# Pruritic Dermatoses of Pregnancy

> Pruritic dermatoses of pregnancy for NEET-PG Dermatology cover PUPPP, intrahepatic cholestasis, atopic eruption and pemphigoid gestationis with fetal risks.

- Canonical URL: https://prepelephant.com/topics/neet-pg/dermatology/pruritic-dermatoses-of-pregnancy
- Exam / course: NEET-PG · Subject: Dermatology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: Fitzpatrick's Dermatology; Williams Obstetrics
- How to cite: "Pruritic Dermatoses of Pregnancy", PrepElephant, https://prepelephant.com/topics/neet-pg/dermatology/pruritic-dermatoses-of-pregnancy

## Direct answer

Pruritic dermatoses of pregnancy are itchy skin eruptions that appear only in pregnancy or flare during it, and the key entities are polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, atopic eruption of pregnancy and pemphigoid gestationis. Polymorphic eruption is benign and arises in the late third trimester, intrahepatic cholestasis carries fetal risk and needs bile acid testing, and pemphigoid gestationis forms blisters with fetal consequences.

## What you must remember

- **PUPPP:** pruritic urticarial papules and plaques, typically in first pregnancies in the late third trimester, sparing the periumbilical skin.
- **Intrahepatic cholestasis of pregnancy:** itch of the palms and soles without a primary rash, with raised serum bile acids and fetal risk.
- **Atopic eruption of pregnancy:** pruritic papules and vesicles on the extensor limbs and flexures, in women with prior atopy.
- **Pemphigoid gestationis:** periumbilical urticarial plaques that progress to tense blisters, with anti-BP180 antibodies and neonatal complications.
- **Benign course:** PUPPP and atopic eruption carry no fetal risk and resolve after delivery.
- **Itch management:** emollients, topical steroids and oral antihistamines for sleep, with care over drug choice in pregnancy.
- **Key test for cholestasis:** serum bile acids, supported by liver enzymes.
- **Obstetric planning:** timing of delivery in cholestasis is individualised by obstetric teams, and ursodeoxycholic acid is commonly used to relieve itch.

## Matching the eruption to its pattern and risk

The four entities overlap in itch, so the rash pattern, the timing and the fetal implications decide the management. The table sets out the differences.

| Condition | Typical timing | Hallmark | Fetal concern |
|---|---|---|---|
| PUPPP | Late third trimester | Striae-associated urticarial papules | None |
| Cholestasis of pregnancy | Later second and third trimester | Itch without rash, raised bile acids | Yes |
| Atopic eruption | Any trimester, flares with atopy | Extensor papules and vesicles | None |
| Pemphigoid gestationis | Second or third trimester | Periumbilical blisters, anti-BP180 | Yes |

The two conditions with fetal concern need specialist obstetric and dermatology input. The two benign ones need reassurance, symptomatic itch control and a plan for resolution after delivery.

Liver tests should be requested early in any woman with unexplained pruritus, because cholestasis can be missed when the skin looks normal. Any blistering or periumbilical eruption in pregnancy should raise pemphigoid gestationis, and a skin biopsy with direct immunofluorescence is the appropriate test to order.

## Where the exam tries to catch you

Stems test whether you can separate a benign itchy rash from the two conditions that carry fetal risk.

- **Trap:** dismissing itch without rash as PUPPP. **Correct:** itch on the palms and soles without rash suggests cholestasis, so check liver tests and serum bile acids.
- **Trap:** labelling periumbilical blisters as PUPPP. **Correct:** PUPPP spares the periumbilical skin, whereas pemphigoid gestationis begins there and needs anti-BP180 testing and specialist care.
- **Trap:** relying on oral antihistamines alone for cholestatic itch. **Correct:** cholestasis needs bile acid testing and specific therapy, since antihistamines rarely control it.

## Frequently asked questions

### What is the typical onset of PUPPP?

PUPPP typically begins in the late third trimester, most often in first pregnancies, with itchy urticarial papules and plaques that spare the periumbilical skin. It is benign and resolves after delivery.

### Which test is key in intrahepatic cholestasis of pregnancy?

Serum bile acid estimation is the key test in intrahepatic cholestasis of pregnancy, supported by liver enzymes. Raised bile acids with itch on the palms and soles confirm the diagnosis, which carries fetal risk and needs obstetric planning.

### How does pemphigoid gestationis differ from PUPPP?

Pemphigoid gestationis forms periumbilical urticarial plaques that progress to tense blisters, with circulating anti-BP180 antibodies, and it can cause neonatal complications. PUPPP lacks blisters and spares the periumbilical skin, and it does not affect the fetus.

### Does atopic eruption of pregnancy affect the baby?

Atopic eruption of pregnancy does not harm the baby, and it occurs in women with a prior history of atopy. It causes itchy papules and vesicles on the extensor surfaces and flexures and responds to topical steroids.