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Exclusion of conditions that mimic APD: Several disorders can worsen premenstrually and must be ruled out, including: Chronic eczema or contact dermatitis Premenstrual flares of inflammatory skin conditions PMDD-related skin changes without immune involvement Mast cell activation disorders or systemic mastocytosis Drug reactions unrelated to hormonal timing Thorough medication and hormone exposure history: Identifying symptom onset after exposure to: Progestin-containing birth control Fertility medications Progesterone creams or suppositories can help distinguish exogenous from endogenous progesterone hypersensitivity