Dermatology Oasis

Editor: Dr. Nameer Al-Sudany (IRAQ)

Pruritic Urticarial Papules and Plaques of Pregnancy

PUPPP jpg

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP).
Synonym: Polymorphic eruption of pregnancy
Rash:
* Erythematous papules and plaques that begin within the abdominal striae then spread over a few days to involve the abdomen, buttocks, thighs. The arms and legs are involved in some cases. Lesions on or above the breasts are rare i.e. the upper chest, face, and mucous membranes are generally spared.
* There is often a pale halo around the papules. These papules coalesce to form large red, urticarial plaques.
* Intense pruritus is characteristic.
* Most cases occur in primigravidas (75%).
* More common in those carrying twins or triplets.
* Begins late in the third trimester and resolves (remits) at or few weeks after delivery. Rarely, it may persist for longer (this may relate to retained placental products).
* Postpartum onset or exacerbation is uncommon.
* The well-being of the mother and fetus is not affected by PUPPP.
* Rarely the newborns manifest the rash of PUPPP but this soon fades.
* Rarely recurs with subsequent pregnancies. If it occurs, it is likely to be milder.
Histopathology:
* Mainly shows upper and mid-dermal perivascular lymphohistiocytic infiltrate with a variable number of eosinophils and dermal edema.
* DIF test shows negative or nonspecific results.
Differential diagnosis:
* The most important one is Pemphigoid gestationis.
* Other pregnancy related dermatoses.
Treatment:
* There is no curative treatment apart from delivery!. Symptoms can be controlled using:
1. Liberal amounts of emollients.
2. Topical steroids (potent) applied thinly twice daily are usually required.
3. Antihistamines – conventional antihistamine tablets appear safe in late pregnancy (though they may make the baby drowsy on delivery).
4. A few patients require prednisone.

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