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Difference Between Pemphigoid Gestationis and Puppp

PUPPP (the Pruritic Urticarial Papules and Plaques of Pregnancy) differs from PG (pemphigoid gestationis) in that it does not include blisters (fluid filled lumps) and an autoimmune response.


Both conditions can show up in third trimester of pregnancy

Pemphigoid Gestationis 

A not common, itchy skin eruption (uncomfortable, irritating sensation) known as pemphigoid gestationis (PG) typically appears in the 2nd or 3rd trimester of pregnancy. Although it can arise on other regions of your body, it frequently starts with the development of extremely itchy, red pimples or blisters (fluid filled lumps) on your stomach and trunk.


PUPPP – the Pruritic Urticarial Papules and Plaques of Pregnancy is an itchy rash that sometimes appears during pregnancy. The letters PUPPP stand for pruritic urticarial papules and plaques of pregnancy. In simpler terms, PUPPP (the Pruritic Urticarial Papules and Plaques of Pregnancy) rash is a patch of itchy (discomfort and irritation), hive-like bumps (lumps) that form in the stretch marks on your belly and spread to other parts of your body when you’re carrying a child.

Difference between Pemphigoid Gestationis and Puppp


Pemphigoid Gestationis 

A rare (not common), particular dermatosis (any skin defect or lesion on the skin) during pregnancy is known as pemphigoid gestationis (PG), formerly known as herpes gestationis. Clinically (involving direct observation of the patient) and pathogenetically (infective, morbific unhealthful), it is a bullous (characterized by blisters) autoimmune sub-epidermal (lying beneath) dermatosis (any skin defect or lesion on the skin) that resembles bullous pemphigoid.


The most typical form of gestational dermatosis (specific to pregnancy) is called pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy (PEP). It is a benign (non-cancerous), itch-inducing skin condition with multiple clinical manifestations, normal laboratory (some clinical tests are done) results, and a negative direct immunofluorescence (technique used for light microscopy with a fluorescence microscope). Primigravidas (a woman who is pregnant for the first time) typically have pruritic urticarial papules and plaques of pregnancy during the third trimester of pregnancy. It does not tend to return in subsequent pregnancies and is less common in the early postpartum term.


Pemphigoid Gestationis 

  • Rashes that are flat or raised red spots
  • The rashes appear as blisters (fluid filled lumps) form
  • The rash may have hive-like characteristics


  • Intensely itchy
  • Small red and swollen papules
  • In and around stretch marks
  • Typically, painless and does not form blisters


Pemphigoid Gestationis 

Starts in the periumbilical area with subsequent spread to the remaining space of the belly and extremities.  


Typically starts on the belly with striae, and the spreads to the legs, arms, chest, the periumbilical region is usually spared.


The points of difference between Pemphigoid Gestationis and Puppp have been summarized as below:


Is polymorphic eruption of pregnancy the same as Pupps?

An itchy, bumpy rash called a polymorphic eruption of pregnancy/conception appears in the stretch marks on the belly during the final three months of pregnancy and disappears after delivery. (PUPPP) – Pruritic Urticarial Papules and Plaques of Pregnancy, or pruritic urticarial papules and plaques of pregnancy, is another name for it.

What does pemphigoid gestationis look like?

The pemphigoid gestationis (PG) rash might start as flat or raised bumps, which frequently first appear on the belly button. The rash (redness and itchiness) then spreads and fluid filled lumps form. The fluid-filled, atypically formed blisters might be tiny or huge in size. There is lot of itching in the rashes. 

What is another name for pemphigoid gestationis?

Herpes gestationis

What is another name for Pupps?

Pruritic Urticarial Papules and Plaques of Pregnancy

What is the difference between PUPPP and PG in pregnancy?

The Pruritic Urticarial Papules and Plaques of Pregnancy rash can resemble the pemphigoid gestationis (PG) skin disease. Itchy hives brought on by pemphigoid gestationis may feel like Pruritic Urticarial Papules and Plaques of Pregnancy. Although pemphigoid gestationis can manifest earlier than the 3rd trimester, both forms of skin disorders manifest at this time. However, pemphigoid gestationis is more uncommon and worrisome than PUPPP rash.

What does the start of Pupps look like?

Itching on your abdomen, particularly in the stretch marks, precedes the rash. As the sores expand, a few bumps (lumps) first appear, then they develop into a broad rash. Hives (urticaria), elevated lumps, tiny fluid filled lumps, and a broad, red, swelling region across your abdomen—but usually not your belly button—are the appearances of the rash.

How do you rule out pemphigoid?

  • Skin biopsy
  • The endoscopy
  • Blood tests for detection and identification of pemphigus-associated blood antibodies.

What are the early stages of pemphigoid?

During mid to late pregnancy (thirteen – forty weeks gestation), pemphigoid gestationis often manifests as a very crawling and tingling, urticaria-like rash.

  • Around the abdominal button, there are first itchiness and red lumps.
  • The rash and tingling begin on one area of the body and quickly spreads to others, including the trunk or torso (chest, abdomen, pelvis, and back), buttocks, and arms. Typically, the mucous (a thick, slippery fluid). membranes of the fizzog, scalp (the skin covering the head), palms, and soles are unaffected.
  • Large, tight blisters (fluid-filled bubble) develop after two – four weeks. Few patients may only have plaques of agitated skin rather than blisters.

How do you test for pemphigoid gestationis?

Blood tests and skin biopsy. 

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References :

[0]Callen, J. P., & Hanno, R. (1981). Pruritic urticarial papules and plaques of pregnancy (PUPPP): a clinicopathologic study. Journal of the American Academy of Dermatology, 5(4), 401-405.

[1]Lipozenčić, J., Ljubojevic, S., & Bukvić-Mokos, Z. (2012). Pemphigoid gestationis. Clinics in Dermatology, 30(1), 51-55.

[2]Matz, H., Orion, E., & Wolf, R. (2006). Pruritic urticarial papules and plaques of pregnancy: polymorphic eruption of pregnancy (PUPPP). Clinics in dermatology, 24(2), 105-108.

[3]Sävervall, C., Sand, F. L., & Thomsen, S. F. (2017). Pemphigoid gestationis: current perspectives. Clinical, Cosmetic and Investigational Dermatology, 441-449.

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