Pruritic urticarial papules and plaques of pregnancy: Clinical and immunopathologic observations in 57 patients,☆☆

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Abstract

Background: Pruritic urticarial papules and plaques of pregnancy (PUPPP) has been described either as a homogeneous or a polymorphic clinical process. Its cause is unknown. Objective: We attempted to characterize the clinical and immunopathologic findings in PUPPP on the basis of long-term clinical and immunopathologic observations. Methods: The clinical and immunopathologic features of 57 patients with PUPPP were evaluated. Results: The clinical features in 57 patients with PUPPP were categorized into three types: mainly urticarial papules and plaques (type I), nonurticarial erythema, papules, or vesicles (type II), and combinations of the two forms (type III). Direct immunofluorescence studies in 48 of the 57 patients showed nonspecific immunoreactants in dermal blood vessels and/or moderate granular deposits at the dermoepidermal junction in 15 patients. Conclusion: Type I PUPPP differed from types II and III in clinical appearance and distribution (absence of face, palm, and sole lesions), but trimester onset, parity, and direct immunofluorescence findings were not significantly different among the three groups. (J Am Acad Dermatol 1998;39:933-9.)

Section snippets

PATIENTS AND METHODS

Between 1979 and 1990, 57 patients with the diagnosis of PUPPP were seen. Timing of onset, distribution of lesions, specific clinical appearance, and medical and drug history were noted.

Specific inquiry was made into the use of antibiotics in the month before onset of eruption. Several patients were excluded from the PUPPP diagnosis group because they had used antibiotics in the weeks preceding the eruption.

After informed consent was obtained, lesional skin biopsy specimens were obtained in 48

Onset

The average age of the patients at onset was 25.4 years (range, 16 to 40 years). Twenty four (42%) of the 57 patients were primagravidas, 16 (28%) were gravida 2, 9 (16%) gravida 3, 4 (7%) gravida 4, 3 (5%) gravida 6, and 1 (1.7%) gravida 7; 68% of the patients were nulliparous. Gestational age at the time of onset of eruption showed variability (Table I); onset occurred in the first and second trimester, as well as in the third. Forty-five of the patients (79%) were in the third trimester, but

DISCUSSION

The most commonly diagnosed pruritic dermatosis of pregnancy is one that presents us with a confusing array of nomenclature and an unknown pathogenetic mechanism. The confusion is created by the broad clinical spectrum and diversity of the cutaneous features. A parallel disease in pregnancy with a wide clinical spectrum and morphologic diversity occurs in HG, but this disease has an identifiable common denominator. A linear band of complement (C3) is always present on DIF examination of

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    Reprint requests: Iris K. Aronson, MD, Department of Dermatology, M/C 624, University of Illinois, College of Medicine, 376 CME, 808 S Wood St, Chicago, IL 60612.

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