Photo Rounds Friday Archive
Pruritic rash on abdomen
Post Date: 11/20/2009
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A 26-year-old woman (gravida 1, para 0) at 36 weeks of pregnancy sought care from her family physician for a progressively itchy rash. The papular rash started within the abdominal striae and spread to her proximal extremities. The patient said that the itching “was maddening.” Her prenatal course was otherwise normal and she had no other symptoms.
What's your diagnosis?
The patient had pruritic urticarial papules and plaques of pregnancy (PUPPP), a dermatosis of pregnancy characterized by a papulovesicular or urticarial eruption on the trunk and limbs. The etiology of PUPPP is unknown. PUPPP is more common with excessive stretching of the skin, possibly due to damage to connective tissue that results in the release of antigens that trigger an inflammatory response. Onset of PUPPP is usually late in the third trimester, but may develop postpartum. Pruritus may worsen after delivery, but generally resolves by 15 days postpartum.
The incidence of PUPPP is 1/160 to 1/300 pregnancies, making it the most common defined dermatosis of pregnancy. Nulliparous women account for over 75% of patients with classic PUPPP. PUPPP is also more common with multiple gestations, possibly due to increased abdominal distension.
The physician prescribed topical steroids (0.1% triamcinolone ointment bid) and antihistamines (diphenhydramine 25 mg tid) to alleviate symptoms. The patient felt better but was not free of all symptoms until 1 week after a normal delivery.
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 (PUPPP). In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill;2009:308-310.
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