pruritis in pregnancy - docrani

[ArchivalUser]

A primigravid 24-year-old woman at 34-weeks gestation comes to the clinic because of a pruritic rash that has been developing on her abdomen over the last week. She is otherwise well and has had normal prenatal visits and blood work. She lives with her husband who does not appear to be affected. Physical examination shows numerous 1-2 mm erythematous, edematous vesicular papules along the periumbilical striae distensae but sparing the umbilicus. There is an extension of similar lesions to her upper medial thighs. No pustules, bullae, or burrows are appreciated. The remainder of the physical examination is unremarkable. A biochemical profile is normal. She should be told that she has

A. a form of pustular psoriasis and should be started on systemic corticosteroid


B. Herpes gestationis and will most likely develop similar lesions in subsequent pregnancies


C. prurigo gravidarum and will be at increased risk for postpartum hemorrhage


D. pruritic urticarial papules and plaques of pregnancy and it typically will resolve postpartum without treatment


E. scabies and needs to be treated with permethrin

[ArchivalUser]

D. pruritic urticarial papules and plaques of pregnancy and it typically will resolve postpartum without treatment

Because the rashes involve striae?

[ArchivalUser]

D)PUPPP.....D/D:HERPES...has no umbilical sparing

[ArchivalUser]

answer:b

[ArchivalUser]

d)

[ArchivalUser]

correct ans is D

[ArchivalUser]

how to differentiate b from d?

[ArchivalUser]

. Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a relatively common, intense pruritic dermatosis of pregnancy that typically occurs in the third trimester in primigravidas. PUPPP typically develops on the abdomen, especially with periumbilical striae distensae, while the umbilicus is usually spared in contrast to patients with Herpes gestationis. PUPPP is characterized by 1-2 mm erythematous papules that coalesce to form urticarial plaques that may involve a large portion of the abdomen. PUPPP usually responds to topical corticosteroid for symptomatic relief and remits postpartum. It does not recur in subsequent pregnancies, flares with ingestion of oral contraceptives, and is not associated with increased fetal morbidity and mortality.

Herpes gestationis also known as pemphigoid gestationis, is a rare autoimmune disease that occurs exclusively during the second or third trimester of pregnancy, or during the immediate postpartum period. It is characterized by intense pruritic papules and tense blisters. Classically, Herpes gestationis presents as urticarial eruption on the abdomen that usually evolves into a pemphigoid like eruption, sparing the face, mucous membranes, palms, and soles. The umbilicus is usually involved, in contrast to PUPPP. The disease tends to recur during subsequent gestations and one quarter of women experience flare-ups with use of oral contraceptives.