Q: What is Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)?
A: PUPPP or PUPPS is an abbreviation for Pruritic Urticarial Papules and Plaques of Pregnancy. PUPPP is the most common specific skin eruption of pregnancy. PUPPP usually begins late in the third trimester of pregnancy, but can occur at any other time, too, and it is seen in about one in 160 pregnancies, most frequently in first-time pregnancies. Reaction to abdominal distention may play a role in the development of PUPPP, since significantly increased maternal weight gain, newborn birth weight, and twin birth rate have all been reported in patients with PUPPP.
The skin rash usually appears suddenly on the abdomen in 90% of patients, and it causes intense itching. In a few days, PUPPP may spread to involve the buttocks, thighs, and proximal (upper) arms. The lesions begin as red bumps that are often surrounded by a narrow, pale halo that later become confluent (joined). In most cases, the rash clears before or within one week of delivery. Recurrence with future pregnancies is unusual, and the fetus is not affected by PUPPP. Treatment is supportive. Itching can be relieved with cool, wet compresses, oatmeal baths, and topical steroids. Prednisone is rarely required, but is an option if itching becomes intolerable.