Pruritic Urticarial Papules and Plaques of Pregnancy

From Wikipedia, the free encyclopedia

**PUPPP**
*Classification & external resources*
DiseasesDB	30030
eMedicine	derm/351

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP), known in United Kingdom as Polymorphic eruption of pregnancy (PEP),^[1] is a chronic hives-like rash that strikes some women during pregnancy. Although extremely annoying for its sufferers (because of the itch), it presents no long-term risk for either the mother or unborn child. PUPPP frequently begins on the stomach and spreads to the legs, feet, arms, chest, and neck.

Although affecting about one in two hundred pregnancies, the condition was only formally identified and described in 1979.^[2]

PUPPP is also known as Toxemic rash of pregnancy (not to be confused with "Toxemia of pregnancy" which is an alternative term for Pre-eclampsia), and Toxic erythema of pregnancy.

1 Etiology
2 Appearance
3 Treatment
4 See also
5 Footnotes
6 External links

[edit] Etiology

The cause of the condition is unknown,^[1] but the distension of the skin is thought to play a role as this condition occurs mostly in first pregnancies (primagravida), in the third trimester and is more likely with multiple pregnancies (more so with triplets than twins or than singletons).^[3]^[4]

Other than additional associations with hypertension and induction of labour, there are no observed difference in the outcome of the pregnancy for mothers or babies.^[5]

[edit] Appearance

The appearance of the condition changes over time.^[6] It starts with pruritic (itchy) urticarial (wheals) papules (small, solid elevations of the skin) in 98% of cases. However over half develop multiple forms (polymorphic) with erythema (redness), vesicles (small blisters), and targetoid and eczematous (eczema-like) lesions. The two sets of appearances gives rise therefore to both the American term of 'Pruritic Urticarial Papules and Plaques of Pregnancy' and the British description of 'Polymorphic eruption of pregnancy'.

[edit] Treatment

Treatment consists mainly of the application of topical moisturising creams, corticosteroid creams are reserved for more severe cases and antihistamines tablets may be used to provide relief from the itch.

[edit] See also

Intrahepatic Cholestasis of Pregnancy

[edit] Footnotes

^ ^a ^b Matz H, Orion E, Wolf R (Mar-Apr 2006). "Pruritic urticarial papules and plaques of pregnancy: polymorphic eruption of pregnancy (PUPPP)". Clin Dermatol 24 (2): 105-8. PMID 16487883.
^ Lawley T, Hertz K, Wade T, Ackerman A, Katz S (1979). "Pruritic urticarial papules and plaques of pregnancy". JAMA 241 (16): 1696-9. PMID 430731.
^ Pruritic Urticarial Papules and Plaques of Pregnancy eMedicine derm/351
^ Brzoza Z, Kasperska-Zajac A, Oleś E, Rogala B (Jan-Feb 2007). "Pruritic urticarial papules and plaques of pregnancy". J Midwifery Womens Health 52 (1): 44-8. PMID 17207750.
^ Ohel I, Levy A, Silberstein T, Holcberg G, Sheiner E (-May 2006). "Pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy". J Matern Fetal Neonatal Med 19 (5): 305-8. PMID 16753771.
^ Rudolph C, Al-Fares S, Vaughan-Jones S, Müllegger R, Kerl H, Black M (Jan 2006). "Polymorphic eruption of pregnancy: clinicopathology and potential trigger factors in 181 patients". Br J Dermatol 154 (1): 54-60. PMID 16403094.