Diagnosis: Polymorphic eruption of pregnancy (PUPPP)
A 32-year-old female in her third trimester presents with an intensely itchy eruption localized to her abdomen and thighs, characterized by erythematous papules and plaques. The lesions develop in association with striae and are often exacerbated by stretching skin. This case exemplifies a common dermatosis of pregnancy that, despite its discomfort, typically resolves postpartum.
A 32-year-old female, G2P1, at 34 weeks of gestation, presents with a 2-week history of an intensely itchy skin eruption. Examination reveals erythematous papules and plaques predominantly located on her abdomen and thighs, with sparing of the umbilicus and face. The lesions are associated with underlying striae. No signs of systemic involvement are noted.Distribution: Eruption primarily on the abdomen and thighs, often in striae.Lesion morphology: Erythematous papules and plaques, sometimes vesicular.Pruritus: Severe itching, affecting the patient’s quality of life and sleep.Onset: Typically occurs in the third trimester, often after 35 weeks of gestation.Exclusion of other conditions: No evidence of systemic disease or other dermatoses.
The patient noted the onset of pruritic lesions approximately 2 weeks prior to presentation, coinciding with significant abdominal stretching. She reports no known triggers, and her obstetric history is unremarkable aside from a previous healthy pregnancy. There is no significant family history of skin disorders. The patient has not used any topical treatments prior to her visit, aside from basic moisturizers.Onset: Lesions began in the last trimester, coinciding with increased skin tension.Prior treatments: No topical or systemic treatments initiated prior to evaluation.Obstetric history: Previous uncomplicated pregnancy with no history of dermatoses.Family history: No known familial skin conditions or allergies.Social history: Non-smoker, no alcohol or drug use, and no recent travel.
Acute / First-Line ManagementTopical corticosteroids (e.g., betamethasone 0.05% cream) applied twice daily to symptomatic areas to reduce inflammation and pruritus.Antihistamines (e.g., diphenhydramine 25-50 mg at bedtime) for symptomatic relief of itching and to aid sleep.Emollients (e.g., petrolatum or thick creams) applied frequently to maintain skin hydration.Workup and Diagnostic ConfirmationClinical diagnosis is typically sufficient; however, a skin biopsy may be performed to rule out other dermatoses if the presentation is atypical.Laboratory tests are generally not required unless systemic symptoms are present.Long-Term ManagementMonitor for resolution of symptoms postpartum; most cases resolve within days to weeks after delivery.Educate the patient on the benign nature of the condition and its self-limiting course.If symptoms persist or worsen, consider referral to a dermatologist for further evaluation.
Intrahepatic cholestasis of pregnancy: Characterized by generalized pruritus, elevated bile acids, and potential fetal risk; often presents in the third trimester.Pregnancy-associated pruritus: Generalized pruritus without rash, usually benign and self-limiting.Atopic eruption of pregnancy (AEP): Includes eczema-like lesions, often occurring in women with a personal or family history of atopy, typically affecting earlier gestational stages.Herpes gestationis: Autoimmune blistering disorder presenting with vesicular lesions, often more severe and systemic than PUPPP.Folliculitis or other infections: May present with itch and localized lesions; typically associated with systemic signs or pustules.Impetigo herpetiformis: A rare, severe form of pustular psoriasis that may occur during pregnancy, characterized by pustular lesions and systemic symptoms.Drug eruptions: Can present with pruritic rashes during pregnancy; careful medication history is essential.
High-Yield PearlsCommon condition: Polymorphic eruption of pregnancy is the most common pregnancy-related dermatosis, typically occurring in the third trimester.Pruritus: Severe itching is a hallmark feature, often leading to significant discomfort.Lesion distribution: The characteristic striae-distributed rash is key for diagnosis, with sparing of the umbilicus.Management: Topical corticosteroids and antihistamines are effective first-line treatments for symptom relief.Postpartum resolution: Most cases resolve spontaneously within days to weeks after delivery, highlighting the self-limiting nature of the condition.Polymorphic eruption of pregnancy is a benign, self-limiting condition that, while distressing, typically resolves after childbirth.
Tags: PUPPP, pregnancy