Clinical dermatology • Concise report CED Clinical and Experimental Dermatology Catamenial dermatoses: has anyone ever considered prostaglandins? R. Verdolini, 1 R. Atkar, 1 N.Clayton, 2 R. Hasan 3 and C. M. Stefanato 4 1 Department of Dermatology, Princess Alexandra Hospital, Harlow, Essex, UK; 2 Department of Dermatology and 3 Institute of Pathology, Royal London Hospital, London, UK; and 4 Department of Dermatopathology, St John’s Institute of Dermatology, St Thomas’ Hospital, London, UK doi:10.1111/ced.12333 Summary Catamenial dermatoses are unusual, cyclic, perimenstrual reactions to hormones pro- duced during the menstrual cycle. They occur in a variety of clinical presentations, including urticaria, eczema, fixed drug eruptions, erythema multiforme and anaphy- laxis. Autoimmune progesterone dermatitis is the most common, and is caused by an autoimmune response to endogenous progesterone in women of reproductive age. We report a case of catamenial dermatosis in a 42-year-old Jamaican woman with a 10-year history of cyclic blistering and ulcerative eruptions of her mouth and limbs. Her symptoms were fully in keeping with a Stevens–Johnson-type reaction, and were associated with production of prostaglandins occurring during her menstrual cycle. It has long been documented that a variety of skin conditions can become exacerbated during particular phases of the menstrual cycle. The pathogenesis of such diseases is poorly understood. They have been attributed to fluctuations in reproductive hormones, especially progesterone and, less commonly, oestro- gens. Catamenial dermatoses are cyclical skin reac- tions to hormones produced during the menstrual cycle. 1,2 The most common of these reactions is auto- immune progesterone dermatitis (APD), which is caused by an autoimmune response to endogenous progesterone in women of reproductive age. 3 We pres- ent a case of recurrent Stevens–Johnson (SJS)-type reaction associated with the production of prostaglan- dins (PGs) during the menstrual cycle. Report A 42-year-old Jamaican woman presented with a clin- ical history of cyclical blistering eruptions of the extremities associated with oral ulceration, spiking temperatures and malaise, which had been present for a period in excess of 10 years. The symptoms consis- tently appeared a few minutes prior to the onset of her menses, and resolved within 5 days of her menstrual cycle. The patient’s symptoms resolved each time with the administration of prednisolone at a dose of 40 mg daily for 5–6 days, usually started at the onset of the symptoms. Prophylactic courses had also been attempted, with good response, by administering pred- nisolone 1 day before the presumptive menstrual date, and continuing it for 5 days during the menstrual cycle. However, the patient was happy to have access to the treatment and to be able to start it at the first onset of the symptoms, and this had become her choice of monthly routine. Her only other relevant medical history was a long-standing history of endometriosis. On physical examination, the patient was seen to have aphthous ulceration of the tongue, buccal mucosa and lower lip, as well as erythematous, target- oid plaques over her hands (Fig. 1a, b). Histopathology of a lesion biopsied from the dorsum of one of the fingers showed interface changes with subepidermal clefting, dyskeratotic keratinocytes, and a mild lichenoid lymphocytic infiltrate of the superfi- cial dermis, consistent with bullous erythema multi- forme (Fig. 1c). Correspondence: Dr Roberto Verdolini, Department of Dermatology, Princess Alexandra Hospital NHS Trust, St Margaret’s Hospital, The Plain, Epping, Essex, CM16 6TN, UK E-mail: rverdolini@hotmail.com Conflict of interest: the authors declare that they have no conflicts of interest. Accepted for publication 5 December 2013 ª 2014 British Association of Dermatologists Clinical and Experimental Dermatology (2014) 39, pp509–512 509