Postpartum pruritic urticarial papules and plaques of pregnancy with an atypical distribution and late onset

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's 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.