Pruritic Urticarial Papules and Plaques of Pregnancy

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

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II. Epidemiology

  1. Occurs more commonly in Primigravidas
  2. More common in third trimester
  3. Incidence: 0.4 to 0.6% of pregnancies

III. Pathophysiology

  1. May be related to Abdominal Distention

IV. Risk Factors

  1. Increased maternal weight gain
  2. Fetal Macrosomia
  3. Twin Gestation
  4. Primigravida

V. 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)

VI. Differential Diagnosis

  1. See Pruritus in Pregnancy
  2. See Pruritus Causes
  3. Erythema Multiforme (target lesion)
  4. Herpes Gestationis
  5. Pemphigoid Gestationis

VII. 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

VIII. 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)

IX. Complications

  1. Not associated with adverse fetal effects

X. 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]

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Related Studies

Ontology: Pruritic urticarial papules plaques of pregnancy (C0269680)

Concepts Pathologic Function (T046)
MSH C535817
ICD10 O26.86
SnomedCT 88697005
English PEP - Polymorph erup of preg, PUPPP - Prur urt pap+plaq preg, Polymorphic eruption pregnancy, Prur urt papules+plaques pregn, PRURITIC URTICARIAL PAPULES AND PLAQUES OF PREGNANCY, PUPPP, POLYMORPHIC ERUPTION OF PREGNANCY, Pruritic urticarial papules and plaques of pregnancy, Papular dermatitis of pregnancy, pruritic urticarial papules and plaques of pregnancy (PUPPP) (diagnosis), pruritic urticarial papules and plaques of pregnancy (PUPPP), Pruritic urticarial papules and plaques of pregnancy (PUPPP), Pruritic urticarial papules plaques of pregnancy, eruption polymorphic pregnancy, papular dermatitis pregnancy, papular dermatitis of pregnancy, Pruritic Urticarial Papules And Plaques of Pregnancy, PEP - Polymorphic eruption of pregnancy, PUPPP - Pruritic urticarial papules and plaques of pregnancy, Polymorphic eruption of pregnancy, Papular dermatitis of pregnancy (disorder)
Dutch polymorfe eruptie tijdens zwangerschap, urticariële prurituspapels en plaques tijdens zwangerschap
French Papules et plaques urticariennes prurigineuses de grossesse, Eruption polymorphe de grossesse
German PUPP Syndrom, polymorphe Dermatose
Italian Eruzione polimorfica da gravidanza, Placche e papule orticarioidi pruritiche di gravidanza
Portuguese Erupção polimórfica da gravidez, Pápulas de urticária com prurido e placas da gravidez
Spanish Erupción polimorfa del embarazo, Urticaria prurítica en placas y pápulas del embarazo, erupción polimórfica del embarazo, dermatitis papulosa del embarazo (trastorno), dermatitis papulosa del embarazo
Japanese 妊娠性そう痒性蕁麻疹様丘疹, 多形妊娠疹, ﾆﾝｼﾝｾｲｿｳﾖｳｾｲｼﾞﾝﾏｼﾝﾖｳｷｭｳｼﾝ, ﾀｹｲﾆﾝｼﾝｼﾝ
Czech Polymorfní erupce těhotenství, Svědivé kopřivkové papuly a povlaky těhotenství
Hungarian pruritusos urticariás papulák és plakkok a terhességben, Terhességi polymorph kiütés
Derived from the NIH UMLS (Unified Medical Language System)

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