Pruritic urticarial papules and plaques of pregnancy: epidemiological, clinical, and histopathological study of 18 cases from Lebanon

Abstract

Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a benign pruritic inflammatory skin disorder that usually affects primigravidae in their third trimester of pregnancy. Studies on this condition from our area are lacking. To describe the epidemiological, clinical, and histopathological findings of all patients diagnosed with PUPPP at the American University of Beirut Medical Center (AUB-MC) between 1998 and 2009 and compare our findings with those published in the literature. PUPPP mainly affected primigravidae (72%) in the third trimester of pregnancy (89%). Multiple gestation pregnancies were observed in 50% of cases. The abdomen and proximal thighs were the most commonly involved sites (67%), with exclusive involvement of the extremities in four cases. Although pruritic urticarial papules and plaques were the main morphological feature of PUPPP observed (98%), five cases had additional features, and one case presented exclusively with papulovesicular lesions. Microscopically, all cases biopsied showed the typical features of PUPPP, including negative direct immunofluorescence findings. Emollients, topical corticosteroids, and/or oral antihistamines were generally adequate to control symptoms in all cases, in which skin lesions resolved in an average of three weeks. This study showed a lower incidence of PUPPP in our population compared with its incidence in other populations. It also confirmed the previously described clinical features, benign course, and excellent outcome of the condition, although variations may occur. Significant associations mainly included multiple gestation pregnancies, excessive maternal weight, and Rh-positive blood type, while fetal gender and weight gain did not contribute.