From the Research
Triamcinolone should be prescribed for 7 days for the treatment of Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP), as this duration is generally sufficient to control symptoms while minimizing potential side effects associated with prolonged corticosteroid use, as seen in a case report where fluticasone propionate 0.05 percent lotion, a class 5 (low-medium potency) corticosteroid, was used for one week with complete resolution of symptoms 1. For PUPPP, a medium-potency formulation such as triamcinolone 0.1% cream or ointment applied twice daily to affected areas is recommended. Patients should apply a thin layer to the affected skin, avoiding healthy skin areas. Some key points to consider when prescribing triamcinolone for PUPPP include:
- The condition typically resolves completely after delivery, but treatment can provide relief from symptoms during pregnancy 2, 3, 4, 5
- PUPPP can occur in multiple gestation pregnancies and is more common in primigravidas 2, 5
- The eruption of changes occurs initially on the abdomen and extends over the thighs, legs, back, buttocks, arms, and breasts 5
- Immunologic mechanisms, hormonal abnormalities, and abdominal skin distension have been suggested as etiologic mechanisms for PUPPP 5 If symptoms persist beyond two weeks, the patient should follow up with their healthcare provider for reassessment, as prolonged use of topical corticosteroids can lead to skin thinning, striae, and other adverse effects. Triamcinolone works by reducing inflammation and suppressing the immune response in the skin, thereby decreasing the itching and rash characteristic of PUPPP. This treatment is considered safe during pregnancy when used as directed, providing relief for this uncomfortable but benign condition that typically resolves completely after delivery.