PUPPP

  • This is a case of pruritic urticarial papules and plaques of pregnancy (PUPPP)

  • Common dermatosis of pregnancy

  • Also known as Polymorphic eruption of pregnancy(PEP)

  • Incidence: 1 in 300 pregnancies

  • Onset during 3rd trimester (mean = 35 weeks)

  • Predominantly affects Primigravids

Pathogenesis

The pathogenesis is unclear.

  • One leading theory is abdominal wall distention, especially since PUPPP is more common in primigravids and multiple gestation pregnancies.
  • Hormonal, immunological, factors may also play a role.

Clinical Findings

1-Typical lesions are erythematous urticarial papules surrounded by a pale halo.

2- In the vast majority of cases, the eruption starts within the abdominal striae (with periumbilical sparing) and progresses from there.

3- Less commonly, PUPPP can present with blisters and the umbilicus may be involved

severe itching

Evaluation

The diagnosis is made based on the history and the clinical picture.

A biopsy is rarely helpful in diagnosing PUPPP.

It does, however, rule out pemphigoid gestationis, which is an important differential diagnosis.Z

  • If the patient has an atypical presentation, or if you are concerned about pemphigoid gestationis, consider referral to a dermatologist or a skin biopsy with immunofluorescence.

  • A skin biopsy of PUPPP would reveal non-specific findings

Prognosis

1- Has not been shown to have increased maternal or fetal risks 2- Excellent prognosis 3- Generally resolves within days postpartum 4- No reports of recurrence postpartum, with menses, or with use of oral contraceptives

Treatment

Therapeutic options are aimed at symptomatic relief:

  • Topical steroids
  • Oral prednisone
  • Non-sedating oral antihistamines

Case Two: History

Rasha is a healthy 28-year-old primigravid.

She is in her 34th week of gestation.

Two weeks ago, she developed a pruritic eruption on her abdomen and thighs.

Case Two: Skin Exam