Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Pruritic urticarial papules and plaques of pregnancy (PUPPP) is an itchy hive-like rash that usually begins on the belly and often spreads to the upper thighs, buttocks, and arms. The belly button and face are usually spared . It usually occurs late in the third trimester, and is more common in first pregnancies.

PUPPP is also known as polymorphic eruption of pregnancy (PEP), toxemic rash of pregnancy , and late-onset prurigo of pregnancy.

PUPPP does not appear to be associated with an increased risk for a bad outcome in either the fetus or mother.

Symptoms are often relieved by the use of steroid creams or ointments such as fluticasone, clobetasol, and betamethasone. Oral steroids are sometimes used for severe cases. Antihistamines such as diphenhydramine  may help with sleep.

PUPPP may be difficult to distinguish from pemphigoid gestationis (PG) in its early stages. However PG is a much less common skin condition and PG usually involves the periumbilical area.

If the rash does not appear typical for PUPPP, then other conditions to consider might include but are not limited to prurigo gestationis , atopic eruption of pregnancy, impetigo herpetiformis ,contact dermatitis, a drug reaction, urticaria, viral exanthem (chicken pox), scabies,  and intrahepatic cholestasis of pregnancy. Consultation with a dermatologist is often helpful in atypical cases of PUPPP.