The patient was given a diagnosis of pruritic urticarial papules and plaques of pregnancy. PUPPP is a dermatosis of pregnancy characterized by a papulovesicular or urticarial eruption on the abdomen (most common initial site), trunk, and limbs. The lesions usually spread to the extremities and coalesce to form urticarial plaques and spare the face, palms, soles, and periumbilical region. Other than maternal itching, PUPPP poses no increased risk of fetal or maternal morbidity.
PUPPP usually occurs late in the third trimester, but may develop postpartum. Pruritus may worsen after delivery, but generally resolves within 15 days of delivery—sometimes even prior to delivery.
The FP prescribed topical 0.1% triamcinolone cream bid and suggested that the patient use over-the-counter oral diphenhydramine, as needed. The medication provided the patient with good relief, and the PUPPP resolved completely after the delivery of a healthy child.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Pruritic urticarial papules and plaques of pregnancy. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:467-470.
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