Pruritic Urticarial Papules & Plaques of Pregnancy

(PUPPS, Toxaemic Rash of Pregnancy)

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Definition

-  Benign dermatosis typically arising in third trimester of pregnancy

 

Features

-  Incidence 0.5%

-  73% seen in primiparous

-  12% cases in multiple gestations (twins..)

-  More common with male fetus

-  Typically presents in late third trimester of pregnancy

-  Second most common dermatoses of pregnancy (after atopic eruption of pregnancy)

-  No effect of perinatal mortality or morbidity

 

Associated S/S

-  Pruritus (intense)

-  Rash: urticarial papules

-  May coalesce into plaques

-  Typically starts on abdomen +/- thighs, buttocks, breasts

-  +/- extremeties

-  Periumbilical area usually spared

-  Usually does not effect face, palms or feet

-  Effects stretch marks (striae distensae)

-  Resolution after delivery (several days)

 

  

 

DDx

-  Obstetric cholestasis: no rash

-  Prurigo of pregnancy

-  Pemphigoid gestationis

-  Atopic eruption of pregnancy

-  Scabies

 

Ix

-  Clinical Dx

-  +/- Skin Bx for DDx

 

Mx

-  Resolves after delivery

-  Symptomatic Mx only

-  Topical corticosteroids

-  Betamethasone dipropionate 0.05% cream topical BD

-  OR Betamethsone valerate 0.05% - 0.1% cream topical BD

-  Severe cases

-   Wet dressings over cream

-   Prednisolone 25mg PO Daily (on O&G or Derm Consultant advice)

-  Antihistamines

-  Cyproheptadine 4mg PO TDS

-  OR Pheniramine, Dexchlorphenarimine or Diphenhydramine

 

 

 

References

 

eMedicine: PUPP, 13/04/2010, emedicine.medscape.com/article/1123725-overview

eTG: Pregnancy Rashes, Feb 2009

Pic (1): www.huidarts.com/cgi-bin/patinfo.pl?cgifunction=form&fid=1073141528

Pic (2): www.obgmanagement.com/pages.asp?id=8699