RE: > I have searched lactnet for information on PUPPS and did find a few comments from the past.  Also checked Lawrence.  However I have another question and wondered if anyone ever heard of "the breastfeeding hormones" being blamed for the rash.
> 

Since its onset is more associated with late pregnancy and less commonly with very early postpartum, blaming breastfeeding hormones makes no sense. (Actually, etiology isn't clear.) It is one more of those ludicrous medical pronouncements by a HP who didn't really know the answer or take the time -- not as bad as the doc who told a mother to wean because he worried lactation would short out her pacemaker and close, but not as bad, as the doc who prescribed antibiotics for prenatal expression of colostrum, which he thought was pus... But it's still right up there.


PUPPP is more common in multiple pregnancy. Here's an abstract from a recent med journal on it:

Rudolph CM, Al-Fares S, Vaughan-Jones SA, Mullegger RR, Kerl H & Black MM (2006). Polymorphic eruption of pregnancy: clinicopathology and potential trigger factors in 181 patients. British Journal of Dermatology, 154(1), 54-60. 

BACKGROUND: Polymorphic eruption of pregnancy (PEP; synonym: pruritic urticarial papules and plaques of pregnancy) is the most common specific dermatosis of pregnancy. However, its clinical characterization is controversial and its pathogenesis uncertain. OBJECTIVES: To evaluate clinical characteristics of and potential trigger factors for PEP in a large mixed ethnic population. METHODS: A retrospective analysis of epidemiological, clinical, immunopathological and obstetric findings in 181 patients with PEP seen at two university-based dermatological hospitals in Graz, Austria, and London, U.K. RESULTS: PEP mainly affected white (88%) primigravidae (70%) in late pregnancy (83%; mean +/- SD onset 34 +/- 5 weeks) or the immediate postpartum period (15%). The most commonly involved sites were the abdomen and proximal thighs (97%). Involvement of the whole skin, including the face, palms and soles, was only rarely observed. While pruritic urticarial papules and plaques were the main morphological features at disease onset (98%), more than one-half of the patients (51%) later developed polymorphous features including erythema, vesicles, and targetoid and eczematous lesions. Topical treatment with corticosteroids and emollients was sufficient to control symptoms in the majority of patients, and skin lesions resolved after a mean +/- SD of 4 +/- 3 weeks. Multiple gestation pregnancies were observed in 13% of cases, excessive maternal weight gain in 78%. CONCLUSIONS: Our data confirm the benign, self-limiting nature of PEP and its favourable outcome for both the mother and the fetus. For the first time, we have documented a characteristic change in morphology with disease progression. The evidence of polymorphous clinical features in more than one-half of the patients favours the use of the term PEP. Multiple gestation pregnancies and excessive maternal weight gain, but not fetal weight and sex, were found to be significantly associated with PEP.


KKG

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