Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Diagnosis: Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Clinical Presentation

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Clinical History

Submitted by Ellie Goulding MD. Originally posted January 23, 2017.

Treatment

See case discussion.

Differential Diagnosis

• Urticarial vasculitis • Drug eruption • Contact dermatitis • Erythema multiforme • Bullous pemphigoid (urticarial phase) • Insect bites (papular urticaria) • Dermatographism • Mastocytosis

Key Learnings

• Individual wheals resolve within 24 hours without residual marks — if lasting >24 hours, consider urticarial vasculitis • Acute urticaria (6 weeks): usually idiopathic; autoimmune mechanism in ~40% • CSU workup: CBC, ESR/CRP, TSH; extensive testing is low-yield • Omalizumab (anti-IgE) is FDA-approved for CSU refractory to antihistamines • Angioedema: deeper involvement — ACE inhibitor-induced angioedema is bradykinin-mediated (antihistamines won't work) • Second-generation antihistamines at up to 4× standard dose before escalating therapy

Tags: pruritic, urticarial, papules, and, plaques, pregnancy, puppp, ellie goulding md