Pruritic Urticarial Papules and Plaques of Pregnancy

Question 1

PUPPP epidemiology

Answer 1

1/160 pregnancies, more likely in nulliparous women, does not occur in subsequent pregnancies, may be a/w maternal htn and weight gain

Question 2

pathogenesis

Answer 2

unknown but can be d/t rapid stretching of skin causing damaged connective tissue and allergic rxn, immune tolerance may develop for future pregnancies

Question 3

clinical features

Answer 3

erythematous, edematous papules and plaques sparing the umbilicus, onset is 3rd trimester in 85% cases and immediate post partum period. spares face, palms, soles. course is 4 weeks, no affect on fetus

Question 4

ddx

Answer 4

contact derm, drug eruptions, uritcarial pemphigoid gestationes - a/w prematurity but this involves umbilicus and is not a/w straie

Question 5

tx

Answer 5

topical steroids, antihistamines, involved OBGYN, only class 6 or 7 steroids stronger will cross placenta. if severe - systemic corticosteroids prednisone monitor for fetal growth if late in pregnancy