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Pruritic urticarial papules and plaques of pregnancy(PUPPP)

MedGen UID:
78710
Concept ID:
C0269680
Disease or Syndrome
Synonyms: Polymorphic eruption of pregnancy; Pruritic urticarial papules and plaques of pregnancy, familial (subtype); Pruritic urticarial papules plaques of pregnancy; PUPPP
SNOMED CT: Pruritic urticarial papules and plaques of pregnancy (1252747005); PUPPP - pruritic urticarial papules and plaques of pregnancy (1252747005); PEP - polymorphic eruption of pregnancy (1252747005); Polymorphic eruption of pregnancy (1252747005)
 
Monarch Initiative: MONDO:0008353
OMIM®: 178995
Orphanet: ORPHA64745

Definition

A rare skin disease characterized by urticarial papules and plaques with severe pruritus mainly on the abdomen, buttocks, and proximal thighs. The condition usually develops during the third trimester of the first pregnancy, although presentation in the postpartum period, which may also feature other types of skin lesions, has been described in some cases. The symptoms generally resolve within few weeks. [from ORDO]

Clinical features

From HPO
Striae distensae
MedGen UID:
57541
Concept ID:
C0152459
Acquired Abnormality
Thinned, erythematous, depressed bands of atrophic skin. Initially, striae appear as flattened and thinned, pinkish linear regions of the skin. Striae tend to enlarge in length and become reddish or purplish. Later, striae tend to appear as white, depressed bands that are parallel to the lines of skin tension. Striae distensae occur most often in areas that have been subject to distension such as the lower back, buttocks, thighs, breast, abdomen, and shoulders.

Professional guidelines

PubMed

Bergman H, Melamed N, Koren G
Can Fam Physician 2013 Dec;59(12):1290-4. PMID: 24336540Free PMC Article
Lehrhoff S, Pomeranz MK
Dermatol Ther 2013 Jul-Aug;26(4):274-84. doi: 10.1111/dth.12078. PMID: 23914884
Sherard GB 3rd, Atkinson SM Jr
Obstet Gynecol Surv 2001 Jul;56(7):427-32. doi: 10.1097/00006254-200107000-00022. PMID: 11435950

Recent clinical studies

Etiology

Brandão P, Sousa-Faria B, Marinho C, Vieira-Enes P, Melo A, Mota L
J Obstet Gynaecol 2017 Feb;37(2):137-140. Epub 2016 Dec 14 doi: 10.1080/01443615.2016.1225019. PMID: 27960565
Taylor D, Pappo E, Aronson IK
Clin Dermatol 2016 May-Jun;34(3):383-91. Epub 2016 Feb 9 doi: 10.1016/j.clindermatol.2016.02.011. PMID: 27265077
Lehrhoff S, Pomeranz MK
Dermatol Ther 2013 Jul-Aug;26(4):274-84. doi: 10.1111/dth.12078. PMID: 23914884
Elling SV, McKenna P, Powell FC
J Eur Acad Dermatol Venereol 2000 Sep;14(5):378-81. doi: 10.1046/j.1468-3083.2000.00026.x. PMID: 11305379
Errickson CV, Matus NR
Am Fam Physician 1994 Feb 15;49(3):605-10. PMID: 8310967

Diagnosis

Brandão P, Sousa-Faria B, Marinho C, Vieira-Enes P, Melo A, Mota L
J Obstet Gynaecol 2017 Feb;37(2):137-140. Epub 2016 Dec 14 doi: 10.1080/01443615.2016.1225019. PMID: 27960565
Taylor D, Pappo E, Aronson IK
Clin Dermatol 2016 May-Jun;34(3):383-91. Epub 2016 Feb 9 doi: 10.1016/j.clindermatol.2016.02.011. PMID: 27265077
Brzoza Z, Kasperska-Zajac A, Oleś E, Rogala B
J Midwifery Womens Health 2007 Jan-Feb;52(1):44-8. doi: 10.1016/j.jmwh.2006.09.007. PMID: 17207750
Matz H, Orion E, Wolf R
Clin Dermatol 2006 Mar-Apr;24(2):105-8. doi: 10.1016/j.clindermatol.2005.10.010. PMID: 16487883
Ahmadi S, Powell FC
Australas J Dermatol 2005 May;46(2):53-8; quiz 59. doi: 10.1111/j.1440-0960.2005.00160.x. PMID: 15842394

Therapy

Brandão P, Sousa-Faria B, Marinho C, Vieira-Enes P, Melo A, Mota L
J Obstet Gynaecol 2017 Feb;37(2):137-140. Epub 2016 Dec 14 doi: 10.1080/01443615.2016.1225019. PMID: 27960565
Ghazeeri G, Kibbi AG, Abbas O
Int J Dermatol 2012 Sep;51(9):1047-53. doi: 10.1111/j.1365-4632.2011.05203.x. PMID: 22909357
Lu PD, Ralston J, Kamino H, Stein JA
Dermatol Online J 2010 Nov 15;16(11):10. PMID: 21163161
Ahmadi S, Powell FC
Australas J Dermatol 2005 May;46(2):53-8; quiz 59. doi: 10.1111/j.1440-0960.2005.00160.x. PMID: 15842394
Yancey KB, Hall RP, Lawley TJ
J Am Acad Dermatol 1984 Mar;10(3):473-80. doi: 10.1016/s0190-9622(84)80097-3. PMID: 6725659

Prognosis

Taylor D, Pappo E, Aronson IK
Clin Dermatol 2016 May-Jun;34(3):383-91. Epub 2016 Feb 9 doi: 10.1016/j.clindermatol.2016.02.011. PMID: 27265077
Matz H, Orion E, Wolf R
Clin Dermatol 2006 Mar-Apr;24(2):105-8. doi: 10.1016/j.clindermatol.2005.10.010. PMID: 16487883
Ahmadi S, Powell FC
Australas J Dermatol 2005 May;46(2):53-8; quiz 59. doi: 10.1111/j.1440-0960.2005.00160.x. PMID: 15842394
Buccolo LS, Viera AJ
J Reprod Med 2005 Jan;50(1):61-3. PMID: 15730177
Elling SV, McKenna P, Powell FC
J Eur Acad Dermatol Venereol 2000 Sep;14(5):378-81. doi: 10.1046/j.1468-3083.2000.00026.x. PMID: 11305379

Clinical prediction guides

Ghazeeri G, Kibbi AG, Abbas O
Int J Dermatol 2012 Sep;51(9):1047-53. doi: 10.1111/j.1365-4632.2011.05203.x. PMID: 22909357
Brzoza Z, Kasperska-Zajac A, Oleś E, Rogala B
J Midwifery Womens Health 2007 Jan-Feb;52(1):44-8. doi: 10.1016/j.jmwh.2006.09.007. PMID: 17207750
Ohel I, Levy A, Silberstein T, Holcberg G, Sheiner E
J Matern Fetal Neonatal Med 2006 May;19(5):305-8. doi: 10.1080/14767050600590573. PMID: 16753771
Rudolph CM, Al-Fares S, Vaughan-Jones SA, Müllegger RR, Kerl H, Black MM
Br J Dermatol 2006 Jan;154(1):54-60. doi: 10.1111/j.1365-2133.2005.06856.x. PMID: 16403094
Aronson IK, Bond S, Fiedler VC, Vomvouras S, Gruber D, Ruiz C
J Am Acad Dermatol 1998 Dec;39(6):933-9. doi: 10.1016/s0190-9622(98)70265-8. PMID: 9843004

Recent systematic reviews

Kroumpouzos G, Cohen LM
Am J Obstet Gynecol 2003 Apr;188(4):1083-92. doi: 10.1067/mob.2003.129. PMID: 12712115

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