Are You Pregnant And Experiencing Extreme Rash? You Might Be Suffering From PUPPP

Are You Pregnant And Experiencing Extreme Rash? You Might Be Suffering From PUPPP

Pregnancy is a time when you have to deal with a lot of things. The ups and down of hormones bring changes in the skin including rashes, acne and blemishes. 

Some can resolve on their own but some others can be really pesky to deal with. One such common skin condition in pregnant women is Pruritic urticarial papules and plaques of pregnancy (PUPPP).

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Also known as polymorphic eruption of pregnancy, Pruritic urticarial papules and plaques of pregnancy (PUPPP) is itchy rash which appears on the stretch marks of a pregnant woman. The condition is known by various other names such as Bourne’s toxemic rash of pregnancy, nurse’s late-onset prurigo and toxic erythema of pregnancy.

The rash is pruritic in nature, means it gives the feeling of scratching, hence its name.

How common is Pruritic urticarial papules and plaques of pregnancy (PUPPP)?

The condition normally occurs in women with first pregnancy and those who are carrying multiple babies. It is estimated that PUPPP occurs in 1 in 150 pregnancies.

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What causes PUPPP?

It is still unknown what exactly causes PUPPP rash. It is neither related to preeclampsia nor to hormonal abnormalities and autoimmune disorder. However, there are various theories associated with the condition such as:

  1. About 70 percent women who experience this condition give birth to baby boys. So it is believed that male DNA might be responsible for this skin irritant.
  2. Pregnant women with increased weight are also thought to have this condition. This makes some researchers believe that rapid growth of the abdominal wall and stretching damages the connective tissue which causes an inflammatory response.
  3. Some experts believe that women who consume dairy are likely to get this condition as the rash has been known to go away when women stop drinking dairy.
  4. Maternal high blood pressure can also cause PUPPP.

Symptoms or Appearance of PUPPP

  • The rash always originates in the stretch marks on the abdomen. It typically appears in the third trimester, especially during the last 5 weeks when the baby’s growth is very rapid.
  • The rash does not cover the belly button making it easier for the doctor to spot the difference between PUPPP and other rashes.
  • These rashes are small reddish/pink itchy bumps resembling hives. They usually grow together to form a large plaque-like area.
  • Sometimes the rash includes small fluid filled bumps.
  • After several days, the rash can spread over buttocks, thighs, arms and breasts.
  • The condition though harmless in nature can be very annoying to both mother and the unborn baby.
  • The condition lasts for an average of 6 weeks and resolves on its own in 1-2 weeks after delivery.
  • The most severe case of itching lasts no more than a week.

Diagnosis of PUPPP

PUPPP rash doesn’t require any kind of testing. The condition can be diagnosed solely by examining the skin. But the doctor may want to rule out any fungal infection or scabies. These tests include:

  • Blood count
  • Liver function test
  • Serum cortisol to check the level of cortisol steroid hormone (which plays role in blood pressure, immune system, bone growth, etc.) in the blood
  • Serum human chorionic gonadotropin (HCG) to measure the level of hCG hormone (secreted only in pregnancy)

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What are available treatments for PUPPP?

The only and ultimate cure for Pruritic urticarial papules and plaques of pregnancy (PUPPP) is to deliver the baby. However, there are several medications and methods that can help reduce itching and prevent the spread of the rash such as:

  • Steroid creams and ointments
  • Oral histamines such as Benadryl, Atarax and Zyrtec
  • Moisturizers
  • Oral steroid for severe itching
  • Taking bath with baking soda
  • Cool wet compress

Instead of oral steroids, the doctor might also consider induced labour (if the delivery date is close) in case of severe itching. While it may be possible that the baby could be born with a mild form of PUPPP rash, but it’s not harmful and goes away within few weeks.

PUPPP rash is certainly uncomfortable and frustrating, but it resolves on its own within a couple of weeks after delivery. Talk to the gynaecologist for reducing symptoms of this irritant skin condition.

Sources

1. Pruritic Urticarial Papules And Plaques Of Pregnancy (n.d.). AOCD read more
2. Pruritic Urticarial Papules and Plaques of Pregnancy (1979). JAMA read more
3. Polymorphic eruption of pregnancy (2017, September). DermNet NZ read more
4. Pruritus in pregnancy: Treatment of dermatoses unique to pregnancy (2013, December). NCBI read more