From the Guidelines
The treatment for pruritic urticarial papules and plaques of pregnancy (PUPPP) primarily focuses on symptom relief, especially controlling the intense itching, with first-line treatment including topical corticosteroids of medium to high potency.
Treatment Options
- Topical corticosteroids, such as triamcinolone 0.1% or betamethasone 0.05% cream, applied to affected areas 2-3 times daily, are considered first-line treatment for PUPPP 1.
- For more severe symptoms, oral antihistamines can be added, with options including diphenhydramine (25-50 mg every 4-6 hours), cetirizine (10 mg daily), or loratadine (10 mg daily) 1.
- Diphenhydramine may be particularly helpful at night due to its sedating effects.
- For severe, widespread cases that don't respond to these measures, a short course of oral corticosteroids like prednisone (starting at 20-40 mg daily with a taper over 7-14 days) may be necessary, though this should be used cautiously during pregnancy 1.
Supportive Measures
- Cool baths with colloidal oatmeal, wearing loose cotton clothing, and avoiding overheating can provide additional relief.
- Moisturizers containing menthol or calamine can also be beneficial.
- Patients should be reassured that PUPPP, while uncomfortable, poses no risk to the mother or baby and typically resolves spontaneously within 1-2 weeks after delivery.
Important Considerations
- Treatment is aimed at managing symptoms until the condition naturally resolves.
- The provided evidence primarily discusses the treatment of intrahepatic cholestasis of pregnancy (ICP), which is a different condition from PUPPP, but some treatments, such as UDCA, may be considered for symptom relief in certain cases 1.
- However, the most recent and highest quality study relevant to PUPPP treatment prioritizes topical corticosteroids and supportive measures for symptom relief.
From the Research
Treatment Options for Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
- Topical corticosteroids, such as fluticasone propionate 0.05 percent lotion, have been shown to be effective in treating PUPPP 2
- Emollients, topical corticosteroids, and/or oral antihistamines are generally adequate to control symptoms 3
- Oral corticosteroids may be used in some cases, although delivery does not usually provide relief of symptoms 4
- Treatment is usually focused on symptom relief, as PUPPP is thought to be harmless for the mother and fetus 5, 6
Characteristics of PUPPP
- PUPPP mainly affects primigravidae in the third trimester of pregnancy 3
- The abdomen and proximal thighs are the most commonly involved sites 3
- Pruritic urticarial papules and plaques are the main morphological feature of PUPPP 3
- Skin lesions typically resolve within 6 weeks postpartum 6
Additional Considerations
- Laboratory investigation, histologic examination, and immunologic study may be necessary to exclude more serious disorders of pregnancy, such as herpes gestationis or intrahepatic cholestasis of pregnancy 6
- PUPPP can arise and resolve during the third trimester, and may not return after parturition 2