Occurrence of Pruritic Urticarial Papules and Plaques in Multiple Pregnancies: Review and Current Update
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Abstract
Pruritic urticarial papules and plaques of pregnancy (PUPPP) present as a benign condition, which is a self- limiting inflammatory reaction that typically affects primigravida within the third trimester of pregnancy. Cases of PUPPP are also seen in the postpartum period. The majority of risk factors are those associated with significant skin stretching, as seen in rapid and excessive weight gain, or multiple pregnancies (such as twins). A preliminary narrative review was conducted to summarize and critically assess the prior literature focusing on the association between PUPPP and multiple gestation. A literature search was carried out in electronic databases using controlled vocabulary. According to current studies, the rapid stretching of the skin is responsible for causing an inflammatory reaction, which causes damage to connective tissue, hence forming urticarial or hive-like lesions. Other risk factors include in-vitro fertilization, hormonal therapy, and a primigravida or nulliparous condition. Moreover, multiple gestations are linked with increased levels of estrogen and progesterone. The lesions are elevated with edematous areas of small papules joining to form bigger plaques. The affected area usually includes the upper and lower abdomen, particularly the area within or next to Striae gravidarum, followed by expansion to proximal limbs, primarily thighs, back, and buttocks. Histopathological findings suggest the presence of perivascular lymphohistiocytic infiltrates of Eosinophils, mononuclear cells, and skin oedema in the dermis, which is mainly composed of T- helper lymphocytes. Women still often seek treatment for symptomatic relief due to the intense itching. Conservative treatments are suitable to control the manifestations during gestation, and the lesions usually resolve shortly after pregnancy. Symptomatic relief can be provided by antihistamines given orally, emollients, and topical steroids.
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