experience this reaction once they stopped taking the medication.

Another potential trigger could also be high doses of progesterone used during IVF rounds.(1,2) So if you’ve gone through IVF, that could be an important clue in your case.

Onset happens typically at some point after a woman begins to menstruate, but pregnancy can also be an unfortunate trigger when progesterone stays high to help maintain the pregnancy.(1,3)

 

Woman scratching her skin

Signs of Progesterone Hypersensitivity

Progesterone sensitivity reactions can look like…

  • Eczema flare-ups(1)
  • Hives (Urticaria)(1)
  • Asthma(1)
  • Anaphylaxisis(1)
  • Itchy vulvar area (Vulvovaginal pruritus)(1,4)
  • Swelling(1)
  • Sore + swollen mouth possibly with ulcerations (Ulcerative Stomatitis)(1,5)
  • Fluid-filled vesicles and blisters(1)
  • Small blood vessels to burst causing petechiae or purpura(1)
  • Fixed-drug reactions(1,6)
  • Stevens-Johnson like syndrome(1)

That said, some interesting research that I came across points towards an interesting trend of a higher rate of pregnancy loss or miscarriage in those who test positive for progesterone hypersensitivity.(7,8)

 

Woman suspecting progesterone sensitivity

Progesterone Hypersensitivity: What To Do If You Suspect It

If you are suspicious that your rash could be hormone-related, tracking your rash flare cycle could prove incredibly helpful.

Considering your body’s hormonal rhythm in conjunction with flares could provide clues that put your flares into context.

In this instance, a consistent flare-up that starts around the progesterone spike in your cycle around day 20 or 21 of a 28-day cycle is important information that you can then bring back to your doctor.

From here, your doctor can do patch testing or run an IgE blood test for progesterone – essentially to see if your body is experiencing an allergic response to your progesterone.(1)

Ultimately that’s how the official diagnosis is made – after ruling out other potential factors and identifying the reaction to progesterone.

This is very different from experiencing rash flares around an estrogen spike (from days 12 to 16 in your cycle). Though you can develop an allergy to your own estrogen, this seems far less common compared to progesterone hypersensitivity.(7)

Typically when it comes to flare-ups with the estrogen spike, there is a histamine overload component that unfortunately high estrogen can make worse.

 

Doctor and patient discussing references

Tips for Progesterone Hypersensitivity

It’s definitely best to get your doctor involved if this is what’s happening to you.

I encourage you to bring the references shared in this episode to your doctor to help you explain what’s you’re experiencing along with the cycle and flare tracking that you’ve done.

And if you do have progesterone hypersensitivity, the options are still pretty limited (though I’m not giving up hope here).

Current options that may be offered to you for treatment from a doctor include anti-histamine (or even mast cell-stabilizing) medications, hormonal birth control, the biologic drug Xolair, gonadotropin-releasing hormone (GnRH) agonists, tamoxifen, and even an oophorectomy (surgical removal of the ovaries).(1)

I’ll also add that elsewhere I found it mentioned that antihistamines may not be helpful so you’d have to see if they work for you.(4)

There may be some desensitization protocols or LDA immunotherapy may be appropriate, but that would be something to discuss with your doctor.(1)

In the one case that I worked on, the client did see some improvement from working on some other underlying root causes and utilizing certain supplements, but ultimately the progesterone reactivity was the overriding problem still to this day for her.

So, if you’re hoping that I have some perfect answer for you about this topic, unfortunately I do not. At this time, the research is still limited and I will continue to look for options to share here on the Healthy Skin Show.

As I said, there is a guest that I’m working to get on the show to share her story with this condition so stay tuned!

If you’ve got any questions or thoughts to share about this, leave a comment below so I can address them.

Then share this with someone you know who thinks they have an issue with rashes triggered by hormones OR if they have been diagnosed with Progesterone Hypersensitivity.

Thank you so much for tuning in and I look forward to seeing you in the next episode!

 

Woman looking at reference books

REFERENCES

  1. https://www.uptodate.com/contents/progestogen-hypersensitivity/print
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560843/
  3. https://www.aaaai.org/allergist-resources/ask-the-expert/answers/old-ask-the-experts/pregss
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560843/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700113/
  6. https://dermnetnz.org/topics/autoimmune-progesterone-dermatitis
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745953/
  8. https://pubmed.ncbi.nlm.nih.gov/17217371/

A consistent flare-up that starts around the progesterone spike in your cycle around day 20 or 21 of a 28-day cycle is an important clue.