Pruritic urticarial papules and plaques of pregnancy (PUPPP). A clinicopathologic study

Pruritic urticarial papules and plaques of pregnancy (PUPPP) was recently defined as an intensely pruritic cutaneous eruption occurring in the third trimester. We are reporting fifteen additional cases of this distinctive eruption. The lesions began in the third trimester in all but two patients. The rash consisted of a symmetric eruption of papules, urticarial lesions, and some erythema multiforme-like target lesions. Histologic examination showed a mild nonspecific lymphohistiocytic perivasculitis. Moderate or intense pruritus was present in all but one case. The abdomen and proximal extremities were most commonly involved, but two patients had lesions only on the lower legs. Clearing occurred prior to delivery (five cases), within 1 week of delivery (nine cases), and at 6 weeks postpartum (one case). The pruritus was decreased with topical corticosteroids and diphenhydramine in all cases except one. Fetal wastage did not occur. Subsequent pregnancies were uneventful in two patients. PUPPP is a benign dermatosis of pregnancy which resolves spontaneously or with delivery.