Polymorphic eruption of pregnancy (PEP), pruritic urticarial papules and plaques of pregnancy (PUPPP),Polymorphic eruption of pregnancy (PEP) (syn., pruritic urticarial papules and plaques of pregnancy [PUPPP]) 3. Prurigo of pregnancy (PP) and 4. ... They included three conditions- eczema in pregnancy (EP), prurigo of pregnancy and pruritic folliculitis of pregnancy under AEP due to their overlapping features.
5. ETIOLOGY
There is no known cause of PEP, but there is some similarities
in cases:
1. Women carrying boys (male-to-female infant ratio of 2:1)
2. First pregnancy
3. Multiple gestation pregnacy(11.7% of patients)
4. Increased maternal weight gain
- Investigators identified fetal deoxyribonucleic acid (DNA) in
the skin of mothers with PEP, suggesting that chimerism
may be relevant to the pathogenesis of this disorder.[10]
- It mostly happens to women during their first pregnancy,
and generally when they are carrying either multiples or
males.
6. PROGNOSIS
The prognoses is excellent in PEP. It typically
resolves within 4-6 weeks, independent of
delivery,[5] and the condition does not tend to recur
in subsequent pregnancies.
No mortality is associated with PEP.
No known systemic complications exist for affected
females, and fetal mortality or morbidity do not
increase.
7. CLINICAL PRESENTATION
HISTORY
Polymorphic eruption of pregnancy (PEP) typically
begins with intensely pruritic papules arising within
striae distensae late in the third trimester of a first
pregnancy(73%).
As many as 15% of PEP cases arise in the
immediate postpartum period,[3] and in one case
report 2 weeks postpartum.[12
9. PHYSICAL EXAMINATION
Itching to be the worst part of PUPPP. Although PUPPP does cause
distinctive red marks on the abdomen, there are other details a woman
should pay attention to before diagnosis that may indicate whether she is
suffering from this condition.
Very itchy rash
Redness
Small blisters
Eczema-like lesions
Appears on abdomen first
Is not found on the belly button
Stretching of the skin, stretch marks are generally the first sign
The appearance of PUPPP has been described as bumpy, itchy papules
that turn to red, scalded skin with welts over time. At first they look like
stretch marks, but as time passes, the rash grows larger in area and
becomes bumpy and red. Oddly, there is never a rash on the belly
button, only around it on the abdomen. From the abdomen, the rash will
begin to spread to all parts of the body, including the chest, legs, feet,
neck, armpits, and face of the expectant mother.
10. DIFFERENTIAL DIAGNOSES
Atopic eruption of pregnancy - Includes eczema of
pregnancy, prurigo of pregnancy, pruritic folliculitis
of pregnancy
Pemphigoid gestationis (herpes gestationis)
Intrahepatic cholestasis of pregnancy
Impetigo herpetiformis
Viral exanthem
Scabies - Check for scabies if the history and
physical examination findings are suggestive
Anaplastic large cell lymphoma - Consider this in a
pregnant patient who presents with cutaneous
symptoms[17]
11. TREATMENT & MANAGEMENT
topical moisturizing creams or aqueous ointments
to treat mild cases.
Corticosteroid creams and ointments (High-potency
topical -class I or II) are usually used when the
condition has reached extreme severity.
And if the condition is too out of control, the doctor
will treat the patient with oral corticosteroids.
Antihistamine tablets may be prescribed to provide
relief from the itchiness.
General treatment measures include the use of
cool, soothing baths; emollients; wet soaks; and
light cotton clothing. PEP tends to resolve
spontaneously shortly after delivery
12. MEDICATION SUMMARY
Antihistamines have a sedative effect that may
improve sleep.
Diphenhydramine (Benadryl, Diphenhist, Allerdryl)
-Diphenhydramine is used for the symptomatic
relief of pruritus caused by the release of histamine
in inflammatory reactions.
Hydroxyzine (Vistaril)
-Hydroxyzine antagonizes H1 receptors in the
periphery. It may suppress histamine activity and
subsequently cause relieve of pruritus.
13. MEDICATION SUMMARY
Corticosteroids have anti-inflammatory properties and cause
profound and varied metabolic effects. In addition, these
agents modify the body's immune response to diverse stimuli.
Use systemic steroids for severe, refractory cases only.
Fluocinonide (Vanos)
-Fluocinonide is a class II, high-potency, topical
corticosteroid that inhibits cell proliferation. It is
immunosuppressive and anti-inflammatory.
Fluticasone (Cutivate)
-Fluticasone is a high-potency, topical corticosteroid that
inhibits cell proliferation. It is immunosuppressive and anti-
inflammatory.
Prednisone
-Prednisone may decrease inflammation by reversing
increased capillary permeability and suppressing
polymorphonuclear leukocyte activity.
14. REFERENCES
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