A 32-year-old patient attends morning surgery, 26-weeks pregnant looking tired and miserable. She complains of an itchy, bumpy rash on her abdomen, that has spread to her legs, arms and back. Pruritic urticarial papules and plaques of pregnancy (PUPP) is an itchy hives-like rash that classically strikes women during their final trimester of pregnancy. It has an approximate incidence of 1 in 160 pregnancies. After atopic eczema, it is the second most common of the dermatoses of pregnancy. Although the itch can cause grief for its sufferers, it presents no long-term risk to either the mother or her developing baby. Generally, the condition starts on the abdomen before extending to the legs, amis, chest and back. Usually the face is spared. PUPP presents typically with polymorphous, erythematous, papular lesions. However, it is the marked pruritic component that usually drives women to distraction. Often the rash persists until delivery but tends to disappear within 6 weeks.
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