Photo Rounds

Itchy abdominal rash

A 26-year-old woman at 36 weeks’ gestation went to her family physician (FP) with a progressive itchy rash. The rash started within the abdominal striae and spread to her proximal extremities. This was the patient’s first pregnancy and she’d never had any rashes like this before.

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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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