{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T09:59:54Z","timestamp":1766656794551,"version":"3.48.0"},"reference-count":19,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,13]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy, is a common dermatological condition of pregnancy that typically presents in the third trimester and resolves spontaneously after delivery. Lesions usually present around the striae gravidarum of the abdomen, with subsequent spread to the lower limbs. We report a case of PUPPP in a postpartum patient who presented with a pruritic rash affecting the buttocks and lower limbs, with abdominal sparing. The patient\u2019s clinical course, histological and lab findings, and response to treatment are discussed. This case contributes to the limited literature on the occurrence of PUPPP in postpartum patients and also PUPPP presenting without involvement of the abdomen. We aim to increase awareness of this atypical presentation and emphasise the need for a comprehensive evaluation in patients presenting with rashes in pregnancy and post partum.<\/jats:p>","DOI":"10.1136\/bcr-2025-269467","type":"journal-article","created":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T09:55:22Z","timestamp":1766656522000},"page":"e269467","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Postpartum pruritic urticarial papules and plaques of pregnancy with an atypical distribution and late onset"],"prefix":"10.1136","volume":"18","author":[{"given":"Hannah","family":"Xuereb","sequence":"first","affiliation":[{"name":"Medicine, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Young","sequence":"additional","affiliation":[{"name":"Dermatology, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6919-5692","authenticated-orcid":false,"given":"Stephanie","family":"Farrugia","sequence":"additional","affiliation":[{"name":"Dermatology, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence","family":"Scerri","sequence":"additional","affiliation":[{"name":"Dermatology, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"2025122501550940000_18.12.e269467.1","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.clindermatol.2016.02.011","article-title":"Polymorphic eruption of pregnancy","volume":"34","author":"Taylor","year":"2016","journal-title":"Clin Dermatol"},{"key":"2025122501550940000_18.12.e269467.2","doi-asserted-by":"crossref","first-page":"584","DOI":"10.52533\/JOHS.2023.31205","article-title":"Dermatoses of Pregnancy: Overview of Presentation, Treatment and Outcome","volume":"3","author":"Bokhari","year":"2023","journal-title":"JOHS"},{"key":"2025122501550940000_18.12.e269467.3","doi-asserted-by":"crossref","first-page":"490","DOI":"10.18203\/issn.2455-4529.IntJResDermatol20211720","article-title":"A review of literature of polymorphic eruption of pregnancy","volume":"7","author":"Vadakkumpadam","year":"2021","journal-title":"Int J Res Dermatol"},{"key":"2025122501550940000_18.12.e269467.4","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1111\/j.1447-0756.2010.01492.x","article-title":"Polymorphic eruption of pregnancy with palmoplantar involvement that developed after delivery","volume":"37","author":"\u00d6zcan","year":"2011","journal-title":"J Obstet Gynaecol Res"},{"key":"2025122501550940000_18.12.e269467.5","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1046\/j.1365-2230.2002.01099.x","article-title":"Polymorphic eruption of pregnancy developing in the puerperium","volume":"27","author":"Kirkup","year":"2002","journal-title":"Clin Exp Dermatol"},{"key":"2025122501550940000_18.12.e269467.6","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1159\/000473874","article-title":"Pruritic Urticarial Papules and Plaques of Pregnancy Occurring Postpartum Treated with Intramuscular Injection of Autologous Whole Blood","volume":"9","author":"Kim","year":"2017","journal-title":"Case Rep Dermatol"},{"key":"2025122501550940000_18.12.e269467.7","first-page":"1387","article-title":"Assessment of cases of Pruritic urticarial papules and plaques of pregnancy (PUPPP)","volume":"12","author":"Bharat","year":"2023","journal-title":"International Journal of Life Sciences Biotechnology and Pharma Research"},{"key":"2025122501550940000_18.12.e269467.8","doi-asserted-by":"crossref","first-page":"109","DOI":"10.2147\/IJWH.S125784","article-title":"Pustular psoriasis of pregnancy: current perspectives","volume":"10","author":"Trivedi","year":"2018","journal-title":"Int J Womens Health"},{"key":"2025122501550940000_18.12.e269467.9","doi-asserted-by":"crossref","DOI":"10.1001\/archderm.1989.01670230076012","article-title":"Pruritic Urticarial Papules and Plaques of Pregnancy and Its Relationship to Maternal-Fetal Weight Gain and Twin Pregnancy","volume":"125","author":"Cohen","year":"1989","journal-title":"Arch Dermatol"},{"key":"2025122501550940000_18.12.e269467.10","first-page":"344","article-title":"Pruritic urticarial papules and plaques of pregnancy occurring postpartum","volume":"95","author":"Dehdashti","year":"2015","journal-title":"PubMed"},{"key":"2025122501550940000_18.12.e269467.11","doi-asserted-by":"crossref","unstructured":"Brand\u00e3o P , Sousa-Faria B , Marinho C , et al . 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