Cases: Apr 08 A pregnant woman in the third trimester of a first pregnancy present with an intensely pruritic papular eruption arising around the abdomen within later extension to striae.
In a few days, the eruption spreads to the trunk and extremities.
Which diagnose and which treatment would you suggest?
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See the answer
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Pruritic urticarial papules and plaques of pregnancy (PUPPP)
This is a benign dermatosis that usually arises late in the third trimester of a first pregnancy. Following atopic eruption of pregnancy, which occurs earlier in gestation, PUPPP is the second most common dermatoses of pregnancy
PUPPP occurs in 1 out of 200 primigravidae pregnancies. 15% of PUPPP cases may however arise in the immediate postpartum period . The cause and pathogenesis of PUPPP are not known.
No blood or urine laboratory tests are diagnostic of PUPPP.
Classic PUPPP reveals papules within prominent striae distensae . Erythematous urticarial papules and plaques of the trunk and extremities also are observed, although the periumbilical area is spared. Small vesicles often are noted, but larger bullae do not occur and would suggest the more rare herpes gestationis. PUPPP usually does not affect the face, palms, or soles. Although the eruption is intensely pruritic, excoriations rarely are found.
Pruritus is the most distressing feature but no mortality is associated with PUPPP.
Likewise no known systemic complications exist for affected females, and fetal mortality or morbidity do not increase.
PUPPP tends to resolve spontaneously shortly after delivery.
High potency topical corticosteroids are the mainstay of treatment of PUPPP. Occasionally, systemic corticosteroids are required to alleviate severe symptoms. Oral antihistamines are only mildly effective.
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