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Pruritic Urticarial Papules and Plaques of Pregnancy

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Pruritic Urticarial Papules and Plaques of Pregnancy, Polymorphic Eruption of Pregnancy, PUPPP

  • See Also
  1. Pruritus in Pregnancy
  2. Pruritus
  3. Skin Conditions of Pregnancy
  • Epidemiology
  1. Occurs more commonly in Primigravidas
  2. More common in third trimester
  3. Incidence: 0.4 to 0.6% of pregnancies
  • Pathophysiology
  1. May be related to Abdominal Distention
  • Risk Factors
  1. Increased maternal weight gain
  2. Fetal Macrosomia
  3. Twin Gestation
  4. Primigravida
  • Signs
  1. Characteristics
    1. Red 1-2 mm, Urticarial Papules with surrounding pale halo
    2. Lesions may coalesce into Urticarial Plaques
    3. Vesicles may also be seen
  2. Distribution
    1. Onset over Abdomen in 90% of cases (especially within Striae Gravidarum)
    2. Symmetric spread to thigh and buttock
    3. May also involve upper arm, back, and hands
    4. Does not involve face or periumbilical area
      1. Contrast with Pemphigoid Gestationis (which does not spare the umbilical region)
  • Differential Diagnosis
  1. See Pruritus in Pregnancy
  2. See Pruritus Causes
  3. Erythema Multiforme (target lesion)
  4. Herpes Gestationis
  5. Pemphigoid Gestationis
  • Management
  1. See Nonspecific Management of Pruritus
    1. Cool compresses
    2. Oatmeal Baths (e.g. Aveeno)
    3. Antihistamines (e.g. Hydroxyzine)
  2. Refractory, severe cases of intolerable itching
    1. Topical Corticosteroids (Group V)
    2. Consider short course of Prednisone 40 mg orally daily
  • Course
  1. Onset in third trimester or early postpartum
  2. Severity decreases within one week of onset
  3. Rash and symptoms persist on average 6 weeks
  4. Resolves after delivery
  5. Typically does not recur in subsequent pregnancy (unless Multiple Gestation)
  • Complications
  1. Not associated with adverse fetal effects
  • References
  1. Gabbe (2002) Obstetrics, Churchill Livingstone, p. 1288
  2. Habif (1996) Dermatology, Mosby, p. 140
  3. Erlandson (2023) Am Fam Physician 107(2): 152-8 [PubMed]