|What Is PUPPs Rash?
Known medically as pruritic urticarial papules and plaques of pregnancy (PUPPs or PUPPPs) and as polymorphic eruption of pregnancy (PEP), PUPPs is the name for an itchy rash that sometimes appears in pregnancy. Up to 1 percent of pregnant women develop it, and while uncomfortable, it is quite harmless. It usually begins in the third trimester of pregnancy (around week 35) and can last up to 2 weeks after childbirth.
Terminology: The term PEP is used extensively in Europe, while PUPP or PUPPP is typically used in the United States.
Signs And Characteristics Of PUPPs
• Red bumpy skin with large patches of itchy hives.
• Severe itching (pruritus) typically lasts about a week although the rash may remain 4 to 6 weeks.
• Typically the rash develops in stretch marks, but it can also appear on the thighs, buttocks, breasts and arms. The hands and feet are usually spared. One 2012 study observed that 67 percent of patients were affected in the abdomen and thighs.
• In 15 percent of cases it starts in the first 2 week postpartum period after childbirth.
• It is more common in women pregnant with twins (12 percent of cases) and those having their first baby (73 percent).
• The good news is, PUPPs does not harm your baby and it seldom reappears in subsequent pregnancies.
What Causes PUPPs?
You may be having a boy.....
Scientists have not worked out what causes PUPPs. It is not associated with any other pregnancy complication such as gestational diabetes, hormone imbalances, fetal abnormalities, hypertension or preeclampsia. Currently there are two theories:
One study discovered male fetal DNA in skin rash biopsies of affected women. As 70 percent of women with PUPPs go on to give birth to boys, it may be that male fetal DNA acts as a skin irritant. However, as 30 percent give birth to baby girls, this cannot be the only cause. Another theory holds that it may be an inflammatory response to rapid abdominal wall stretching (particularly as it is associated with twins).
Finally researchers are looking into other connections to do with:
• Obesity in expectant mothers
• Rh-positive blood types.
• Genetic factors, one 2008 study found that in 25 percent cases, the patient's mother had suffered the same problem in pregnancy.
How Is It Diagnosed?
PUPPs is usually diagnosed by appearance alone. There is no lab test to diagnose the condition. A skin biopsy of the rash is only performed if the doctor suspects another cause such as:
• Eczema of pregnancy.
• Atopic Eruption of Pregnancy (AEP) previously called prurigo of pregnancy.
• Pruritic folliculitis of pregnancy: widespread itchy rash.
• Herpes gestationis: Rare condition, blistering of the skin.
• Intrahepatic cholestasis of pregnancy (ICP): Rare liver disorder that causes itchy skin.
• Impetigo herpetiformis (IH): Causes pustular eruptions.
• Viral exanthem: Viral rashes.
• Scabies: skin disease spread by a small mite.
How Is It Treated?
The first line of treatment is to apply a strong (prescription-only) steroid cream or ointment such as fluticasone (Cutivate lotion) several times a day. For severe cases an oral corticosteroid, such as prednisone or prednisolone (Pediapred, Orapred, Flo-Pred) may be necessary to control itching. Oral antihistamines tend to be less effective but they can be useful in helping to get a good nights sleep. In particular antidiphenhydramine (Benadryl, Diphenhist, Allerdryl) has a soothing sedative effect and is also effective in treating pruritus (itching) resulting from histamines released during inflammatory reactions.
How Long Does It Take To Go?
Unfortunately delivery does not usually cure the problem overnight - on average it takes 4 to 6 weeks for the rash to clear up (the recovery period is independent of delivery, in other words, delivery doesn't appear to affect the duration of the disease). You will need to continue treatment until it resolves. If you need to take medications into the postpartum period, talk to your doctor about potential adverse effects with breastfeeding.
Self Help Remedies
In addition to steroids, other things you can do to relieve itching include:
• Avoid hot showers and baths, instead take cool baths. Add an oatmeal bath preparation to your baths to soothe your skin (available in most drugstores).
• Put cool, wet compresses on itchy areas.
• Wear light cotton clothing.
• Avoid going out in the hottest part of the day as this can intensify itching.
PUPPP: Epidemiological, clinical and histopathological study of 18 patients. Department of Obstetrics, American University of Beirut-Medical Center, Lebanon (2012).
Pruritic urticarial papules and plaques of pregnancy: Akush Ginekol, 2008 reported in US National Library of Medicine National Institutes of Health.