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
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
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.