Pronounced Polymorphic Eruption of Pregnancy in a Primipara

Figure

Maculopapular erythema, particularly pronounced over the abdomen in the area of the stretch marks (wide arrow), with slightly less reddening around the navel (narrow arrow), target-like (>) and vesicular foci (>>) on the extremities

A 38-year-old primipara presented in the 36^th week of gestation with strongly itching maculopapular erythema that was particularly pronounced over the abdomen in the area of the stretch marks, with less reddening around the navel. Target-like and vesicular foci were present on the extremities. Taken together, the skin findings, the absence of relevant medications in the patient’s medical history, and the lack of potential differential diagnoses (herpes simplex virus polymerase chain reaction [PCR], varicella zoster virus PCR, histology, direct and indirect immunofluorescence) indicated the diagnosis of polymorphic eruption of pregnancy (or PUPPP, pruritic urticarial papules and plaques of pregnancy). The healthy newborn had no cutaneous abnormalities. The mother’s erythema regressed completely when treated with topical antipruritics and medium-strength glucocorticoids. PUPPP is a common (incidence 1 : 200) self-limiting form of dermatosis that occurs most frequently in the final weeks of pregnancy or post partum (15 %). The individual risk factors include first pregnancy, multiple gestation, and excessive maternal weight gain. In pregnant women with pruritus the following differential diagnoses have to be ruled out: atopic gestational dermatosis, intrahepatic gestational cholestasis, gestational pemphigoid, and unspecific dermatoses of pregnancy (cutaneous drug reactions, viral exanthema).

Dr. med. Maria Isabel Schmidgen, Dr. med. Beate Weidenthaler-Barth, Hautklinik und Poliklinik, Universitätsmedizin Mainz, [e-mail]

Prof. Dr. med. Kerstin Steinbrink, Klinik für Dermatologie, Universitätsklinikum Münster

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Schmidgen MI, Steinbrink K, Weidenthaler-Barth B: Pronounced polymorphic eruption of pregnancy in a primipara. Dtsch Arztebl Int 2019; 116: 644. DOI: 10.3238/arztebl.2019.0644