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Case report
A 27-year old Caucasian woman presented herself at the Department of Dermatology for a recurrent pruritic skin eruption during the last 3 months. The patient was breastfeeding for the last 10 months a healthy baby that was born in normal vaginal delivery. The patient recalls having used oral contraceptives as a preventive birth control method for 2 to 5 years prior to the conception that occurred naturally, without need of hormonal treatment or in vitro fertilization.
The cutaneous examination revealed well demarcated, round and oval shaped erythemato-edematous papules and plaques on the cheeks, chin, neck, upper and lower limbs, as well as some target-like lesions, ranging from 5 to 20 mm (Fig. 1). The patient reported a sudden onset of the skin eruption 3 months prior to the medical visit, starting a few days before the menses and lasting until after the completion of menstruation, with clinical worsening at every episode.
A 4-mm punch biopsy was performed and revealed on the histopathological examination spongiosis, a perivascular and diffuse lymphocytic infiltrate in the dermis, a few eosinophils and apoptosis of the basal cells.
Intradermal testing with 0.01 ml progesterone (50 mg/ml progesterone at a dilution of 1:10 in aqueous solution) read at 20 min was positive, showing a 5 mm wheal, compared to no skin reaction to the saline solution control.
The patient was advised to take oral contraceptives and mid-potency topical corticosteroids but chose to apply only topical treatment. Two months later, the patient became pregnant and delivered a healthy baby on term. The skin eruptions ceased during the second pregnancy and did not reappear at a 1...