History: Pruritic urticarial papules and plaques of pregnancy (PUPPPS) is usually seen in first pregnancies, late in the third trimester.The lesions are intensely itchy and of sudden onset, occuring in the stretch marks but often sparing the periumbilical area.Rapid or excessive weight gain may be a predisposing factor as may twin pregnancies as in this case.Topical steroids reduce the itch but the condition rapidly clears after delivery.