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      A case of catamenial erythema multiforme major successfully treated with goserelin

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          Abstract

          Summary

          We report a case of catamenial erythema multiforme major in a 46-year-old female. She was treated successfully with goserelin, a GnRH agonist, until the expected age of menopause; however, its therapeutic effects persisted for longer than expected, possibly due to accumulation in adipose tissue.

          Learning points
          • A group of menstrual cycle-related dermatoses and hypersensitivity syndromes exist but are rarely reported in the literature.

          • A history of recurrent cutaneous eruptions in premenopausal females should be considered in the context of the menstrual cycle.

          • The diagnosis of menstrual cycle-related dermatoses is largely clinical, although provocation testing can assist.

          • Treatment options are broad and are aimed at reducing the immune response and/or suppressing ovulation.

          • Goserelin may accumulate and have a gonadotrophin-suppressing effect for longer than expected.

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          Most cited references10

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          Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist.

          Erythema multiforme (EM) is an uncommon, immune-mediated disorder that presents with cutaneous or mucosal lesions or both. In herpes simplex virus (HSV)-associated EM, the findings are thought to result from cell-mediated immune reaction against viral antigen-positive cells that contain the HSV DNA polymerase gene (pol). The target lesion, with concentric zones of color change, represents the characteristic cutaneous finding seen in this disorder. Although EM can be induced by various factors, HSV infection continues to be the most common inciting factor. Histopathologic testing and other laboratory investigations may be used to confirm the diagnosis of EM and to differentiate it from other clinical imitators. Imitators of EM include urticaria, Stevens-Johnson syndrome, fixed drug eruption, bullous pemphigoid, paraneoplastic pemphigus, Sweet's syndrome, Rowell's syndrome, polymorphus light eruption, and cutaneous small-vessel vasculitis. Because disease severity and mucosal involvement differ among patients, treatment should be tailored to each patient, with careful consideration of treatment risk vs benefit. Mild cutaneous involvement of EM can be managed primarily with a goal of achieving symptomatic improvement; however, patients with HSV-associated recurrent EM and idiopathic recurrent EM require treatment with antiviral prophylaxis. Inpatient hospitalization may be required for patients with severe mucosal involvement that causes poor oral intake and subsequent fluid and electrolyte imbalance. With this review, we strive to provide guidance to the practicing dermatologist in the evaluation and treatment of a patient with EM. © 2012 The International Society of Dermatology.
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            The menstrual cycle and the skin.

            Perimenstrual exacerbations of dermatoses are commonly recognized, yet our knowledge of the underlying pathophysiological mechanisms remains imperfect. Research into the effects of oestrogen on the skin has provided evidence to suggest that oestrogen is associated with increases in skin thickness and dermal water content, improved barrier function, and enhanced wound healing. Research into the effects of progesterone suggests that the presence of various dermatoses correlates with peak levels of progesterone. Dermatoses that are exacerbated perimenstrually include acne, psoriasis, atopic eczema and irritant dermatitis, and possibly also erythema multiforme. Exacerbations occur at the peak levels of progesterone in the menstrual cycle. Underlying mechanisms include reduced immune and barrier functions as a result of cyclical fluctuations in oestrogen and/or progesterone. Autoimmune progesterone and oestrogen dermatitis are the best-characterized examples of perimenstrual cutaneous reactions to hormones produced during the menstrual cycle. In this review, we describe the current understanding of the menstrual cycle, and its effect on the skin and cutaneous disorders.
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              Progesterone-induced erythema multiforme.

                Author and article information

                Journal
                Endocrinol Diabetes Metab Case Rep
                Endocrinol Diabetes Metab Case Rep
                EDM
                Endocrinology, Diabetes & Metabolism Case Reports
                Bioscientifica Ltd (Bristol )
                2052-0573
                23 November 2023
                01 October 2023
                : 2023
                : 4
                : 23-0030
                Affiliations
                [1 ]Department of Endocrinology and Diabetes , Sir Charles Gairdner Hospital, Nedlands, WA, Australia
                [2 ]Keogh Institute for Medical Research , Nedlands, WA, Australia
                [3 ]Medical School , University of Western Australia, Nedlands, WA, Australia
                Author notes
                Correspondence should be addressed to L T Tyack; Email: lauren.tyack@ 123456health.wa.gov.au
                Author information
                http://orcid.org/0009-0007-9326-2235
                Article
                EDM230030
                10.1530/EDM-23-0030
                10762591
                38006658
                d8e6311c-3cf5-4b6d-b9e5-7d23d58f75f2
                © the author(s)

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 07 March 2023
                : 31 October 2023
                Categories
                Adult
                Female
                White
                Australia
                Ovaries
                Gynaecological Endocrinology
                New Disease or Syndrome: Presentations/Diagnosis/Management
                New Disease or Syndrome: Presentations/Diagnosis/Management

                adult,female,white,australia,ovaries,gynaecological endocrinology,new disease or syndrome: presentations/diagnosis/management,november,2023

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