PUPP syndrome


A PUPP (now referred to as a PEP) includes what are known as polymorphic exanthema together in pregnancy. Under a polymorphic rash one understands different-shaped, reddish skin irritations that occur in different parts of the body and can sometimes be very itchy.

The exact causes usually remain unknown. Treatment is usually purely symptomatic. The abbreviation is written out PUPP pruritic urticarial papules and plaques of pregnancy. Translated, that would mean itchy, hives-like papules and plaques during pregnancy.


The causes of the emergence of a PUPP syndrome are largely unknown. Most PUPP syndromes are based on the fact that they usually develop in the second half of pregnancy and disappear immediately after the child is born.
This fact makes one hormonal involvement probably. But there is no proof of this. Also whether factors such as stress and or nutrition It is not known to promote PUPP syndrome. There is little evidence to suggest that women who had a skin condition before pregnancy were slightly more likely to have a PUPP than women who never had skin problems. A PUPP syndromethat occurs during pregnancy does not mean that this skin problem must also be present in a subsequent pregnancy.

Diagnosis of PUPP syndrome

At a PUPP syndrome it is a diagnosis of exclusion that can be made without further diagnosis. A skin swab is usually only necessary if there are doubts about the diagnosis.

That is crucial sudden onset in the second half of pregnancy and the typical appearance on the skin, which consists of reddish, sometimes converging raised structures. As a rule, the pregnant woman also becomes stronger itching specified. Sometimes they describe similar symptoms in previous pregnancies. However, it would also be important to rule out other skin diseases as causes during pregnancy, which would have to be treated accordingly. That would be mentioned Shingles, as well as a Fungal attack on the skin, pure allergic skin reactions on environmental factors or care products.

When interviewing the patient, attention should also be paid to whether there are other accompanying symptoms, such as e.g. fever, malaise, Weight loss etc. gave. A PUPP syndrome typically develops at the beginning on the stomach out. As the disease progresses, the plaques can also spread to the arms and legs (typically near the torso). Shortly after the formation of plaque-like formations, the painful itching begins, which then decreases in intensity after a few days. With the formation of new plaques that typically follow again and again, the itching also comes back. Those affected suffer from a change in skin symptoms and itching.


The first symptoms of one PUPP syndrome start around the second half of pregnancy and completely regress after the birth of the child. First of all, reddish skin irritations develop in the area of ​​the abdomen. These can be about the size of a cent coin but can also be several centimeters in diameter. After the plaques have formed, the itching begins, which can be limited to the skin area, but it can also be transmitted to the surrounding, unaffected tissue. A few days later the plaque begins to heal again, and with it the agonizing itchiness disappears. A short time later, or often overlapping, one or more new plaque-like skin changes begin to appear at a mostly different part of the body, which also have accompanying itching. These alternations of plaque formation and healing can take several weeks or months. Symptoms usually go away immediately after the baby is born.
During the plaque formation and itching, there are no other accompanying symptoms, such as fever, nausea and or Weight loss. Not to be despised, however, is the psychological strain on those affected. If left untreated, the itching can be very severe and lead to restlessness, aggressiveness and concentration problems. It also often happens that the affected pregnant women scratch the itchy skin, which not only increases the itching again after the first reduction, but also leads to skin defects and bleeding. In rare cases, especially if the itching is untreated and the person scratches badly, it can also develop Scarring of the skin come.

Treatment of PUPP Syndrome

Antihistamines help against itching

Because the cause of one PUPP syndrome is not known, there is no therapeutic treatment, only one symptomatic treatment. This is based on the treatment of the symptoms caused by PUPP syndrome. Since the itching and the inflammatory skin changes are leading in a PUPP syndrome, come above all anti-inflammatory and antiallergic drugs for use.

Mainly to relieve the itchiness Antihistamines and Cortisone preparations used in ointment form. Since both the mother's body and the unborn child produce a large part of their own cortisone during pregnancy, a certain upper limit must be observed for medicinal cortisone therapy in order to avoid an overdose of total cortisone in the blood. Cortisone supplements used in PUPP syndrome Are used, are usually given to the patient in the form of ointments or creams. Systemic uptake in the body is relatively low and the cortisone has the strongest local effects on the skin. Antihistamines are usually given in tablet form and are intended to relieve severe itching. In most cases, a daily dose of one tablet a day is sufficient, although it should be noted that severe fatigue occurs with an antihistamine. For this reason, the tablet should only be taken in the evening. The antihistamine (ex. Cetirizine known from the treatment of hay fever) can only be used when necessary or only for a short time in one go.

As supportive treatment you can skin-friendly creams or Washing lotions be applied to the affected skin areas. Also with chamomile Soaked compresses can cause the skin to heal quickly and relieve itching.

PUPP syndrome in pregnancy

The PUPP syndrome Always occurs during the outbreak during pregnancy. Non-pregnant women are never affected by this itchy rash. As a rule, at the beginning of the second half of pregnancy, the rash begins, which begins on the stomach and trunk. As the pregnancy progresses, the rash spreads towards the arms, while the rash on the abdomen begins to heal.

During pregnancy there can also be several attacks in different parts of the body, which can also be of different strength. In some cases a PUPP syndrome very mild, treatment is not necessary in this case. If a very strong PUPP syndrome is pronounced, it may be necessary to take cortisone ointments and so-called antihistamines, which are normally used for allergies such as hay fever.

Compared to all pregnant women and the symptoms accompanying pregnancy, the PUPP syndrome occurs only relatively rarely. Just in about 5-7% of all pregnant women is an indication of a PUPP syndrome. There are also some other dermatoses that can occur independently of a PUPP syndrome. Depending on the cause, a decision can be made to either indicate a treatment or to wait and see.

PUPP syndrome after childbirth

In the vast majority of cases, a begins PUPP syndrome with the Beginning of the second half of pregnancy. In some exceptional cases, pregnant women suffer from the excruciating itching and typical skin symptoms earlier. It is interesting that almost all PUPP syndromes heal immediately after pregnancy. This happens just a few days after the birth, which suggests a certain connection with the woman's hormonal balance. In a few cases, the itching and reddening of the skin persist even after birth. In this case, one should actually stimulate the diagnosis again in order to determine other triggering factors for this rash.

PUPP syndrome during breastfeeding

In the vast majority of cases, the itchy and annoying rash will have passed and healed after the baby is born. For this reason, women are symptom-free while breastfeeding and can continue breastfeeding without further treatment. In a few cases, however, the symptoms also develop after the birth, so that women who are still breastfeeding sometimes also have to take medication against the itching and against the reddening of the skin.

Duration of a PUPP syndrome

The beginning of a PUPP syndrome usually occurs at the beginning of the second half of pregnancy. Shortly after the birth, 95% of the symptoms have already disappeared and the skin disease has healed. So you can with one mean duration of illness of 4.5 months calculate. In the worst case, however, the onset of the disease occurs shortly after the start of pregnancy, which then extends until shortly after the birth. It can also happen that illness and treatment times of more than 9 months occur. In the case of very long illness times, other causes should always be excluded. Every patient who suffers from a skin rash typical of PUPP syndrome should also have one complete blood count created to see if it might be a infection-related cause acts. Sometimes, even in the second half of pregnancy, there may be a slight skin involvement of several weeks. The skin reddens and itches slightly, also begins to flake, but then heals after a few weeks.Why there is a stronger and sometimes a weaker course in some cases is just as unknown as the actual cause of the PUPP syndrome.