Polymorphic eruption of pregnancy


Polymorphic eruption of pregnancy

Also known as pruritic urticarial papules and plaques of pregnancy (PUPPP)

What is polymorphic eruption of pregnancy?

Polymorphic eruption of pregnancy (PEP) is a relatively common pregnancy dermatosis that causes very itchy red bumps to appear over the abdomen. The condition develops late in pregnancy and usually resolves soon after birth. This condition does not cause any harm to the baby.

What causes PEP?

The cause of polymorphic eruption of pregnancy is unknown. This condition is more common in first pregnancies and has been associated with large babies, twins and increased weight gain during pregnancy. One popular theory is that PEP may be related to the stretching of the skin during pregnancy.

What does PEP look like?

Polymorphic eruption of pregnancy usually starts in the 3rd trimester (average onset around 36 to 39 weeks of pregnancy). Red bumps develop on the abdomen, often involving stretch marks (striae) but sparing the belly button (umbilicus). The rash may spread to the buttocks, legs and arms. PEP is usually very itchy.

Polymorphic eruption of pregnancy
Polymorphic eruption of pregnancy

Polymorphic eruption of pregnancy
Polymorphic eruption of pregnancy
Images reproduced with permission of Dr Genevieve Sadler

What other problems can occur with PEP?

There are no known associated diseases. Polymorphic eruption of pregnancy does not adversely affect the pregnancy or cause any harm to the baby.

How is PEP diagnosed?

A skin biopsy may be performed to exclude other conditions such as pemphigoid gestationis.

How is PEP treated?

Steroid ointments are the treatment of choice for PEP. They do not cure the condition but relieve itching and redness. Steroid tablets may be required in rare cases. Keeping cool, generous application of a moisturiser, oatmeal baths, topical compounded menthol and the regular use of antihistamines may all improve comfort.

What is the likely outcome of PEP?

Polymorphic eruption of pregnancy usually clears within days to weeks after the baby is born, but sometimes lasts 1 month into the postnatal period. This condition does not usually recur in future pregnancies.




This information has been written by Dr Genevieve Sadler


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