Autoimmune Progesterone Dermatitis (APD)

What is Autoimmune Progesterone Dermatitis (APD)?

According to a Natural Fertility.com's article, Autoimmune Progesterone Dermatitis - Cyclical Skin Issues Due To Progesterone, "Autoimmune Progesterone Dermatitis is a rare autoimmune condition that is thought to be a reaction caused by a woman’s hypersensitivity to her own endogenous progesterone. Because it is rare, the author suggests those who feel they may have it to seek a doctor for diagnosis and if they would like to try to treat it naturally to seek a naturopathic doctor" (Willett).

APD & Menstrual Cycles

"There was a case study done on a woman who has Autoimmune Progesterone Dermatitis, also known as APD and Endometriosis with irregular menstrual cycles. She had not been diagnosed or correctly treated for over 20 years. In women with irregular menstrual cycles, the diagnosis of Autoimmune Progesterone Dermatitis can remain elusive for years because they may not have a clear correlation. In the case study, they define Autoimmune Progesterone Dermatitis as the menstrual cycle being associated with skin conditions, such as eczema and urticaria, and occurs 3-10 days prior to the onset of menstrual flow and resolves 1-2 days into the menstrual cycle. Progesterone is frequently identified as the etiologic agent" (Baptist). According to Deadly Deceit.com, "Etiologic agents are microorganisms and micro toxins that cause diseases in humans and include bacteria, bacterial toxins, viruses, fungi, protozoans, and parasites". To read the case study, click here.  According to Natural Fertility.com's article, Autoimmune Progesterone Dermatitis - Cyclical Skin Issues Due To Progesterone, "APD is considered to be cylic, so it follows the same pattern each cycle. Even though it primarily subsides  on its own with the onset of menstration, for some women it returns each cycle" (Willett).

APD & Birth Control

"Some studies noted a majority of patients have taken oral contraceptive prior to the onset of APD. However, there are cases where women have not been exposed to exogenous (developing from external factors) progesterone" (Baptist). "There is speculation that APD occurs in some women who have used exogenous progesterone, such as oral hormonal birth control pills, which may sensitize them to their own progesterone. Case studies have been shown that women with preexisiting fertility issues, especially those treated with with birth control often, are more likely to experience APD " (Willett).

Symptoms of APD

"Symptoms of APD correlate with Progesterone levels during the luteal phase of a menstrual cycle. Progesterone begins to rise 14 days prior to the onset of menstruation, peaks 7 days prior to menstruation, and returns to a low baseline 1-2 after menstruation begins. In studies where the etiologic agent has been sought, progesterone has mostly been found. Symptoms may appear, improve, or worsen during pregnancy. Spontaneous abortions have been associated with APD. Pregnancy is associated with an increase of maternal progesterone which may explain the worsening. A few theories for explaining why it may improve during pregnancy is a slow rise of progesterone may act as a method of desensitization or a decrease of maternal immune response. The exact pathogenesis for APD is unknown" (Baptist).  "Presenation can range from subcontaneous and muscoal legions and is hard to diagnose based on presentation alone. It can be found on different parts of the body, such as mouth, lips, legs, arms, elbows, palms, hands and feet. Pimples and acne are not considered signs of APD" (Willett).

Diagnosis of APD

I did find in a forum (here) that one commenter said she had doctors who had never heard of APD and had to see an allergist to confirm her suspecisons of APD. "APD is often diagnosed by allergy skin testing" (Willett). "Skin tests results with progesterone have shown immediate (within 30 mins) and delayed reactions (24-48 hours later). The diagnosis requires appropriate clinical history and intradermal injection test with progesterone. Some advocate patch testing to further evaluate for hypersensitive reactions. However, intradermal testing has been negative in some patients with symptoms of clinical APD and improved with APD treatment. The negative result maybe because intradermal testing may not be positive until 24-48 hours later" (Baptist). "The intradermal injection is an injection into the dermal skin layer, the layer beneath the epidermis - upper skin layer" (Intramural Injection). 

Treatment of APD

"Autoimmune Progesterone Dermatitis is usually resistant to conventional thearpy, such as antihisitimaines. Antihistimaines were noted to have fewer side effects and well tolerated. However, considered to be rarely effective as mono thearpy. There is no clear treatment options, although different things have been tried, such aklayated sterioids that can be combined with low dose steriods, but can cause symptoms of excess androgens (facial hair, heptatic dsyfunction, and mood disorders). More research is needed" (Baptist).  "Medical treatment may also include over the counter topic anti-itch creams and hormone thearpy to stop ovulation and the production of progesterone. For severe cases, removal of the ovaries may be suggested" (Willett). Comments I have read is to find a doctor who is knowledgeable about APD and knows how to desantize with success.

Support for APD

If you have a facebook account there is a support group page on there: https://www.facebook.com/livingwithAutoimmuneProgesteroneDermatitis

APD & Trying To Conceive

"There is little information available about trying to conceive with Autoimmune Progesterone Dermatitis. Some sources suggest finding a healthcare provider who has had success “desensitizing” women to endogenous progesterone without suppressing ovulation, if you have had trouble conceiving with APD" (Willett). Howwever,, when I was doing my research for this, it seems there have been some women who have previously had children that have or suspect they have this and are currently have troube trying to conceive. I did find in a forum (here) that one commenter suspects she has APD and was able to conceive, had relief during her pregnancy, but her syptoms returned as soon as her menstrual cycle came back postpartum. She explains that it took her 14 cycles to conceive her baby, she feels because she had a short luteal phase and possibly Endometriosis.  On another formum (here), a commenter said she has has APD and gotten pregnant twice.

Antihistimaes & Trying to Conceive

For those with APD trying to conceive, if you choose anthestimaines for treatment, know that antihistimaes can lessen cervical mucus in some women. According to Pregnant Naturally.com, "Little to no fertile cervical mucus for some can make it a little more difficult for some women to become pregnant. This may not be the case for all women. However, there are ways to increase cervical mucus if you find that you are affected by frequent use of antishitimaines. 

Some of the ways from the article are listed below: 

1. Stay Hydrated (Read more on Staying Hydrated)

2. Drink Grapefruit Juice (Read more about Grapefruit for Fertility)

3. Eat Veggies

4. Eat Raw Garlic

5. Be Careful with Antihistamines

6. Try Cough Syrup 

7. Take Evening Prim Oil

8. Take L-Arginine 

9. Take Fertile CM

10.  Supplement with Pre-Seed Lubricant

To read this article, click here" (10 Ways To Improve Your Fertile Cervical Mucus).

APD & Pregnancy

Symptoms may appear, improve, or worsen during pregnancy. Spontaneous abortions have been associated with APD. Pregnancy is associated with an increase of maternal progesterone which may explain the worsening. A few theories for explaining why it may improve during pregnancy is a slow rise of progesterone may act as a method of desensitization or a decrease of maternal immune response. The exact pathogenesis for APD is unknown" (Baptist). I did find in a forum (here) that a few commenters suspects they have APD and was able to conceive, however, during the pregnancy the APD worsen.

Bibliography

"10 Ways to Improve Your Fertile Cervical Mucus." Getting Pregnant Naturally. N.p., 13 Feb. 2013. Web. 10 Nov. 2015. <http://pregnant-naturally.com/ten-ways-to-improve-cervical-mucu/>.

Baptist, Alan P., and James L. Baldwin. "Autoimmune Progesterone Dermatitis in a Patient with Endometriosis: Case Report and Review of the Literature." Clinical and Molecular Allergy (2004): n. pag. BioMed Central. Web. 28 Apr. 2016.

http://deadlydeceit.com/Etiologic_agents.html
http://www.novosanis.com/healthcare/intradermal-injection
http://natural-fertility-info.com/autoimmune-progesterone-dermatitis.html
http://www.experienceproject.com/stories/Have-Autoimmune-Progesterone-Dermatitis/2243628 (author lulu2001)
http://www.medhelp.org/posts/Autoimmune-Disorders-/Autoimmune-Progesterone-Dermatitis/show/360972#post_answer_header (cup n)