Estrogen sensitivity also can imitate the clinical picture of APD. Clinical manifestations include papulovesicular exanthemas, eczemas, urticaria, and localized or generalized pruritus. The face, upper arms, and trunk are the regions affected principally, which may be attributable to an increased density of estrogen receptors in these regions. This disorder is considerably more rare than APD but, like APD, it is marked by the cyclic occurrence prior to menstruation (48). Murano and Koyano (49) described a patient in whom an exacerbation of the cutaneous manifestations occurred twice within the course of each menstrual cycle, i.e., premenstrually and at the time of ovulation. This can be explained by the two-peak course in the estrogen curve within the menstrual cycle. The diagnosis of autoimmune estrogen dermatitis can be corroborated by a positive
intracutaneous test to estrogen; progesterone provocation will be negative. Treatment options include antihistamines, corticosteroids, tamoxifen, progesterone, and a surgical- or drug-induced elimination of ovarian function (48).
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