Definition

Polymorphic eruptions of pregnancy are also known as pruritic urticarial papules and plaques of pregnancy (PUPPP). This skin problem commonly occurs in the third trimester of the first pregnancy. This condition results in a widespread bumpy rash on the belly skin of pregnant women. Pruritic means itching. As implied by its name, this illness is characterized by intense itchiness and can be very bothersome, especially in the third trimester of pregnancy. The disease typically persists throughout the pregnancy until the woman gives birth.

Polymorphic eruptions of pregnancy are a common occurrence that many first-time pregnant women face. They do not impact fetal growth, and mothers with this skin condition can breastfeed without any risks. This condition merely induces discomfort and affects the appearance of the skin. This syndrome seldom recurs, except in cases where the woman is carrying several fetuses in the subsequent pregnancy.

Causes

The exact cause of polymorphic eruptions of pregnancy remains uncertain, but it is strongly associated with pregnancy itself. The stretching of the mother's abdominal skin and hormonal fluctuations during pregnancy can initiate an immune response, resulting in skin tissue damage and rashes, especially in areas of the skin most affected by stretching, such as the navel. Polymorphic eruptions of pregnancy are more frequently observed in women carrying multiple fetuses.

Several studies suggest a connection between these eruptions and factors such as weight gain, increased fetal weight, and sexual hormones, but further research is needed to confirm this.

Risk factor

Not all pregnant women have polymorphic eruptions of pregnancy. It is said that this skin disease was only detected in one pregnant woman out of 160 pregnancies. Polymorphic eruptions of pregnancy typically occur during the first pregnancy and are uncommon in multiparous women. White pregnant women are more commonly affected by this disorder compared to dark-skinned pregnant women.

Polymorphic eruptions of pregnancy frequently occur in pregnant women who have substantial weight gain, particularly in those with twin pregnancies. Pregnant women carrying three fetuses had a 14% higher chance of developing this skin problem compared to those with two fetuses, when the risk of skin illness is only 2.9%.

Furthermore, research suggests that pregnant women carrying male fetuses are more likely to experience polymorphic eruptions of pregnancy than those carrying female fetuses.

Symptoms

Common symptoms of polymorphic eruptions of pregnancy include the development of a skin rash and itching. The skin rash typically emerges initially in the abdomen, along with papules. The papules are noticeable along the striae or stretch marks on the abdomen. Similar lesions can also be present in the buttocks, extending across the body and limbs.

Skin rashes and papules can make the skin feel uneven and redder or darker in color. The rash may appear on the torso, lower belly, breast folds, and other body folds. When the small vesicles on the skin are scratched, they release clear fluid, which can cause dry fluid marks if not cleaned immediately.

Diagnosis

A doctor typically diagnoses polymorphic eruption of pregnancy by assessing the skin lesions, rash distribution on the skin, and the mother's maternal history in pregnancy. Skin lesion symptoms can often be challenging to distinguish from other skin illnesses.

Healthcare providers rarely perform skin biopsy procedures because they lack specific findings to establish a diagnosis. Blood or urine testing is also rarely requested in diagnosing polymorphic eruptions of pregnancy due to the lack of distinguishing features.

Management

Currently, no medicine is available to cure or prevent polymorphic eruptions of pregnancy. Doctors typically offer treatments to manage and alleviate symptoms that affect the mother's comfort. Skin moisturizers can alleviate symptoms. Using them more frequently increases their effectiveness.

Steroid ointments may be administered based on specific situations. Apply the topical medication thinly to the itching rash as per the doctor's instructions. Steroid medication minimizes skin inflammation. For patients with severe symptoms, the doctor may also consider prescribing oral systemic steroids. It is not advised to begin treatment on your own without a doctor's supervision; instead, you should see a doctor who will prescribe treatments based on your conditions with your fetus in mind. Using medicines to relieve pruritus can also be a safer treatment option during pregnancy.

Complications

One of the most common complications of polymorphic eruptions of pregnancy is skin infection from open wounds on the expectant mother. Scratching skin rashes due to itchiness, along with poor skin hygiene, significantly increases the risk of infection. In addition, blisters or vesicles that emerge and burst can lead to infection. To prevent harm, avoid scratching or applying pressure to bumps and blisters. Your doctor will recommend wearing soft, non-irritating clothing.

Prevention

Since the primary cause of polymorphic eruptions of pregnancy remains unknown, prevention measures are challenging. Pregnant women should be aware of any allergies that could exacerbate their skin issues, particularly by avoiding ingredients that may irritate them. Throughout pregnancy, especially for first-time mothers, it's essential to monitor skin abnormalities and be cautious if experiencing itching in specific areas of the body. Controlling the urge to scratch is crucial as scratching can increase the risk of infection. Maintaining clean skin and preventing it from drying out by ensuring adequate hydration is advisable. Opt for comfortable, non-irritating clothing to minimize aggravating the skin condition associated with polymorphic eruptions of pregnancy.

When to see a doctor?

Seek medical attention promptly if you notice any itchiness or other abnormalities in your skin's appearance. If you have a history of allergies, visit a doctor to avoid scratching your skin and reduce the risk of getting infected.

Typically, this condition resolves spontaneously and gradually improves. If the lesions are troublesome, it is advisable to consult a doctor for the necessary treatment.

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