PUPPP
Encyclopedia
Pruritic urticarial papules and plaques of pregnancy (PUPPP), known in United Kingdom as polymorphic eruption of pregnancy (PEP), 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 and the commonest of the dermatoses of pregnancy, the condition was only formally identified and described in 1979.
PUPPP is also known as Late-onset prurigo of pregnancy, 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.
It starts with pruritic (itchy) urticaria
l (wheals) papule
s (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 eczema
tous (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'.
Papules and plaques usually start appearing on the abdomen (although not on the umbilicus/bellybutton/tummybutton itself) and often spreads to the legs, chest, underarms, etc. The face is usually also spared and does not seem to become affected.
Skin distension (stretching) is a common factor in PUPPP, which is more common in mothers with large fundal measurements and/or those who are carrying large babies, twins, and triplets. The papules and plaques often first appear within stretch marks.
Certain studies reveal that this condition is more frequent in women carrying boys, although no formal research has been conducted. Statistics cite that 70% percent of PUPPP sufferers deliver boys.
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.
creams and ointments are used in more aggressive cases, and oral (systemic) corticosteroids can be used to treat very severe cases—although the benefits of a pregnant woman's ingesting high-potency corticosteroids must be weighed carefully against possible (and mostly unknown) risks to the developing fetus or fetuses. Rarely, in unusually persistent and distressing cases, some women have had their labor induced as soon as they are considered to be at term (37 weeks).
Antihistamine
tablets may be prescribed to provide relief from the itch, although they are generally considered much less effective than corticosteroid treatments, and may act as little more than a sleep aid.
In the majority of cases, PUPPP resolves spontaneously within a week of delivery. However, a few women continue to experience symptoms long into the postpartum period.
Rash
A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...
that strikes some women during pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
. Although extremely annoying for its sufferers (because of the itch
Itch
Itch is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to classify it as any one type of sensory experience. Modern science has shown that itch has many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response...
), 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 and the commonest of the dermatoses of pregnancy, the condition was only formally identified and described in 1979.
PUPPP is also known as Late-onset prurigo of pregnancy, Toxemic rash of pregnancy (not to be confused with "Toxemia of pregnancy" which is an alternative term for Pre-eclampsia
Pre-eclampsia
Pre-eclampsia or preeclampsia is a medical condition in which hypertension arises in pregnancy in association with significant amounts of protein in the urine....
), and Toxic erythema of pregnancy.
Signs and symptoms
The appearance of the condition changes over time.It starts with pruritic (itchy) urticaria
Urticaria
Urticaria is a kind of skin rash notable for pale red, raised, itchy bumps. Hives is frequently caused by allergic reactions; however, there are many non-allergic causes...
l (wheals) papule
Papule
A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to 1 cm.With regard to the quote "...varying in size from a pinhead to 1cm," depending on which text is referenced, some authors state the cutoff between a papule and a plaque as 0.5cm,...
s (small, solid elevations of the skin) in 98% of cases. However over half develop multiple forms (polymorphic) with erythema
Erythema
Erythema is redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation...
(redness), vesicles (small blisters), and targetoid
Targetoid
In medicine, targetoid is a structure or lesion that has the appearance of a target or is target-like.Examples:*Targetoid hemosiderotic hemangioma*Targetoid Michaelis-Gutmann bodies*Targetoid calcification-External links:* - granuloma.homestead.com....
and eczema
Eczema
Eczema is a form of dermatitis, or inflammation of the epidermis . In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.The term eczema is broadly applied to a range of persistent skin conditions...
tous (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'.
Papules and plaques usually start appearing on the abdomen (although not on the umbilicus/bellybutton/tummybutton itself) and often spreads to the legs, chest, underarms, etc. The face is usually also spared and does not seem to become affected.
Skin distension (stretching) is a common factor in PUPPP, which is more common in mothers with large fundal measurements and/or those who are carrying large babies, twins, and triplets. The papules and plaques often first appear within stretch marks.
Certain studies reveal that this condition is more frequent in women carrying boys, although no formal research has been conducted. Statistics cite that 70% percent of PUPPP sufferers deliver boys.
Cause
The cause of the condition is unknown, but the distension of the skin is thought to play a role as this condition occurs mostly in first pregnancies (primigravida), in the third trimester and is more likely with multiple pregnancies (more so with triplets than twins or than singletons).Other than additional associations with hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
and induction of labour, there are no observed difference in the outcome of the pregnancy for mothers or babies.
Treatment
Treatment of mild cases during pregnancy consists mainly of the application of topical moisturising creams or aqueous/emollient ointments. Class I or II corticosteroidCorticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
creams and ointments are used in more aggressive cases, and oral (systemic) corticosteroids can be used to treat very severe cases—although the benefits of a pregnant woman's ingesting high-potency corticosteroids must be weighed carefully against possible (and mostly unknown) risks to the developing fetus or fetuses. Rarely, in unusually persistent and distressing cases, some women have had their labor induced as soon as they are considered to be at term (37 weeks).
Antihistamine
Antihistamine
An H1 antagonist is a histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions...
tablets may be prescribed to provide relief from the itch, although they are generally considered much less effective than corticosteroid treatments, and may act as little more than a sleep aid.
In the majority of cases, PUPPP resolves spontaneously within a week of delivery. However, a few women continue to experience symptoms long into the postpartum period.