Clinical Reference / Therapeutic Strategies / Pruritic Urticarial Papules and Plaques of Pregnancy

Pruritic Urticarial Papules and Plaques of Pregnancy

Key Points

  • Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a benign and common eruption of pregnancy but can be highly symptomatic.
  • The eruption is generally self-limited and responds well to topical management in most cases.
  • Maternal and fetal outcomes are not affected.



Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a common disorder of pregnancy with a reported incidence of about 1 in 200 pregnancies. It usually begins in the third trimester, especially in the last month of pregnancy, and typically resolves within a few weeks after delivery. The eruption is more common in primiparous women and rarely recurs with subsequent pregnancies. Postpartum onset is rare but can occur. Most importantly, PUPPP does not affect maternal and fetal outcomes and neonatal skin is not typically affected by this condition

The cause of PUPPP is unknown. Some studies suggest a relationship between increased weight gain and abdominal distention and the development of PUPPP. One theory suggests that rapid weight gain and subsequent stretching of skin and connective tissue leads to exposure of antigens that elicits an inflammatory response. This could explain the tendency for lesions of PUPPP to present within striae, a hallmark of the disorder. Other studies have found evidence of fetal DNA within maternal skin lesions suggesting that the skin lesions develop secondary to an immunologic response to fetal antigens.

Synonyms: polymorphic eruption of pregnancy (some authors prefer this term as it encompasses the various morphologies that can occur with PUPPP).

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