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Home :: Pruritic Urticarial Papules and Plaques of Pregnancy
Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a distinct pruritic eruption of pregnancy that usually begins in the third trimester, most often in primigravidae. There is no increased risk of fetal morbidity or mortality.
Causes of PUPPP
Not understood. There is little evidence to suggest that PUPPP is an autoimmune disease. This reaction may represent a maternal response to paternal antigens expressed in the fetal placenta. No HLA subtypes appear to be predisposed when patients are compared with North American controls.
Symptoms of PUPPP
The rash of PUPPP almost always begins in the stretch marks (striae) of the abdomen. It does not involve the belly button distinguishing it from other common rashes of pregnancy.
The rash is very itchy, or pruritic, hence the name. This condition is harmless to mother and baby, but can be very annoying. Sometimes the rash can include small vesicles.
Diagnosis
Clinical; immunofluorescence studies may be needed to differentiate PUPPP from herpes gestationis (HG), especially if there are papulovesicular lesions. HG has to be excluded because it has been claimed that it may be associated with increased risk of fetal morbidity and mortality. It often starts in the periumbilical areas, and the striae are not prominently involved. HG always has C3 deposition at the basement membrane zone and is associated with HLA-B8, -DR3.
Treatment
Tropical High-potency topical steroids may relieve the pruritus within 24 to 72 h. Application of topical steroids often can be tapered off after 1 week of therapy. Baths and emollients may be helpful as supportive measures.
Systemic Oral prednisone in doses of 10 to 40 mg/d has been used for severe cases; often the symptoms are relieved in 24 h. Oral antihistamines are generally ineffective.
Delivery The symptoms can be so severe and exhausting for the pregnant woman that early delivery may be a consideration; often, however, the patient is better within several days.
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