{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:54:35Z","timestamp":1781484875486,"version":"3.54.1"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2010,12,24]],"date-time":"2010-12-24T00:00:00Z","timestamp":1293148800000},"content-version":"vor","delay-in-days":1452,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"published-print":{"date-parts":[[2007,1,2]]},"abstract":"<jats:p>Pruritic urticarial papules and plaques of pregnancy (PUPPP) are among the most common pruritic dermatoses observed in pregnant women. PUPPP appears most frequently in the third trimester, in primigravidas, and in multiple gestation pregnancies. The eruption of changes occurs initially on the abdomen and extends over the thighs, legs, back, buttocks, arms, and breasts. Skin changes typical for PUPPP are erythematous, urticarial plaques, and papules. Rash regression is usually observed within 6 weeks postpartum. Immunologic mechanisms, hormonal abnormalities, and abdominal skin distension have been suggested as etiologic mechanisms. PUPPP is thought to be harmless for the mother and fetus and usually requires intervention only for symptom relief. In some cases, laboratory investigation, histologic examination, and immunologic study should be performed to exclude more serious disorders of pregnancy, such as herpes gestationis or intrahepatic cholestasis of pregnancy. This article reviews the epidemiology, clinical manifestation, etiology, differential diagnosis, and treatment of PUPPP.<\/jats:p>","DOI":"10.1016\/j.jmwh.2006.09.007","type":"journal-article","created":{"date-parts":[[2007,1,8]],"date-time":"2007-01-08T19:22:02Z","timestamp":1168284122000},"page":"44-48","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Pruritic Urticarial Papules and Plaques of Pregnancy"],"prefix":"10.1111","volume":"52","author":[{"given":"Zenon","family":"Brzoza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja","family":"Kasperska\u2010Zajac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Ole\u015b","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Rogala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2010,12,24]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(83)70046-0"},{"key":"e_1_2_9_3_2","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1001\/jama.1979.03290420022018","article-title":"Pruritic urticarial papules and plaques of pregnancy","volume":"241","author":"Lawley TJ","year":"1979","journal-title":"JAMA"},{"key":"e_1_2_9_4_2","first-page":"44","article-title":"Pruritic urticarial papules and plaques of pregnancy: An unusual case","volume":"102","author":"Gaetano JS","year":"2002","journal-title":"J Am Osteopath Assoc"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdermsci.2005.11.001"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0906-6705.2005.00311.x"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(98)70265-8"},{"key":"e_1_2_9_8_2","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1001\/archderm.1989.01670230076012","article-title":"Pruritic urticarial papules and plaques of pregnancy and its relationship to maternal\u2010fetal weight gain and twin pregnancy","volume":"125","author":"Cohen LM","year":"1989","journal-title":"Arch Dermatol"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(81)70101-4"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(84)80097-3"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-3083.2000.00026.x"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000159564.69522.f9"},{"key":"e_1_2_9_13_2","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1001\/archderm.1991.01680010137029","article-title":"Pruritic urticarial papules and plaques of pregnancy and skin distension","volume":"127","author":"Beckett MA","year":"1991","journal-title":"Arch Dermatol"},{"key":"e_1_2_9_14_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.1996.d01-942.x"},{"key":"e_1_2_9_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(88)90168-8"},{"key":"e_1_2_9_16_2","first-page":"884","article-title":"Skin immune system activation in pruritic urticarlial papules and plaques of pregnancy","volume":"33","author":"Carli P","year":"1994","journal-title":"Int J Dermatol"},{"key":"e_1_2_9_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(08)80623-8"},{"key":"e_1_2_9_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(92)70098-Z"},{"key":"e_1_2_9_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)05121-6"},{"key":"e_1_2_9_20_2","first-page":"861","article-title":"Is there an association between PUPPP and preeclampsia, abruptio placentae and fetal death?","volume":"143","author":"Lowenstein L","year":"2004","journal-title":"[in Hebrew] Harefuah"},{"key":"e_1_2_9_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006254-200107000-00022"},{"key":"e_1_2_9_22_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.105430"},{"key":"e_1_2_9_23_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.129"},{"key":"e_1_2_9_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.141.6.705"},{"key":"e_1_2_9_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003081-199012000-00009"},{"key":"e_1_2_9_26_2","first-page":"497","article-title":"Pruritic urticaria\u2010related papules and plaques of pregnancy: A case report","volume":"72","author":"Rotsztejn H","year":"2001","journal-title":"Ginekol Pol"},{"key":"e_1_2_9_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(08)80308-8"}],"container-title":["Journal of Midwifery &amp; 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