History: 5003jc This lady delivered twins by Caesarian section. On day 8 after delivery she developed this rash around her caesarian section scar. It has spread since across the abdomen and to her upper thigh. No history of a contact allergen.

Description: Perivascular lymphocytes and eos.

Comments: Sections show a biopsy of skin in which there is some spongiosis of the epidermis. There is also focal subepidermal oedema. There is a moderately dense upper and mid dermal infiltrate of lymphocytes, histiocytes and easily found eosinophils. In addition a number of dermal interstitial eosinophils are also noted. A diagnosis of pruritic urticarial papules and plaques of pregnancy (PUPPP)is favoured. There is a variant in which there are interstitial eosinophils resembling a bite reaction.