A review of literature of polymorphic eruption of pregnancy
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20211720Keywords:
PEP, PUPPP, Pruritus, DermatosesAbstract
Polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy [PUPPP] is the most common of all the specific dermatoses of pregnancy. It is a benign, self-resolving, pruritic disorder of pregnancy, usually affecting primigravida during the last trimester of pregnancy or immediately postpartum. Its exact pathogenesis is still unknown, and its clinical presentations are variable. It may mimic many common dermatoses. In PEP, the histological findings are non-contributory and the laboratory results, including direct and indirect immunofluorescence are negative. Diagnosis mainly depends on clinical findings. Significant diagnostic confusion may occur with early lesions of pemphigoid gestationis, which needs to be differentiated from PEP as the former may have a bad fetal outcome. PEP is not associated with any fetal or maternal risk, and symptomatic treatment is all that is usually required. The awareness of this condition helps the physician recognize this entity, reassure the patient, and avoid unnecessary investigations. This review focuses on etiology, various clinical presentations, differential diagnosis, and management of PEP.
References
Taylor D, Pappo E, Aronson IK. Polymorphic eruption of pregnancy. Clin Dermatol. 2016;34(3):383-91.
Ahmadi S, Powell FC. Pruritic urticarial papules and plaques of pregnancy: current status. Australas J Dermatol. 2005;46(2):53-8.
Lehrhoff S, Pomeranz MK. Specific dermatoses of pregnancy and their treatment. Dermatol Ther. 2013;26(4):274-84.
Ambros-Rudolph CM, Müllegger RR, Vaughan-Jones SA, Kerl H, Black MM. The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-center study on 505 pregnant patients. J Am Acad Dermatol. 2006;54(3):395-404.
Petropoulou H, Georgala S, Katsambas AD. Polymorphic eruption of pregnancy. Int J Dermatol. 2006;45(6):642-8.
Beard MP, Millington GWM. Recent developments in the specific dermatoses of pregnancy. Clinic Experi Dermatol. 2012;37:1-5.
Ghazeeri G, Kibbi A, Abbas O. Pruritic urticarial papules and plaques of pregnancy: epidemiological, clinical, and histopathological study of 18 cases from Lebanon. Inter J Dermatol. 2012;51(9):1047-53.
Rudolph CM, Al-Fares S, Vaughan-Jones SA, Müllegger RR, Kerl H, Black MM. Polymorphic eruption of pregnancy: clinicopathology and potential trigger factors in 181 patients. Br J Dermatol. 2006;154(1):54-60.
Ohel I, Levy A, Silberstein T, Holcberg G, Sheiner E. Pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy. J Maternal-Fetal Neonat Med. 2006;19(5):305-8.
Weiss R, Hull P. Familial occurrence of pruritic urticarial papules and plaques of pregnancy. J Am Acad Dermatol. 1992;26(5 Pt 1):715-7.
Dominguez-Serrano AJ, Quiroga-Garza A, Jacobo-Baca G, De LFD, Gonzalez-Ramirez RA, Vazquez-Barragan MA, et al. Polymorphic eruption of pregnancy in Mexico. Int J Dermatol. 2019;58(3):259-62.
Aronson IK, Bond S, Fiedler VC, Vomvouras S, Gruber D, Ruiz C. Pruritic urticarial papules and plaques of pregnancy: Clinical and immunopathologic observations in 57 patients. J Americ Aca Dermatol. 1998;39(6):933-9.
Aractingi S, Berkane N, Bertheau P, Goué CL, Dausset J, Uzan S, et al. Fetal DNA in skin of polymorphic eruptions of pregnancy. Lancet. 1998;352(9144):1898-901.
Kasp-Grochowska E, Beck J, Holmes RC, Black MM, Timlin D. The role of circulating immune complexes in the aetiology of polymorphic eruption of pregnancy. Arch Dermatol Res. 1984;276(2):71-3.
Dehdashti AL, Wikas SM. Pruritic urticarial papules and plaques of pregnancy occurring postpartum. Cutis. 2015;95(6):344-7.
Pritzier EC, Mikkelsen CS. Polymorphic eruption of pregnancy developing postpartum: 2 case reports. Dermatol Rep. 2012;4(1):7.
Patel P, Ashack KA, Aronson IK. Postpartum polymorphic eruption of pregnancy: an unusual presentation. Int J Dermatol. 2019;58(3):357-9.
Park SY, Kim JH, Lee WS. Pruritic urticarial papules and plaques of pregnancy with unique distribution developing in postpartum period. Ann Dermatol. 2013;25(4):506-8.
Özcan D, Özçakmak B, Aydoğan FÇ. Polymorphic eruption of pregnancy with palmoplantar involvement that developed after delivery. J Obstet Gynaecol Res. 2011;37(8):1158-61.
Normand F, Armingaud P, Estève E. Dyshidrosis and acral purpura during polymorphic dermatitis in pregnancy: 2 cases. Ann Dermatol Venereol. 2001;128(4):531-3.
Alcalay J, David M, Sandbank M. Facial involvement in pruritic urticarial papules and plaques of pregnancy. J Am Acad Dermatol. 1986;15(5 Pt 1):1048.
Bohdanowicz M, Ghazarian D, Rosen CF. Targetoid form of polymorphic eruption of pregnancy: A case report. SAGE Open Med Case Rep. 2019;7.
Journet-Tollhupp J, Tchen T, Remy-Leroux V, Hezard N, Grange F, Bernard P. Polymorphic eruption of pregnancy and acquired hemophilia A. Ann Dermatol Venereol. 2010;137(11):713-7.
Kanj RV, Gerber D, Frey MK, Rahmanou F, Hardy C. Anaplastic Large Cell Lymphoma in Pregnancy. A Case Report. J Reprod Med. 2015;60(5-6):265-8.
Goolamali SI, Salisbury JR, Higgins EM. Polymorphic eruption of pregnancy in a photodistribution: a potentially new association? Clin Exp Dermatol. 2009;34(7):381-2.
Sherley-Dale AC, Carr RA, Charles-Holmes R. Polymorphic eruption of pregnancy with bullous lesions: a previously unreported association. Br J Dermatol. 2010;162(1):220-2.
Cohen LM, Capeless EL, Krusinski PA, Maloney ME. Pruritic urticarial papules and plaques of pregnancy and its relationship to maternal-fetal weight gain and twin pregnancy. Arch Dermatol. 1989;125(11):1534-6.
Roger D, Vaillant L, Lorette G. Pruritic urticarial papules and plaques of pregnancy are not related to maternal or fetal weight gain. Arch Dermatol. 1990;126(11):1517.
Pauwels C, Bucaille-Fleury L, Recanati G. Pruritic urticarial papules and plaques of pregnancy: relationship to maternal weight gain and twin or triplet pregnancies. Arch Dermatol. 1994;130(6):801-2.
Brandão P, Portela-Carvalho AS, Melo A, Leite I. Postpartum polymorphic eruption of pregnancy. Obstet Gynaecol Cases Rev. 2018;5:139.
Powell AM, Sakuma-Oyama Y, Oyama N, Albert S, Bhogal B, Kaneko F, et al. Usefulness of BP180 NC16a enzyme-linked immunosorbent assay in the serodiagnosis of pemphigoid gestationis and in differentiating between pemphigoid gestationis and pruritic urticarial papules and plaques of pregnancy. Arch Dermatol. 2005;141(6):705-10.
Barnadas MA, Rubiales MV, González MJ, Puig L, García P, Baselga E, et al. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence testing in a bullous pemphigoid and pemphigoid gestationis. Int J Dermatol. 2008;47(12):1245-9.
Abel MK, Suresh R, Raffi J, McCalmont TH, Murase JE. Diagnostic testing in gestational bullous pemphigoid: has enzyme-linked immunosorbent assay replaced direct immunofluorescence as the new gold standard? JAAD Case Rep. 2019;5(12):1081-3.
Kwon EJ, Ntiamoah P, Shulman KJ. The utility of C4d immunohistochemistry on formalin-fixed paraffin-embedded tissue in the distinction of polymorphic eruption of pregnancy from pemphigoid gestationis. Am J Dermatopathol. 2013;35(8):787-91.
Slobbe AMV, Bohnen AM, Bernsen RMD, Koes BW, Bierma-Zeinstra SMA. Incidence rates and determinants in meralgia paresthetica in general practice. J Neurol. 2004;251(3):294-7.
Kester MSV, Langeveld TJC, Bouwsma H, Rees JBV, Holman ER, Teng YKO, et al. A breathtaking DRESS due to amoxicillin-clavulanate presenting as polymorphic eruption of the pregnancy. J Eur Acad Dermatol Venereol. 2018;32(12):436-7.
Proietti I, Bernardini N, Tolino E, Mambrin A, Balduzzi V, Marchesiello A, et al. Polymorphic eruption of pregnancy as a possible COVID-19 manifestation. Dermatol Ther. 2020;33(6):e14117.
Al-Fares SI, Jones SV, Black MM. The specific dermatoses of pregnancy: a re-appraisal. J Eur Acad Dermatol Venereol. 2001;15(3):197-206.
Beltrani VP, Beltrani VS. Pruritic urticarial papules and plaques of pregnancy: a severe case requiring early delivery for relief of symptoms. J Am Acad Dermatol. 1992;26(2 Pt 1):266-7.
Kroumpouzos G, Cohen LM. Dermatoses of pregnancy. J Am Acad Dermatol. 2001;45(1):1-19.
Kim EH. Pruritic Urticarial Papules and Plaques of Pregnancy Occurring Postpartum Treated with Intramuscular Injection of Autologous Whole Blood. Case Rep Dermatol. 2017;9(1):151-6.
