Are Sex Hormones to Blame for Aphthous Stomatitis?

Dr David Kaplan presented the case of a teenager with aphthous stomatitis in aDermclinic feature. He noted that the condition developed following the onset ofthe patient's menses (Figure). Autoimmune progesterone dermatitis is a simpleallergy in a woman or girl to endogenous progesterone and can have several differentdermal manifestations; these include erythema multiforme, eczema, urticaria/angioedema, anaphylaxis--and aphthous stomatitis.All these manifestations are recurrent; they are often (butnot always) associated with the luteal phase of the menstrualcycle--usually 3 or 4 days before the onset of menses,when the progesterone level is at its peak.
Autoimmune progesterone dermatitis is diagnosed bysubcutaneous administration of aqueous progesterone, whichreproduces the skin reaction. Prostaglandins and estrogenhave also produced similar reactions.
Treatment consists of interruption of the menstrual cycle.Conjugated estrogens were used in the past, but because oftheir association with an increased risk of endometrial cancer,agents such as luteinizing hormone-releasing hormone agonistsand even tamoxifen are now used--with relative success.In severe cases, bilateral oopherectomy is an option.
-- Joy Snyder, MD
A meta-analysis that reviewed all relevant studies from the prior 60years concluded: "No associations have been established betweenaphthous stomatitis and the premenstrual period, pregnancy, ormenopause. No properly designed study has shown a therapeuticeffect of ovarian hormones on aphthous "stomatitis."¹ However, it isalways exciting when our knowledge on a particular topic is expanded. It isimportant to keep an open mind when approaching difficult clinical situations,so that one may find a suitable alternative treatment when conventional therapyis inadequate.
-- David L. Kaplan, MD
   Clinical Assistant Professor
   University of Missouri Kansas City School of Medicine
   University of Kansas School of Medicine
   Kansas City

References:

REFERENCE:
1.

McCartan BE, Sullivan A. The association of menstrual cycle, pregnancy, and menopause with recurrentoral aphthous stomatitis: a review and critique.

Obstet Gynecol.

1992;80:455-458.