It is also known as Pruritic & Urticarial Papules & Plaques of Pregnancy (PUPPP). It is fairly common, occurring in about 1:200 pregnancies. It usually starts in the last 3 months of the first pregnancy.

Signs

It characteristically begins as itchy lumps of variable sizes on the abdominal striae (stretched lines) around the umbilicus. Some even appear as annular (ring like) or target shapes. There may be some small blisters but never large ones. The immediate surrounding of the umbilicus is however usually spared. It frequently spread to the trunk and limbs, predominantly the upper legs, breasts and lower back.

The rash typically lasts for a few weeks and gradually goes away after delivery of the baby, although there is sometimes a brief worsening. It does not usually recur in subsequent pregnancies.

The main problem is the intense itching as the rash is otherwise harmless to both the mother and baby.

Treatments

Treatments aim to reduce the itch. Topical treatments such as calamine lotion and mild topical steroid are helpful. The anti-histamine chlorpheniramine is safe to use in pregnancy. If the patient is distressed, then a short course of oral steroid may be used.