What is a polymorphic eruption of pregnancy?
Polymorphic eruption of pregnancy is a relatively common skin disorder that can occur in women during pregnancy. It usually presents within a women’s first pregnancy. It is characterized by an itchy rash that commonly begins on the abdomen, particularly within stretch marks (striae).
It most usually develops during late pregnancy (third trimester) but can also present immediately after the baby is born. It was previously known as PUPPP (pruritic and urticarial papules and plaques of pregnancy).
What causes PEP?
The cause of PEP is unknown. It is thought to occur due to the stretching of the abdomen skin and hormonal changes within pregnancy. It occurs more commonly with multiple pregnancies (twins or triplets). Previous studies have suggested a link between increased maternal weight gain during pregnancy, increased birth weight, and sex hormones, but these are not proven.
Does PEP run in families?
No.
What are the symptoms of PEP, and how does it look like?
Itching is common and often starts on the abdomen, usually sparing the umbilicus (belly button) during late pregnancy (3rd trimester). If stretch marks (striae) are present, the itching may start within them.
Itching may then be followed by a rash with wheals (like hives from nettles), small raised lumps in the skin (papules), and large red, inflamed areas of skin (plaques). It commonly spreads on the trunk, lower abdomen, under the breasts, and limbs.
The face, scalp, and mucous membranes (mouth and genital area) are hardly ever affected.
Small blisters are occasionally present, and if these are scratched, then straw-colored fluid may leak out and cause crusts to form.
It is crucial to seek advice from your dermatologist if you develop numerous blisters as PEP can resemble an early form of another skin condition in pregnancy called Pemphigoid gestastionis. This condition may require different treatment and monitoring for you and the baby.
How will PEP be diagnosed?
Diagnosis is usually made by a dermatologist or another doctor based on the typical appearance and distribution of the rash. However, if the appearance is not distinctive, your dermatologist may take a skin biopsy (sample of skin under local anesthetic) and a blood test to help make the diagnosis and rule out other causes of the rash.
Can PEP be cured?
In most cases, this condition is self-limiting and will get better towards the end of pregnancy or immediately following delivery. It can be suppressed with treatment. In most cases, symptoms resolve within a few weeks after giving birth.
How can PEP be treated?
The primary aim of treatment is to relieve itching and to reduce inflammation and redness in the skin. Soothing agents can help to relieve itching and soreness. These include cold baths, wet soaks, and wearing cotton clothes. Bath emollients and soap substitutes followed by emollient creams or ointments will help to moisturize the skin.
Topical steroid creams or ointments are often prescribed to reduce the inflammation in the skin and are safe to use during pregnancy. Oral antihistamines (only those suitable for use during pregnancy, such as loratadine) can be used to relieve itching. Rarely, if the condition is very severe, a short course of steroids by mouth may be prescribed.
Will the baby be affected? No. There have been no reports of the baby being affected. Is normal delivery possible? Yes. Cesarean section is not required.
Can women with PEP still breastfeed? Yes. Breastfeeding does not appear to affect PEP. It is safe to breastfeed your baby even if you take steroid tablets as only a tiny amount of steroid gets into breast milk.
Is any special monitoring required? No, but regular attendance at the antenatal clinic is essential. It is recommended that your midwife or obstetrician is informed of this diagnosis. Will PEP reoccur? The condition tends not to reoccur, except in multiple pregnancies.