Parity, polypregnancy, paternity, and PUPPP

Pruritic urticarial papules and plaques of pregnancy in twin and triplet pregnancies

“…The other patients all had previous single pregnancies, only one having a history of a skin eruption. The conception of a multiple pregnancy in a patient with a previous uneventful single pregnancy has been associated with the development of PUPPP, 14 presumably due to increased abdominal distension.…”

Pruritic urticarial papules and plaques of pregnancy: Current status

“…This is not thought to be a significant factor in PUPPP. However, the possibility is raised by the report of a multiparous patient whose rash began in her fifth pregnancy as a result of a new relationship, which, however, was also her first twin pregnancy, with marked abdominal distension 25 . The role of paternal antigens is also suggested by the observation of Weiss and Hull, who reported PUPPP in two sets of sisters married to two brothers 26 …”