Can chronic spontaneous urticarial produce symptoms of neuropathic pain?

Abstract Background Chronic spontaneous urticaria (CSU) is a condition that is associated with recurrent pruritic hives and/or angioedema lasting for more than 6 weeks and is known to affect 1% of the population. Neuropathic pain can be defined as abnormal pain in the peripheral or central nervous system following injury and results from dysfunctions in the peripheral or central nervous system without peripheral nociceptor stimulation. Histamine appears in the pathogenesis of both the CSU and diseases of the neuropathic pain spectrum. Objective To evaluate the symptoms of neuropathic pain in patients with CSU using scales. Method Fifty-one patients with CSU and 47 sex- and age-matched healthy controls were included in the study. Results The results of the short-form McGill Pain Questionnaire revealed the scores in the sensory and affective domains, Visual Analogue Scale (VAS) scores and pain indices to be significantly higher in the patient group (p < 0.05 for all cases), while the overall pain assessment and sensory assessment based on the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale were also significantly higher in the patient group. Based on the assumption that scores of > 12 indicated neuropathy, 27 (53%) of the patients in the patient group and 8 (17%) in the control group were found to have neuropathy (p < 0.05). Study limitations Cross-sectional study, small patient sample and use of self-reported scales. Conclusion In addition to itching, patients with CSU should be aware of the potential for the association of neuropathic pain. In this chronic disease that is known to affect the quality of life, using an integrated approach with the patients and identifying accompanying problems are as important as treating the dermatological disorder.

Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through in vitro fertilization

Abstract Background: Pruritic urticarial papules and plaques of pregnancy development may have a strong relationship with hormone treatments during in vitro fertilization and hormonal changes during pregnancy. Objectives: The aim of this study was to evaluate and compare the frequency of papules and plaques of pregnancy and related factors in in vitro fertilization pregnancies and spontaneous pregnancies. Methods: In this study, 517 in vitro fertilization pregnancies and 1253 spontaneous pregnancies were retrospectively reviewed for papules and plaques of pregnancy frequency. The diagnosis of papules and plaques of pregnancy was performed by referral to the dermatology department and according to the typical clinical manifestations of the disease. Results: The papules and plaques of pregnancy was more common in all in vitro fertilization pregnancies (including single pregnancies) than in spontaneous pregnancies. Age, Rh positivity, mother weight gain, onset of disease during gestation, duration of disease, birth weight and the frequency of male fetus were similar between the two groups (p > 0.05). The rate of multiple pregnancies was higher in in vitro fertilization pregnancies with papules and plaques of pregnancy than in vitro fertilization pregnancies without papules and plaques of pregnancy (p < 0.001). Duration of progesterone treatment was also significantly longer in in vitro fertilization pregnancies with papules and plaques of pregnancy compared to in vitro fertilization pregnancies without papules and plaques of pregnancy (p < 0.001). Study limitations: The limitations of the study were the retrospective and single-centered design. Conclusion: The results of this study indicate that increased progesterone dosage or prolonged treatment may play a role in the pathogenesis papules and plaques of pregnancy.

Episodic angioedema with eosinophilia (Gleich's syndrome) associated with urticarial vasculitis: a coincidence or a novel clinical entity?

Episodic angioedema with eosinophilia (EAE) is a rare condition characterized by recurrent attacks of angioedema and urticaria accompanied by a marked elevation of peripheral eosinophil count. We report the case of a young female patient diagnosed with EAE associated with urticarial vasculitis. A 40-year-old female patient was admitted to our institution due to recurrent episodes of cheek and eyelid angioedema in the previous year. Episodes of facial angioedema lasted for two months with spontaneous remission afterwards. In addition, she presented pruritic and painful skin eruptions of erythematous circles, which persisted for longer than 24 h, that were palpable, somewhat purplish, and more pronounced on the face, arms, and trunk. Laboratory investigation showed a sustained elevation of white cell counts with marked eosinophilia. Serum IgM, IgE, and IgA were normal; IgG was slightly elevated. C1-esterase inhibitor and tryptase test were normal. Reverse transcriptase-polymerase chain reaction was performed for detection of FIP1L1-PDGFRA and BCR-ABL rearrangements. None of these alterations were found. Skin biopsies were suggestive of urticarial vasculitis. The patient was submitted to esophagogastroduodenoscopy, which showed mild chronic gastritis, with no eosinophilic infiltration. Cardiac dimensions and function were normal. Abdominal ultrasound and total body CT-scan failed to show lymphadenopathy, organomegaly, and tumors. We report the first case of association between episodic angioedema with eosinophilia and urticarial vasculitis. It is possible that both conditions share a physiopathological mechanism, suggesting that it is not just a chance association.

Urticaria vasculitis como manifestación de Lupus Eritematoso Sistémico / Urticarial Vasculitis as a manifestation of Systemic Lupus Erythematosus

Resumen La urticaria vasculitis (UV) es una vasculitis de pequeños vasos caracterizada clínicamente por lesiones urticarianas que muestran en la histología una vasculitis leucocitoclástica. Puede ser normo o hipocomplementémica, y mayormente es de etiología idiopática. Presentamos un caso de una paciente de 15 años con un cuadro de urticaria vasculitis en el contexto de un lupus eritematoso sistémico (LES).

Abstract Urticarial vasculitis (UV) is a vasculitis of small vessels clinically characterized by urticarial lesion that show a leukocytoclastic vasculitis in the histology. It may be normal or hypocomplementemic, mostly of idiopathic etiology. Here we present a case of a female patient 15 years old, who presents a clinical history of urticaria vasculitis in the context of a systemic lupus erythematosus.

Dermatoses associadas ao trabalho em profissionais de saúde de um centro hospitalar português / Occupational dermatoses among healthcare workers in a hospital center in Portugal

Introdução: As patologias cutâneas representam mais de 35% das doenças relacionadas com o trabalho, afetando anualmente 1/1.000 trabalhadores. Objetivos: Caracterizar as dermatoses associadas ao trabalho em profissionais de um centro hospitalar e identificar possíveis agentes desencadeantes e fatores de suscetibilidade. Métodos: Estudo transversal com recolha da informação registrada no processo clínico eletrônico dos trabalhadores observados em exame de saúde periódico no período de um ano. Resultados: Nos 1.741 trabalhadores estudados, 3,56% tinham registro de dermatoses associadas ao trabalho, a maioria mulheres (76,85%). Dos profissionais com dermatoses, 34 (54,84%) tinham dermatite de contato irritativa, 17 (27,42%) urticária ao látex, seis (9,68%) dermatite de contato alérgica e cinco (8,06%) duas dermatoses concomitantes. Encontrou-se diferença estatisticamente significativa entre os vários grupos profissionais (p=0,008), sendo os auxiliares de enfermagem os mais afetados (5,11%). Verificou-se também maior prevalência (8,47%) em profissionais de blocos operatórios (p=0,001). Os principais agentes desencadeantes foram desinfetantes cutâneos, látex, luvas de nitrilo e contato prolongado com água (4,84%). Conclusões: Por tratar-se de um estudo baseado em registros clínicos, a informação está dependente da qualidade destes. Para além disso, os auxiliares de enfermagem foram a maioria representada na amostra no que se refere à população do centro hospitalar, o que limita a extrapolação dos resultados. Este estudo encontrou prevalência de dermatoses de somente 3,56%, o que talvez se deva à implementação de medidas preventivas. Os profissionais mais afetados foram os de blocos operatórios e os auxiliares de enfermagem. Os desinfetantes cutâneos foram os principais agentes apontados como desencadeantes.

Background: Skin diseases account for more than 35% of occupational diseases, affecting 1/1,000 workers annually. Objective: To characterize occupational dermatoses affecting hospital workers and identify possible triggers and susceptibility factors. Methods: Cross-sectional study in which we analyzed information extracted from electronic medical records of workers who performed periodic examinations in the course of one year. Results: About 3.56% of 1,741 included workers had a diagnosis of occupational dermatosis, being mainly women (76.85%). Thirty-four (54.84%) of the affected workers had irritant contact dermatitis, 17 (27.42%) latex allergy, 6 (9.68%) allergic dermatitis, and 5 (8.06%) two concomitant conditions. We found significant difference in prevalence as a function of occupational group (p=0.008), being highest for nursing assistants (5.11%). Prevalence was also higher for employees allocated to surgery departments (8.47%, p=0.001). Main triggers were skin disinfectants, latex, nitrile gloves, and prolonged contact with water (4.84%). Conclusion: The quality of the analyzed data depends on the quality of the analyzed medical records. Most subjects were nursing assistants, which fact hinders the generalization of the results. The prevalence of occupational dermatosis was just 3.56%, which might be explained by previously implemented preventive measures. The employees most frequently affected were those allocated to surgery departments and nursing assistants. Skin disinfectants were the most frequent triggers.

Clinical Course of Chronic Spontaneous Urticaria in the Korean Adult Population

Knowledge of the clinical course of chronic spontaneous urticaria (CSU) remains unclear. The purpose of our study was to investigate the clinical course of CSU in the Korean adult population. Each patient in the CSU group who was defined by disease codes between 2003 and 2007 was tracked whether he or she went into remission or not until 2013. Kaplan-Meier survival analysis was carried out to analyze remission, and log-rank tests were performed for between-group comparisons. Demographic differences between subjects who went into remission 1 year after the initial diagnosis and those who did not were analyzed using χ² tests. A total of 13,969 subjects were included in the CSU group. The 1-, 2-, 3-, 4-, and 5-year remission rates of CSU were 21.5%, 33.0%, 38.9%, 42.6%, and 44.6%, respectively. The proportion of subjects in the 65+ age group (P=0.050) and with male gender (P=0.002) was significantly higher among subjects who did not go into remission 1 year after the initial diagnosis. Our study indicates that CSU could have a more persistent course than previously reported.

Hypocomplementemic Urticarial Vasculitis Syndrome with Membranous Nephropathy: Case Report

Urticarial vasculitis is a rare disorder that principally manifests with recurrent urticarial, sometimes hemorrhagic, skin lesions and/or angioedema. Its clinical presentation is not always limited to cutaneous lesions and it can potentially affect other organs, such as the joints, lungs, kidneys, and eyes. Systemic involvement can either be present at the onset of disease or develop over time. In cases with systemic manifestations, urticarial vasculitis is more likely to be associated with a low complement level. We present the case of a teenage boy with hypocomplementemic urticarial vasculitis syndrome (HUVS) that occurred shortly following swine-origin influenza A virus infection in 2009. Afterwards, HUVS was systemically complicated with myositis and membranous nephropathy that developed several months and about 2 years after its onset, respectively. A combination of glucocorticoid and immunosuppressive agents has been used to effectively control disease activity.

Treatment Effect of Tranexamic Acid in Plasma D-dimer Level Elevated Anti-histamine Resistant Chronic Urticaria Patients / 대한피부과학회지

No abstract available.

Prevalence and Risk Factors of Urticaria With a Focus on Chronic Urticaria in Children

PURPOSE: Limited data is available on the prevalence and risk factors of acute and chronic urticaria in children. Our purpose was to determine the prevalence and identify the risk factors of acute and chronic urticaria in Korean children. METHODS: This population-based study examined 4,076 children (age 4 to 13 years) who were enrolled in the 2015 prospective Seongnam Atopy Project (SAP 2015) in Korea. The parents completed an urticaria questionnaire that included questions regarding the duration, severity, and triggering factors of urticaria. Blood sampling (n=464) was performed to measure vitamin D, total eosinophil count (TEC), and total IgE levels, and skin prick tests (n=503) were done. RESULTS: The prevalences of the life-time, acute, and chronic urticaria were 22.5%, 13.9%, and 1.8% (chronic continuous urticaria, 0.7%; and chronic recurrent urticaria, 1.1%), respectively. Acute urticaria was significantly associated with allergic diseases and parental history of allergy (P<0.001), but chronic urticaria was not associated with these clinical factors. There was no significant difference in the 25-hydroxyvitamin D level between subjects with chronic urticaria and controls (P=0.124). Chronic continuous urticaria was associated with living in a new residence (aOR=2.38, 95% CI=1.02-5.54, P=0.044) and belonging to a family with a high income (aOR=4.24, 95% CI=1.24-14.56, P=0.022). CONCLUSIONS: A total of 1.8% of children were found to have chronic urticaria. Living in a new residence and belonging to a family with a high income increased the risk of chronic continuous urticaria.

Urticarial Dermatitis: Clinical Characteristics of Itch and Therapeutic Response to Cyclosporine

BACKGROUND: Urticarial dermatitis, which is characterised by persistent wheals with eczematous papules and plaques, is frequently misdiagnosed and difficult to treat. Patients commonly experience intolerable pruritus which may greatly affect their quality of life. OBJECTIVE: The objective of this study is to characterize the clinical patterns of pruritus in patients with urticarial dermatitis and to determine the effectiveness of cyclosporine treatment. METHODS: This prospective study included 50 histopathologically confirmed patients with urticarial dermatitis. A face-to-face structured questionnaire was given to all patients, and they were treated with low-dose cyclosporine (1~3 mg/kg/d) for at least 2 weeks. RESULTS: The majority of patients (80.0%) had moderate to severe pruritus. Most patients experienced exacerbation of the itch in the evening (74.0%), with the extremities (upper, 86.0%; lower, 94.0%) being the most commonly involved sites. Due to severe pruritus, patients complained about reduced social contact, quality of life and difficulties in falling asleep et al. Cyclosporine significantly reduced the mean itch score and extent of erythema, and improved interference with daily activities and sleep. CONCLUSION: Our study highlights the detailed description and characteristics of pruritus in patients with urticarial dermatitis. And we recommend alternative and effective therapeutic option of low-dose cyclosporine.

Urticarial Vasculitis Associated with Mycoplasma pneumoniae / 대한피부과학회지

No abstract available.

Vasculitis urticarial hipocomplementémica: aclaraciónhistórica / Hypocomplementemic urticarial vasculitis: Clarification of a historical fact

El síndrome de vasculitis urticarial hipocomplementémica ha recibido enorme interés enla literatura médica, a partir de la publicación original en 1973, en Mayo Clinic Proceedings.El caso índice fue identificado en 1968, como entidad clínica distintiva, por uno de loscoautores de la primera publicación y de la revisión actual (JEM), que cierra un ciclo demás de 45 años. Las características clínicas diferenciales del síndrome vasculitis urticarialhipocomplementémica determinaron que el Consenso 2012 sobre Nomenclatura de lasVasculitis de la American Association of Rheumatology le asignara un lugar propio dentro delas enfermedades vasculares inflamatorias. En los últimos años y, sobre todo, en los últimosmeses, se ha reconocido el síndrome de vasculitis urticarial hipocomplementémica comouna forma monogénica de lupus eritematoso, lo cual completa la secuencia histórica de laenfermedad y la coloca dentro del espectro de trastornos del complemento.E l énfasis de la publicación está centrado en los aspectos históricos iniciales del proceso,que tienen el singular mérito de ser relatados por el principal autor y testigo, y que nohabían sido publicados hasta ahora, aunque sí conocidos de manera personal o privada porreconocidos reumatólogos e inmunológos.L a revisión histórica de la evolución del síndrome se ha fundamentado en la revisión dela literatura y en la concatenación de las observaciones ulteriores hasta finales de 2013,cuando se reconoció como una entidad específica y como una forma monogénica del lupuseritematoso.

Hypocomplementemic urticarial vasculitis has received extraordinary interest in the medical literature since the original publication in 1973 in Mayo Clinic Proceedings. The index case was identified in 1968 as a distinct clinical entity, by one of the co-authors of the first publication and of the current review, which closes a cycle of more than 45 years. The differential clinical characteristics of hypocomplementemic urticarial vasculitis syndrome determined that the 2012 consensus on nomenclature of Vasculitis of the american rheumatology association, designated the syndrome as a separate entity with its own place among the inflammatory vascular diseases. In the last few years, and particularly in the last few months, hypocomplementemic urticarial vasculitis syndrome has been recognized as a monogenic form of lupus erythematosus, an observation that completes the historical sequence of the disease, and places it among the spectrum of complement disorders.The emphasis of the article is centered on the initial historical aspects of the process, that have the unique merit of being recorded by the principal author and witness, and not previously published, albeit privately known by prominent rheumatologists and immunologists.The historical review of the evolution of the syndrome is based on a review of the literature, relating subsequent observations until the end of 2013, when the syndrome was recognized as a monogenic form of lupus erythematosus.

Plasmapheresis in a Patient With "Refractory" Urticarial Vasculitis

Immune complexes are found in the circulation of 30%-75% of patients with urticarial vasculitis and much evidence supports the role of these immune complexes in the pathogenesis of urticarial vasculitis. Plasmapheresis is effective for removing these immune complexes; however, there are few reports on the use of plasmapheresis in the treatment of urticarial vasculitis. We describe a case of "refractory" urticarial vasculitis in which the symptoms improved after plasmapheresis treatment. We suggest that plasmapheresis be considered as an option in patients with severe or treatment-resistant urticarial vasculitis.

Vasculite urticariforme com comprometimento renal glomerular: relato de caso / Urtical vasculitis with renal glomerular disease: case report

JUSTIFICATIVA E OBJETIVOS: A vasculite urticariforme (VU) corresponde entre 5% a 10% das urticárias crônicas, devendo-se distinguir suas lesões daquelas da urticária crônica idiopática, que é a forma mais comum. Apesar de comumente ser de origem idiopática, pode ocorrer em associação com doenças autoimunes, reação a drogas, infecções ou malignidade, podendo ocorrer de forma sistêmica ou limitada à pele. O diagnóstico de VU deve ser considerado na presença de urticária persistente com achados clínicos e sorológicos sugestivos, ou evidência de doença sistêmica. O objetivo deste estudo foi mostrar um caso raro de acometimento renal da forma normocomplementêmica da vasculite urticariforme. RELATO DO CASO: Paciente do sexo masculino, 38 anos, previamente hígido, que apresentava lesões papulares eritêmato-violáceas extensas. Exames laboratoriais iniciais não apresentavam alterações significativas; exame qualitativo de urina demonstrava alteração progressiva da função renal e níveis nefróticos de proteinúria. A imunofluorescência renal foi negativa. Sorologias foram todas negativas e exames imunológicos não reagentes. Dosagemde complemento sérico (C3 e C4) foi normal. Realizou-se pulsoterapia com corticoide endovenoso e seguimento com corticoide oral, obtendo-se boa resposta clínica. A lesão cutânea apresentou regressão espontânea sem o uso de medicação tópica. CONCLUSÃO: O diagnóstico da doença sistêmica a partir de uma alteração cutânea salienta a importância da investigação adicional das lesões vasculares de pele.

BACKGROUND AND OBJECTIVES: Urticarial vasculitis (UV) corresponds between 5% to 10% of chronic urticaria, and their lesions must be distinguished from those of chronic idiopathic urticaria, which is more common. Although commonly idiopathic, it may occur associated with autoimmune diseases, drug reactions, infections or malignancy, which may occur in asystemic presentation or limited to the skin. The diagnosis of UV should be considered in the presence of persistent urticaria with suggestive clinical and serologic findings, or evidence of systemic disease. The case report illustrates a rare renal complication of the normocomplementemic form of urtical vasculitis. CASE REPORT: Male patient, 38 years, previously healthy, who presented extensive erythematous-violaceous papules. Initial laboratory tests showed no significant changes, qualitative urine test showed progressive impairment of renal function and levels of nephrotic proteinuria. Renal immunofluorescence was negative. Serology and immunological tests were all negative. Dosage of serum complement (C3 and C4) was normal. We performed intravenous steroid pulse therapy and follow up with oral steroids,obtaining good clinical response. The skin lesions regressed spontaneously without the use of topical medication. CONCLUSION: The diagnosis of systemic disease from a skin change emphasizes the importance of further investigation of cutaneous vascular lesions.

Two Cases of Pruritic Urticarial Papules and Plaques of Pregnancy in the Postpartum / 대한피부과학회지

Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as a polymorphic eruption of pregnancy, is the most common dermatosis of pregnancy. Typically, PUPPP starts with erythema and urticarial papular eruption in the abdominal striae and may extend to the buttocks and thighs. It usually evolves in the third trimester and resolves rapidly in the postpartum. It is not usually recurrent in subsequent pregnancies. We report herein two patients with postpartum PUPPP.

A Clinical Study of Urticarial Dermatitis / 대한피부과학회지

BACKGROUND: Urticarial dermatitis is not a commonly used term but may be a useful term representing clinical and histological features as a subset of the dermal hypersensitivity reaction pattern. However, there have been no previous clinical studies on urticarial dermatitis in Korea. OBJECTIVE: The purpose of this study was to investigate the clinical characteristics, courses, and responses to various treatments in patients with urticarial dermatitis. METHODS: From January 2007 to February 2009, a total of 24 Korean patients who were diagnosed with urticarial dermatitis by clinical and histological criteria were involved in this study. Retrospective analysis using their medical records and the routine blood tests including IgE was performed. RESULTS: Men (n=19) were involved more predominantly than women (n=5). The mean age of the patients was 49.4 years and the mean duration of the disease was 21.1 months. The skin lesion involved the trunk most commonly and spread throughout the entire body, particulary to the proximal part of the extremities. An abnormally elevated IgE level (mean 819.7 mg/dl) and eosinophil count (mean 7.3%) were observed in 12 patients and 9 patients, respectively. Combination therapy of an oral antihistamine agent and topical steroids was mostly not effective. The skin lesions and symptoms were improved transiently by low-dose corticosteroid therapy, dapsone, and narrow-band UVB (NBUVB) phototherapy, but relapsed or aggravated shortly after cessation of treatment or reduction of drug dosage. CONCLUSION: Urticarial dermatitis is mostly chronic with a waxing and waning disease course. The administration of dapsone or NBUVB phototherapy are additional therapeutic options to oral corticosteroids in the treatment of urticarial dermatitis.

Hypocomplementemic Urticarial Vasculitis in Systemic Lupus Erythematosus

Urticarial vasculitis is characterized clinically by urticarial skin lesions and histologically by leukocytoclastic vasculitis. Hypocomplementemic urticarial vasculitis is associated with connective tissue diseases such as systemic lupus erythematosus (SLE). We report a case of urticarial vasculitis that preceded manifestations of SLE.

Pruritic Urticarial Papules and Plaques of Pregnancy: Clinical Experience with 22 Patients / 대한피부과학회지

BACKGROUND: Pruritic urticarial papules and plaques of pregnancy is a common benign dermatosis of pregnancy. It occurs mainly in primigravidas in the third trimester, it resolves spontaneously or with delivery, and it is usually responsive to topical treatment. The morphological spectrum of pruritic urticarial papules and plaques of pregnancy includes (1) urticarial papules and plaque (type I), (2) non-urticarial erythematous patches that are discrete or confluent and they are surrounded by tiny papules or vesicles, or clusters or sheets of 1-mm to 2-mm erythematous papules (type II) and (3) a combination of these features (type III). OBJECTIVE: This study evaluated our clinical experience with 22 Korean patients with pruritic urticarial papules and plaques of pregnancy. METHODS: From June 1997 to August 2008, 22 patients with pruritic urticarial papules and plaques of pregnancy were evaluated. The clinical manifestations, the lesion distribution and the obstetric and pediatric findings were retrospectively investigated with using the patients' medical records and clinical photographs. RESULTS: There were 9, 11 and 2 patients with types I to III, respectively. Many patients (n=14) were primigravida and the mean time of onset was a gestational age of 29.8 weeks. There were no pediatric problems such as intra-uterine growth retardation, or a small or large size for the gestational age.Most of the patients (n=20) were treated with topical corticosteroid or antihistamine; there was one case of recurrent pruritic urticarial papules and plaques of pregnancy. CONCLUSION: Pruritic urticarial papules and plaques of pregnancy usually occur in primigravidas, but this can also occur in multigravida patients. The number of patients with pruritic urticarial papules and plaques of pregnancy and who had obstetric obesity, a multiple pregnancy or pregnancy-induced hypertension was fewer than we expected. Pruritic urticarial papules and plaques of pregnancy can be divided into three categories, although this is rather redundant because the disease prognosis and treatments are not different according to the type.

A Case of Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) Syndrome Supposedly Caused by the Paternity in Late Pregnancy / 대한주산의학회잡지

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) is a common dermatosis of pregnancy which usually occurs in the third trimester and generally in that of primigravida. Clinical feature is characterized by tiny erythematous papules which soon coalesce to form large, erythematous plaques. It generally occurs in abdomen, buttocks, thighs and upper inner arms. Since 1979 when Lawley et al. first described and reported PUPPP, there has been a lot of reports on PUPPP but the etiology is still not known. Many etiologic factors were reported but paternity as an etiologic factor was rarely reported. We had a very rare case which showed paternity could be one of the possible etiologic factors and we would like to share our case though this report.