Pruritic urticarial papules and plaques of pregnancy (PUPPP)

DiagnosisThe diagnosis of PUPPP is primarily clinical and based on characteristic morphology, distribution of lesions, and timing during pregnancy.Routine laboratory investigations are generally within normal limits. Recommended investigations include:-Complete blood count -Liver function tests -Basic metabolic panel (blood glucose, blood urea nitrogen, creatinine, calcium, and electrolytes) -Serum cortisol levels -Serum human chorionic gonadotropin (hCG) -Direct immunofluorescence when differentiation from pemphigoid gestationis is required Assessment of the severity of pruritus is essential, as management is largely symptomatic.Maternal weight gain and fetal growth should be monitored throughout pregnancy.PUPPP alone is not an indication for early delivery. ManagementManagement of PUPPP focuses on symptomatic relief.Most patients achieve satisfactory improvement with topical corticosteroids and oral antihistamines.First-generation sedating antihistamines are considered safe during pregnancy and may be useful in relieving nocturnal pruritus.In severe cases associated with sleep disturbance and maternal exhaustion, a short course of systemic corticosteroids may be administered under medical supervision.Supportive measures such as cool baths, frequent application of emollients, and wearing loose, light cotton clothing provide additional comfort.Recent reports have described the use of intramuscular autologous whole blood injections in postpartum PUPPP, showing subjective and objective improvement, though further studies are required. Differential DiagnosisThe most important condition to exclude is pemphigoid gestationis, which typically presents earlier in pregnancy, involves the umbilical region, and shows positive immunofluorescence findings.Other conditions to consider include:-Atopic eczema -Drug-induced eruptions -