Pruritic Urticarial Papules and Plaques of Pregnancy Workup

  • Author: Joseph C Pierson, MD; Chief Editor: William D James, MD   more...
 
Updated: May 23, 2012
 

Approach Considerations

Lab studies

No blood or urine laboratory tests are diagnostic of pruritic urticarial papules and plaques of pregnancy (PUPPP). However, one large series of cases showed a significant reduction of serum cortisol levels in patients with PUPPP compared with normal pregnant controls.[9]

Serum submitted for indirect immunofluorescence or NC16a enzyme-linked immunosorbent assay may help to differentiate between PUPPP and herpes gestationis.[15] Both studies detect autoantibodies that are present in persons with herpes gestationis but are not present in those with PUPPP.

Direct immunofluorescence

In punch biopsy specimens of the skin, direct immunofluorescence (DIF) characteristically is negative in PUPPP. DIF results differentiate PUPPP from herpes gestationis. The latter disorder is a rare, autoimmune blistering disease characterized by linear deposits of C3 along the basement membrane zone.

Histologic findings

Routine biopsy specimens from PUPPP usually reveal a normal epidermis, but focal spongiosis and parakeratosis may be seen. Within the papillary dermis and middermis, a lymphohistiocytic infiltrate with a variable number of eosinophils and dermal edema is present.[16]

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Joseph C Pierson, MD  Chief of Dermatology Service, Guthrie Army Clinic, Fort Drum; Assistant Professor of Dermatology, University of Vermont College of Medicine

Joseph C Pierson, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Christine C Tam, MD  Staff Physician, Dermatology Office of David A Spott, MD

Christine C Tam, MD is a member of the following medical societies: American Medical Association

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 and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

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. Apr 20 1979;241(16):1696-9. [Medline].

  2. Bourne G. Toxaemic rash of pregnancy. Proc R Soc Med. Jun 1962;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. Mar 2006;54(3):395-404. [Medline].

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

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

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

  7. 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. Jan 2006;154(1):54-60. [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. May 2006;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. Jul 1999;141(1):71-81. [Medline].

  10. Aractingi S, Berkane N, Bertheau P, et al. Fetal DNA in skin of polymorphic eruptions of pregnancy. Lancet. Dec 12 1998;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. Jan 2008;58(1):63-7. [Medline].

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

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

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

  15. 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. Jun 2005;141(6):705-10. [Medline].

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

  17. 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. Nov 15 2008;14(11):4. [Medline].

  18. 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. Feb 1992;26(2 Pt 1):266-7. [Medline].

 
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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.
 
 
 
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