Pruritic Urticarial Papules and Plaques of Pregnancy

Authors

  • Zenon Brzoza MD, PhD,

    Corresponding author
    1. Zenon Brzoza, MD, PhD, is an assistant at the Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
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  • Alicja Kasperska-Zajac MD, PhD,

    1. Alicja Kasperska-Zajac, MD, PhD, is an assistant at the Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
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  • Ewa Oleś MD, and,

    1. Ewa Oleś, MD, is an assistant at post-graduate training at the Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
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  • Barbara Rogala MD, PhD

    1. Professor Barbara Rogala, MD, PhD, is the Head of Chair and Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
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Zenon Brzoza, MD, PhD, Chair and Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland. E-mail: zbrzoza@mp.pl

Abstract

Pruritic urticarial papules and plaques of pregnancy (PUPPP) are among the most common pruritic dermatoses observed in pregnant women. PUPPP appears most frequently in the third trimester, in primigravidas, and in multiple gestation pregnancies. The eruption of changes occurs initially on the abdomen and extends over the thighs, legs, back, buttocks, arms, and breasts. Skin changes typical for PUPPP are erythematous, urticarial plaques, and papules. Rash regression is usually observed within 6 weeks postpartum. Immunologic mechanisms, hormonal abnormalities, and abdominal skin distension have been suggested as etiologic mechanisms. PUPPP is thought to be harmless for the mother and fetus and usually requires intervention only for symptom relief. In some cases, laboratory investigation, histologic examination, and immunologic study should be performed to exclude more serious disorders of pregnancy, such as herpes gestationis or intrahepatic cholestasis of pregnancy. This article reviews the epidemiology, clinical manifestation, etiology, differential diagnosis, and treatment of PUPPP.

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