What Are Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)?
Pruritic urticarial papules and plaques of pregnancy (PUPPP), also called polymorphic eruption of pregnancy (PEP), is a common benign, pruritic, inflammatory skin disorder that affects pregnant women in their third trimester of pregnancy. Pruritic urticarial papules and plaques of pregnancy appear in about every 1 in 160 pregnancies. It occurs less frequently after delivery or in the immediate postpartum period and does not tend to recur in subsequent pregnancies. Case reports have associated excessive maternal weight gain and increased newborn birth weight with PUPPP. PUPPP rash appears as a patch of itchy, hive-like bumps that form in the stretch marks on pregnant women's bellies and spread to other parts of the body. PUPPP is painful, but it is usually harmless to both mother and the baby. It usually resolves after the delivery.
Why Do Pruritic Urticarial Papules and Plaques of Pregnancy occur during pregnancy?
The cause of pruritic urticarial papules and plaques of pregnancy is still unknown, although various etiological factors may be associated with it, including:
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Abdominal distension.
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Hormonal changes.
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Placental factors.
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The role of fetal DNA in skin lesions of people with pruritic urticarial papules and plaques of pregnancy.
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Peripheral chimerism (deposition of fetal DNA).
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Fibroblast proliferation in the maternal skin.
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Allergic-type reaction.
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The stretching during pregnancy damages the connective tissue in the skin that later becomes inflamed, causing bumps and a rash to appear.
What Are the Risk Factors of Pruritic Urticarial Papules and Plaques of Pregnancy?
Women are at a higher risk of pruritic urticarial papules and plaques of pregnancy if:
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They are white.
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They are carrying a male fetus.
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They have their first pregnancy.
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They are carrying twins or triplets.
What Are the Symptoms of Pruritic Urticarial Papules and Plaques of Pregnancy?
Pruritic urticarial papules and plaques of pregnancy rashes may appear as follows:
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Scattered, itchy red bumps develop near the stretch marks on the belly that may develop into raised patches of skin or a rash.
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The rash spreads to the areas such as the thighs, butt, breasts, and arms.
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The patches or bumps may appear pink or red on women with lighter skin, while the patches may be the same color as those on dark-skinned women.
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The itching from the PUPPP rash makes it tough to concentrate on daily activities and often interferes with sleep.
How Are Pruritic Urticarial Papules and Plaques of Pregnancy Diagnosed?
The health care provider diagnoses based on a complete physical examination. Pruritic urticarial papules and plaques of pregnancy do not usually show up during the first and second trimesters. If an itchy rash occurs, the health care provider may rule out other skin conditions, like contact dermatitis. In suspected cases, the health care provider may perform the following diagnostic tests:
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Complete blood count.
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Metabolic panel.
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Serum cortisol test.
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Liver function test.
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Serum hCG test.
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Skin biopsy.
How Are Pruritic Urticarial Papules and Plaques of Pregnancy Treated?
Pruritic urticarial papules and plaques of pregnancy often last from four to six weeks and go away within a few days up to a few weeks after the delivery. Meanwhile, a few medications and home remedies can help ease the symptoms.
Medications:
The health care provider can prescribe medications, including:
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Oral antihistamines.
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Anti-itch creams.
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Systemic corticosteroids.
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Intramuscular injection of autologous whole blood is an alternative treatment option in postpartum PUPPP cases, with the subjective and objective improvement of the symptoms.
At-Home Treatments:
Certain home remedies can also provide additional symptomatic relief, such as:
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Shower with oatmeal baths.
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Take cool soothing baths or showers.
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Wearing light cotton clothes.
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Using cold compresses on the bumps or rash.
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Frequent application of emollients.
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Avoid scratching the rashes as it can make the itching worse.
What Is the Outlook for Women With Pruritic Urticarial Papules and Plaques of Pregnancy?
PUPPP rashes typically go away after the pregnancy and do not leave scars. Apart from the discomfort from the PUPPP rashes, the maternal prognosis remains unaffected. Early delivery is rarely done for the relief of intractable pruritus. There are no associated fetal morbidities, and neonatal skin is often not affected. Recurrence of the eruptions in subsequent pregnancies is uncommon, except for multiple-gestation pregnancies. If PUPPP recurs, it is usually less severe than in the first episode.
How Are Pruritic Urticarial Papules and Plaques of Pregnancy Prevented?
It is impossible to prevent PUPPP rash, but women with PUPPP can soothe their symptoms until it goes away on their own. Here are a few ways that may be helpful to provide some relief:
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Avoid wearing tight-fitted clothes during pregnancy to avoid skin irritation. Instead, wear loose-fitted cotton clothes that let the skin breathe and ensure utmost comfort.
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Refrain from using harsh chemical-based skin products that may cause dryness or irritate the skin and worsen the condition.
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Avoid taking hot baths or showers during pregnancy as this deprives the skin of its moisture and is unsafe for the baby. Instead, take cool or lukewarm water baths and moisturize the skin well after each bath.
Conclusion
Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a benign skin disorder in almost all cases that resolve naturally after a few weeks. However, close cooperation between dermatologists, obstetricians, and neonatal pediatricians is essential in managing severe PUPPP cases. Although one cannot eliminate the chances of getting PUPPP during pregnancy, proper care and precaution may help people deal with it. Ensure not to take the stress from it because it is normal to get PUPPP during pregnancy. In addition, people should understand that PUPPP is a common and temporary condition, usually limited in duration, and does not signify any increased maternal or fetal risk.
