English: Left side view of the abdomen at nearly 36 weeks' gestation, on which the papules and plaques of PUPPP can clearly be seen. The patient's fundal height is above the 95th percentile, and the skin is quite distended (stretched). Skin distension is a common factor in PUPPP, which is more common in mothers carrying large babies, twins, and triplets. Although no stretch marks can be seen in this patient, the papules and plaques often first appear within stretch marks.