Pruritic urticarial papules and plaques of pregnancy: Clinical experience in twenty-five patients

During the past eight years, twenty-five patients with pruritic urticarial papules and plaques of pregnancy (PUPPP) have been prospectively evaluated at our institution. This distinct eruption of the third trimester was most frequently seen in primigravidas. Lesions began on the abdomen in all patients, and 48% specified that initial lesions were localized to periumbilical striae distensae. Other common sites of involvement included the buttocks, hips, thighs, legs, and upper inner arms. The face was uniformly spared. Initial lesions were 1- to 2-mm erythematous papules that quickly coalesced to form urticarial plaques. Although pruritus was the major complaint of all patients, excoriations were very rare. Frequent applications of high-potency topical corticosteroids were generally effective in relieving pruritus and controlling the eruption. Systemic corticosteroids were efficacious in three patients with extensive disease. No severe maternal complications were documented. There were no cases of prematurity, postmaturity, or spontaneous abortion. Two congenital abnormalities and one developmental problem have been documented in children of these patients, but patient numbers preclude definitive interpretation of these findings. As much as 6 years of follow-up on nineteen patients revealed no recurrence of PUPPP in the postpartum period, during eight subsequent pregnancies, or upon exposure to oral contraceptives.