What are the other Names for this Condition? (Also known as/Synonyms)

• Nurse’s Late-Onset Prurigo
• Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
• Toxic Erythema of Pregnancy

What is Polymorphic Eruption of Pregnancy? (Definition/Background Information)

• Polymorphic Eruption of Pregnancy (PEP) is described as itchy red rashes that occur particularly in the last 3 months of pregnancy. It is a relatively common, but benign condition in pregnant women
• The skin condition was also known as Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) earlier. The rashes are present on the abdomen (swollen tummy); other areas may include the buttocks and thighs, in some cases
• The skin condition is observed in women with multiple pregnancies, those who gain excessive weight during pregnancy, or during the first pregnancy. Also, Polymorphic Eruption of Pregnancy is associated with diabetes (during pregnancy) and maternal hypertension
• There is no cure for Polymorphic Eruption of Pregnancy, although the symptoms may be reduced through the application of moisturizing creams and short-term systemic steroids, if necessary
• The prognosis of Polymorphic Eruption of Pregnancy is good in a majority of cases. It is known to disappear a month or so after delivery of the baby; but rarely, the condition may recur, albeit mildly, in subsequent pregnancies

Who gets Polymorphic Eruption of Pregnancy? (Age and Sex Distribution)

• Polymorphic Eruption of Pregnancy may occur during the later stages of pregnancy; a vast majority of cases (over 80% of them) are noted in the third trimester i.e., during the last 3 months of pregnancy
• The skin condition occurs in about 1 in 150 expectant mothers. However, in about 15% of the women, Polymorphic Eruption of Pregnancy may occur after delivery
• Individuals of all racial and ethnic background can be affected, although Caucasians are affected more than any other races
• For some unknown reason, the condition occurs more frequently in pregnant women with male fetuses than with female fetuses (in a 7:3 ratio)

What are the Risk Factors for Polymorphic Eruption of Pregnancy? (Predisposing Factors)

The risk factors for Polymorphic Eruption of Pregnancy may include:

• First pregnancy
• Multiple pregnancy such as twins and triplets
• Women who gain excessive weight during pregnancy are at a higher risk
• Gestational diabetes
• Polyhydramnios
• Maternal hypertension including eclampsia and pre-eclampsia

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Polymorphic Eruption of Pregnancy? (Etiology)

• The cause of Polymorphic Eruption of Pregnancy is not well-established. It may be probably caused by an abnormal immune system, due to stretching of the abdominal skin
• The condition is not caused by what the expectant mother does or does not do, either prior to or during pregnancy

Polymorphic Eruption of Pregnancy is non-contagious and it cannot be transmitted from one individual to another. This means that one cannot get the condition through direct contact or from being in close proximity to an individual having the condition.

What are the Signs and Symptoms of Polymorphic Eruption of Pregnancy?

The signs and symptoms of Polymorphic Eruption of Pregnancy include:

• Presence of itchy red rashes in the region of the stretch marks of the abdomen, typically around the umbilicus (where the stretch marks are prominent); however, the umbilicus may not present any itching
• The rash is reddish to pink in color. A pale halo may be seen around individual papules
• The papules merge to form larger plaques; rarely, there can be small fluid-filled vesicles noted
• Other sites include the buttocks and thighs; rarely, the arms, legs, and feet are involved. However, usually the face is spared
• In some, the itching can be very severe

How is Polymorphic Eruption of Pregnancy Diagnosed?

A diagnosis of Polymorphic Eruption of Pregnancy may involve the following:

• A thorough medical history assessment and complete physical examination
• Assessment of the signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood tests to diagnose underlying disorders including complete blood count and liver function test
• Culture studies to rule out any infection
• Imaging studies to diagnose underlying conditions, if any
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: Usually, a skin biopsy is not required to diagnose Polymorphic Eruption of Pregnancy. However, if such rash occurs early in the pregnancy, it may be caused by a condition called prurigo of pregnancy (or atopic eczema of pregnancy). Another similar rash that can occur in pregnancy is pemphigoid gestationis. In such cases, a skin biopsy may be helpful in arriving at a definitive diagnosis.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Polymorphic Eruption of Pregnancy?

The more severe complications of Polymorphic Eruption of Pregnancy are typically from the presence of any underlying disorder/condition. In general, the complications may include:

• The rashes may ulcerate and bleed
• Itchiness may cause difficulty in sleeping
• Secondary bacterial and fungal infections: The condition may providing a suitable environment for bacteria and fungi to grow and thrive, resulting in secondary infections
• Cosmetic issues resulting in emotional stress in some individuals
• Presence of persistent skin lesions
• On disappearance of the skin lesions, it may heal with increased pigmentation
• Recurrence of the skin rashes in subsequent pregnancy, in rare cases

It is important to note that Polymorphic Eruption of Pregnancy does not affect the growth of the developing fetus.

How is Polymorphic Eruption of Pregnancy Treated?

It is very important to note that Polymorphic Eruption of Pregnancy should be carefully evaluated by a qualified healthcare provider, before starting and/or performing any treatment. This is because some of the treatment measures may have the potential to affect the developing fetus, and hence, the guidance of a healthcare expert is crucial.

There is no cure for Polymorphic Eruption of Pregnancy, but it is self-limiting in many women. The treatment is usually undertaken based on the specific set of skin symptoms noted and under the recommendation of a professional healthcare provider. The treatment measures may include:

• Use of moisturizing creams and topical steroids
• If the symptoms are severe, then systemic steroids may be prescribed for a short duration
• In some individuals, anti-histamine therapy may be recommended
• Undertaking the treatment of any underlying condition

How can Polymorphic Eruption of Pregnancy be Prevented?

Currently, there are no known methods to prevent the occurrence of Polymorphic Eruption of Pregnancy. However, one may lower the risk for the skin condition by considering the following factors:

• Treating any underlying conditions early and adequately
• Undertake early and appropriate treatment for gestational diabetes and hypertension, prior to planning for pregnancy
• A careful and periodic monitoring of the pregnancy is advised and recommended
• Inform your physician if you are allergic to certain medications or foods

What is the Prognosis of Polymorphic Eruption of Pregnancy? (Outcomes/Resolutions)

The prognosis for Polymorphic Eruption of Pregnancy is usually good, in a vast majority of cases. Also, the condition is not known to affect the developing fetus.

• In many, it resolves 4-6 weeks after delivery. The rash usually disappears after the baby is born and the symptoms are known to subside
• However, the condition lasts longer if the pregnancy is complicated by retained placenta in the uterus
• Usually, Polymorphic Eruption of Pregnancy does not recur in subsequent pregnancies. But, even if it occurs in later pregnancies, the condition is usually milder

Additional and Relevant Useful Information for Polymorphic Eruption of Pregnancy:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse