初次怀孕的宝妈们，身上长红疹？！：你可能得了这个病

多形性妊娠疹（PUPPP），是最常见的妊娠期皮肤病。它是一种良性、瘙痒性、炎性皮肤病，其特征在于皮损多形性，实验室检查正常和病变部位直接免疫荧光染色阴性。 PUPPP通常影响处于晚期妊娠的初次怀孕的孕妇，分娩后症状显著减轻，并且再次怀孕时不会复发。

那么PUPPP是如何发病的？怎么治疗？让我们继续看下去吧～

Pruritic urticarial papules and plaques of pregnancy (PUPPP) is the most common gestational dermatosis. It is a benign, pruritic, inflammatory skin disorder, characterized by a polymorphous clinical presentation, normal laboratory tests, and negative direct immunofluorescence. PUPPP usually affects primigravidas in their third trimester of pregnancy, less frequently in the immediate postpartum period, and has no tendency for recurrence in subsequent pregnancies.

Now let's take a look at this disease in detail.

01

PUPPP的病因是什么？Causes

尽管关于PUPPP的发病机制已有很多理论，包括腹胀、激素变化、胎盘因素和胎儿DNA等，但是PUPPP皮损产生原因仍是未知的。另外，有人提出，特别是在妊娠晚期发生的外周嵌合体（胎儿DNA的沉积），会在血管分布增加和胶原受损的皮肤处额外沉积，可能随后成为免疫反应的目标。
The cause of pruritic urticarial papules and plaques of pregnancy is still unknown, although various etiological theories have been proposed, including abdominal distension, hormonal changes, placental factors and the  role of foetal DNA in skin lesions. Additionally, there are suggestions that peripheral chimerism (deposition of foetal DNA), which occurs particularly during the third trimester, and favors skin with increased vascularity and damaged collagen, could be subsequently the target of immune reactivity.

02

PUPPP如何诊断？Diagnosis

通常通过全面检查皮损即可诊断，不需要进一步测试。然而，应通过进行全血细胞计数，肝功能检查以及血清皮质醇和血清人绒毛膜促性腺激素（HCG）水平的测定来仔细排除其他感染，如真菌感染或疥疮。
A PUPPP rash is typically diagnosed by thorough examination of the skin lesions. Usually no further testing is required. However, other infections such as fungal infection or scabies should be carefully ruled out by performing a complete blood count, liver function test, and the determination of serum cortisol and serum human chorionic gonadotropin (HCG) levels.

03

PUPPP需要与哪些疾病鉴别诊断？

Differential Diagnoses

最需要与UPPP进行鉴别的是妊娠型类天疱疮。由于临床特征可能重叠，因此必须进行组织学和免疫学研究以区分这两种疾病。但在妊娠性类天疱疮中，皮损通常在妊娠期早期出现，常常位于脐周，且皮损周围皮肤直接免疫荧光反应阳性。
与湿疹鉴别诊断时，湿疹患者通常具有典型的个人或家族史，并且皮损多为在于瘙痒性红斑病变。
也需与药疹，荨麻疹或病毒疹临床鉴别。
The most important diagnosis to exclude is urticarial pemphigoid gestationis. As the clinical features can overlap, histological and immunological studies are necessary to make the distinction between these two disorders. Although in pemphigoid gestationis, lesions usually appear earlier during gestation, often involvong the umbilicus, along with positive immunofluorescence of perilesional skin.
In eczema, patients typically have a personal or family history of atopy and the eruption is characterized by pruritic erythematous lesions.
Drug eruptions, urticaria, or viral exanthems may also be included in the clinical differential diagnosis.

04

PUPPP有什么症状？Symptoms

皮损通常由发痒的小红斑和水肿性丘疹组成，斑块首先发生于妊娠纹上，脐周一般无皮损。皮损可以聚结形成更大的荨麻疹性斑块，位于腹部，通常被白晕包围。皮损在几天发展到躯干和四肢，但很少累及面部，手掌或脚掌。之后，随着疾病的发展，几乎所有患者都会发展出更多的多态性皮损，包括广泛的红斑，靶型病变，微小水疱和湿疹斑块。通常没有粘膜受累。
The rash consists of itchy small erythematous and oedematous papules and plaques usually first start in the stretch marks, typically with periumbilical sparing. The lesions can coalesce to form larger urticarial abdominal plaques often surrounded by blanched halos. The eruption spreads over a matter of days, to the trunk and the extremities, but rarely involves the face, palms, or soles. After that, almost all patients develop more polymorphic features as the disease evolves, including widespread erythema, targetoid lesions, tiny vesicles, and eczematous patches. Mucosal involvement is usually not observed.

05

PUPPP如何治疗？Treatments

PUPPP患者通常只需要对症治疗。大多数患者使用外用皮质类固醇（1％氢化可的松乳膏或地奈德乳膏）即可达到令人满意的控制。此外，镇静类第一代抗组胺药在怀孕期间是安全的，并且可以用作辅助治疗以缓解瘙痒。对于严重影响睡眠、导致体力透支的较严重的情况，短期系统性糖皮质激素治疗可能有所帮助。一般措施，如清爽、舒缓的沐浴，频繁使用润肤剂和棉质衣物，可进一步缓解症状。

最后说一句，就算得了PUPPP，各位准妈妈也不用担心。PUPPP通常在平均4周内自发消退或分娩后消退，不伴随炎症后色素沉着或瘢痕形成。再次妊娠也通常不会复发。在发疹早期于皮肤科就诊即可～
Only symptomatic treatment is usually necessary for patients with PUPPP. The majority of affected ladies achieve satisfactory control with topical corticosteroids (1% hydrocortisone cream) and oral antihistamines (cetirizine). Further, sedating first-generation antihistamines appear to be safe in pregnancy and can be used as adjunct therapy to provide relief from pruritus. For severe disease with disturbed sleep leading to exhaustion of the mother, a short course of systemic corticosteroids can be helpful. General measures, such as cool, soothing baths, frequent application of emollients and light cotton clothing, offers additional symptomatic relief.

Last but not least, the soon-to-be moms don't need to worry too much even if you got the disease, all you need to do is go to a dermatologist immediately once there appears likely symptoms. PUPPP typically spontaneously resolves over an average of 4 weeks or with delivery, there is no post-inflammatory pigment change or scarring of the skin. The eruption tends to not recur with subsequent pregnancies.