Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Pruritic urticarial papules and plaques of pregnancy (PUPPP). This cutaneous eruption usually occurs in the last trimester. It is seen only rarely in the postpartum period. PUPPP is more common in primigravidas but can occur in any pregnant patient.

The eruption begins as discrete pruritic papules that first emerge on the abdomen, often within striae. The papules become more numerous and coalesce to form urticarial plaques on the abdomen, buttocks, arms, and legs (Figure). There is generally no facial or upper chest involvement.

The rash usually resolves within several days after delivery. Unlike HG, PUPPP does not recur with subsequent pregnancies. In addition, skin lesions do not develop in infants born to mothers with PUPPP, and the disease does not appear to have any effect on the well-being of the fetus.

The histopathology of PUPPP is nonspecific. There is a lymphohistiocytic perivascular infiltrate in the superficial dermis and sometimes in the mid-dermis. Direct immunofluorescence studies are negative.

Treatment is geared toward relief of symptoms. Frequent application of topical corticosteroids is often effective. Occasionally, however, a short course of systemic corticosteroids is used.