Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Polymorphic Eruption of Pregnancy Medication

  • Author: Joseph C Pierson, MD; Chief Editor: William D James, MD  more...
 
Updated: Feb 12, 2016
 

Medication Summary

As previously mentioned, topical corticosteroids are the mainstay of treatment for polymorphic eruption of pregnancy (PEP).[20] Symptom alleviation may require high-potency topical (class I or II) steroids, such as fluocinonide, or even systemic steroids. Oral antihistamines are only mildly effective.

Diphenhydramine, an antihistamine, has a sedative effect that may help patients to sleep better; it is also an effective agent against pruritus resulting from histamine release during inflammatory reactions.

Medications may need to be used into the postpartum period. Pay attention to potential adverse effects with breastfeeding.

Next

Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli. Use systemic steroids for severe, refractory cases only.

Fluocinonide (Vanos)

 

Fluocinonide is a class II, high-potency, topical corticosteroid that inhibits cell proliferation. It is immunosuppressive and anti-inflammatory.

Fluticasone (Cutivate)

 

Fluticasone is a high-potency, topical corticosteroid that inhibits cell proliferation. It is immunosuppressive and anti-inflammatory.

Prednisone

 

Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity.

Prednisolone (Pediapred, Orapred, Flo-Pred)

 

This glucocorticosteroid occurs naturally and synthetically. It is used for both acute and chronic asthma. It may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity.

Previous
Next

Antihistamines, 1st Generation

Class Summary

Antihistamines have a sedative effect that may improve sleep.

Diphenhydramine (Benadryl, Diphenhist, Allerdryl)

 

Diphenhydramine is used for the symptomatic relief of pruritus caused by the release of histamine in inflammatory reactions.

Hydroxyzine (Vistaril)

 

Hydroxyzine antagonizes H1 receptors in the periphery. It may suppress histamine activity and subsequently cause relieve of pruritus.

Previous
 
Contributor Information and Disclosures
Author

Joseph C Pierson, MD Dermatology Residency Program Director, University of Vermont College of Medicine

Joseph C Pierson, MD is a member of the following medical societies: Association of Professors of Dermatology, New England Dermatological Society, American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Christine C Tam, MD Managing Member, Certified Dermatologists

Christine C Tam, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Abdul-Ghani Kibbi, MD Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon

Disclosure: Nothing to disclose.

References
  1. Lawley TJ, Hertz KC, Wade TR, Ackerman AB, Katz SI. Pruritic urticarial papules and plaques of pregnancy. JAMA. 1979 Apr 20. 241(16):1696-9. [Medline].

  2. Bourne G. Toxaemic rash of pregnancy. Proc R Soc Med. 1962 Jun. 55:462-4. [Medline].

  3. Ambros-Rudolph CM, Mullegger RR, Vaughan-Jones SA, Kerl H, Black MM. The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-center study on 505 pregnant patients. J Am Acad Dermatol. 2006 Mar. 54(3):395-404. [Medline].

  4. Roth MM. Pregnancy dermatoses: diagnosis, management, and controversies. Am J Clin Dermatol. 2011 Feb 1. 12(1):25-41. [Medline].

  5. Rudolph CM, Al-Fares S, Vaughan-Jones SA, Mullegger RR, Kerl H, Black MM. Polymorphic eruption of pregnancy: clinicopathology and potential trigger factors in 181 patients. Br J Dermatol. 2006 Jan. 154(1):54-60. [Medline].

  6. Kroumpouzos G, Cohen LM. Specific dermatoses of pregnancy: an evidence-based systematic review. Am J Obstet Gynecol. 2003 Apr. 188(4):1083-92. [Medline].

  7. Elling SV, McKenna P, Powell FC. Pruritic urticarial papules and plaques of pregnancy in twin and triplet pregnancies. J Eur Acad Dermatol Venereol. 2000 Sep. 14(5):378-81. [Medline].

  8. Ohel I, Levy A, Silberstein T, Holcberg G, Sheiner E. Pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy. J Matern Fetal Neonatal Med. 2006 May. 19(5):305-8. [Medline].

  9. Vaughan Jones SA, Hern S, Nelson-Piercy C, Seed PT, Black MM. A prospective study of 200 women with dermatoses of pregnancy correlating clinical findings with hormonal and immunopathological profiles. Br J Dermatol. 1999 Jul. 141(1):71-81. [Medline].

  10. Aractingi S, Berkane N, Bertheau P, et al. Fetal DNA in skin of polymorphic eruptions of pregnancy. Lancet. 1998 Dec 12. 352(9144):1898-901. [Medline].

  11. Regnier S, Fermand V, Levy P, Uzan S, Aractingi S. A case-control study of polymorphic eruption of pregnancy. J Am Acad Dermatol. 2008 Jan. 58(1):63-7. [Medline].

  12. Dehdashti AL, Wikas SM. Pruritic urticarial papules and plaques of pregnancy occurring postpartum. Cutis. 2015 Jun. 95 (6):344-7. [Medline].

  13. Sherley-Dale AC, Carr RA, Charles-Holmes R. Polymorphic eruption of pregnancy with bullous lesions: a previously unreported association. Br J Dermatol. 2009 Nov 3. [Medline].

  14. Roger D, Vaillant L, Fignon A, et al. Specific pruritic diseases of pregnancy. A prospective study of 3192 pregnant women. Arch Dermatol. 1994 Jun. 130(6):734-9. [Medline].

  15. Sirikudta W, Silpa-Archa N. Polymorphic eruption of pregnancy presented with targetoid lesions: a report of two cases. Case Rep Dermatol. 2013 May. 5 (2):138-43. [Medline].

  16. Goolamali SI, Salisbury JR, Higgins EM. Polymorphic eruption of pregnancy in a photodistribution: a potentially new association?. Clin Exp Dermatol. 2009 Oct. 34(7):e381-2. [Medline].

  17. Kanj RV, Gerber D, Frey MK, Rahmanou F, Hardy C. Anaplastic Large Cell Lymphoma in Pregnancy. A Case Report. J Reprod Med. 2015 May-Jun. 60 (5-6):265-8. [Medline].

  18. Powell AM, Sakuma-Oyama Y, Oyama N, et al. Usefulness of BP180 NC16a enzyme-linked immunosorbent assay in the serodiagnosis of pemphigoid gestationis and in differentiating between pemphigoid gestationis and pruritic urticarial papules and plaques of pregnancy. Arch Dermatol. 2005 Jun. 141(6):705-10. [Medline].

  19. Ahmadi S, Powell FC. Pruritic urticarial papules and plaques of pregnancy: current status. Australas J Dermatol. 2005 May. 46(2):53-8; quiz 59. [Medline].

  20. Scheinfeld N. Pruritic urticarial papules and plaques of pregnancy wholly abated with one week twice daily application of fluticasone propionate lotion: a case report and review of the literature. Dermatol Online J. 2008 Nov 15. 14(11):4. [Medline].

  21. Beltrani VP, Beltrani VS. Pruritic urticarial papules and plaques of pregnancy: a severe case requiring early delivery for relief of symptoms. J Am Acad Dermatol. 1992 Feb. 26(2 Pt 1):266-7. [Medline].

  22. Jeon IK, On HR, Oh SH, Hann SK. Three cases of pruritic urticarial papules and plaques of pregnancy (PUPPP) treated with intramuscular injection of autologous whole blood. J Eur Acad Dermatol Venereol. 2015 Apr. 29 (4):797-800. [Medline].

 
Previous
Next
 
Papules within prominent striae distensae. Courtesy of Jeffrey P. Callen, MD of Louisville, Kentucky.
Papules within prominent striae distensae. Courtesy of Jeffrey P. Callen, MD of Louisville, Kentucky.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.