Pruritic Urticarial Papules and Plaques of Pregnancy
Saturday, January 01, 2011
This common and very pruritic disorder of pregnancy of unknown
cause usually begins in the third trimester and resolves with
delivery. Unlike herpes gestationis, postpartum onset or
exacerbation is rare. Therapy is empiric and aims to control
symptoms until the eruption abates following delivery.
- A topical high-potency to superpotent steroid cream applied two
to four times daily. The strength should be guided by the severity
of the pruritus.
- Oral diphenhydramine 25-50 mg 3 times daily.
Only rarely are systemic steroids required in this condition.
Prescribe the minimum effective dose (initially usually 0.5-1 mg/kg
in a single dose each morning) and rapidly taper to the lowest
- Herpes gestationis initially may resemble the pruritic
urticarial papules and plaques of pregnancy. A biopsy for direct
immunofluorescence may be indicated.
- Scabies and other insect bites are morphologically similar to
the pruritic papular rashes of pregnancy. Look carefully for
burrows and take a history of animal exposure.