We read with interest the article by Cohen et al1 describing the possible relationship between pruritic urticarial papules and plaques of pregnancy (PUPPP) and maternal-fetal weight gain and twin pregnancy. Several authors2,3 agree with this hypothesis.
We describe 12 patients with PUPPP who were seen at the Hospital of Saint-Germain-en-Laye (France) between February and March 1989, January and October 1990, and June and November 1991 and compare them with 1828 pregnant control women delivering at the same hospital and at the same time. Five of 12 patients were primigravidas, six were gravida 2, and one was gravida 3. There were three twin pregnancies and two triplet pregnancies.
The onset of PUPPP occurred in the third trimester in 10 patients and in the postpartum period in two women. The mean time of onset was 35 weeks. Clinical and histopathologic features were typically characteristic of PUPPP. Lesions appeared initially on