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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

  • 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
  • Signs
  • Locations
  1. Onset over Abdomen in 90% of cases (especially striae)
  2. Symmetric spread to thigh and buttock
  3. May also involve upper arm, back, and hands
  4. Does not involve face or periumbilical area
  • Signs
  • Appearance
  1. Red 1-2 mm Papule with surrounding pale halo
  2. Lesions may coalesce into Urticarial Plaques
  3. Vesicles may also be seen
  • Management
  1. See Nonspecific Management of Pruritus
    1. Cool compresses
    2. Oatmeal Baths (e.g. Aveeno)
    3. Antihistamines (e.g. Hydroxyzine)
  2. Refractory cases of intolerable itching
    1. Topical Corticosteroids (Group V)
    2. Consider short course of Prednisone 40 mg PO qd
  • Course
  1. Severity decreases within one week of onset
  2. Rash and symptoms persist on average 6 weeks
  3. Resolves with delivery
  • References
  1. Gabbe (2002) Obstetrics, Churchill Livingstone, p. 1288
  2. Habif (1996) Dermatology, Mosby, p. 140