Pruritic urticarial papules and plaques of pregnancy

Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy (PEP), is a benign, self-limiting skin condition that occurs most commonly during the third trimester of pregnancy, particularly in first pregnancies (primigravidae). It is the most common specific dermatosis of pregnancy. The condition is characterized by intensely itchy (pruritic) red papules and urticarial plaques that typically begin within the abdominal striae (stretch marks), often sparing the periumbilical area. The rash may subsequently spread to the thighs, buttocks, and occasionally the arms, but rarely involves the face, palms, or soles. The skin is the primary organ system affected, and importantly, PUPPP poses no risk to the mother or fetus beyond the significant discomfort caused by the intense itching. The exact cause of PUPPP remains unclear, but it has been associated with rapid abdominal distension, multiple gestations (twins or higher-order pregnancies), and excessive maternal weight gain. It is more frequently observed in women carrying male fetuses. The condition typically resolves spontaneously within days to weeks after delivery and rarely recurs in subsequent pregnancies. Treatment is symptomatic and aimed at relieving pruritus. First-line therapies include topical corticosteroids (medium to high potency), emollients, and oral antihistamines. In severe cases, a short course of systemic corticosteroids may be considered. Cool baths and moisturizers can also provide symptomatic relief. No long-term complications for mother or baby have been documented.

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