Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy, is the most common rash in pregnant women. It normally occurs in first pregnancies during the third trimester with an average onset of 35 weeks. Thankfully, PUPPP does not usually affect subsequent pregnancies.
Appearance of PUPPP
The rash of PUPPP almost always begins in the stretch marks (striae) of the abdomen. It does not involve the belly button distinguishing it from other common rashes of pregnancy. The rash itself consists of small, red wheals in the stretch marks that grow together to form larger wheals on the abdomen. Sometimes the rash can include small vesicles. Over the next several days, the rash can spread over the thighs, buttocks, breasts, and arms.
The rash is very itchy, or pruritic, hence the name. This condition is harmless to mother and baby, but can be very annoying. It lasts an average of 6 weeks and resolves spontaneously 1 to 2 weeks after delivery. The most severe itching normally lasts for no more than 1 week.
Cause of PUPPP
The cause of PUPPP is unknown. It is not associated with preeclampsia, autoimmune disorders, hormonal abnormalities, or fetal abnormalities. Some investigators suggest that the rapid abdominal wall distension damages connective tissue and causes an inflammatory response. One study has shown that male fetal DNA can be found in skin biopsies of the rash. Since 70% of women with PUPPP give birth to boys, a new hypothesis is that male fetal DNA acts as a skin irritant.
Diagnosis of PUPPP
The diagnosis of PUPPP is clinical, meaning it is based solely on the appearance of the rash. There are no laboratory tests that detect PUPPP. Skin biopsies are not generally performed unless there is a question about the diagnosis.
The treatment of PUPPP is symptomatic. High strength steroid creams or ointments, such as clobetasol (Temovate) or betamethasone (Diplrolene), used up to 5 to 6 times a day usually relieve the itching and prevent the spread of the rash. Once the rash is under control, changing to a lower strength steroid used less frequently is advisable. For severe cases, daily oral steroids may be necessary to control itching. Oral antihistamines such as atarax, benadryl, and zyrtec, are generally less effective for itching than steroids, but may be useful at night to help with sleep.
How did PUPPPs affect me, do you ask? Well it sucked. It has been taking this pregnancy and filled it with a lot of miserable itching, ice packs, prescriptions, scabs, and general discomfort, modesty... The list goes on. I am almost certain I will have scars on my arms and legs from the scabs left behind from this. Hot showers didn't help me, oatmeal didn't help, aloe, diaper ointment... anything that you can slather on your skin.... Olive oil, shea butter, cocoa butter... Nothing. Even the steroid creams didn't 'help'. Now, I have general control over the problem because I have been told to take 4 steroid pills a day, 5 antihistamines a day, 2 different creams, and even have a sleeping pill for when it gets super bad. I got about a week and a half of the welts being under control before they started forming on my upper belly again. I currently still have them, but since I have my medication, it hasn't gotten as bad as it was. I have some pictures that I artfully (not) took myself to help you see what it is I have, in case you may have it too. Please disregard my poor job. :)
Under my arms...
and my belly of course. I was unable to take pictures of my own back... but I had plenty of welts there as well. Really, my body was covered. Even on my bum! Terrible. In the information I posted, it says it can be 'annoying'. But this is really the understatement of the year. Most women who have it this bad will explain how it is the worst thing they have ever experienced, as one feels a huge sense of helplessness. I felt as though I was slowly losing my mind, the constant itching and nothing being able to scratch, my skin felt and looked disgusting, covered in red welts all over. I was embarrassed to go outside. And still mostly am. Most people do not understand this condition, as it only affect 1% of pregnant women. So being pregnant, and covered in huge red welts everywhere, constantly itching everywhere, or as I am now, covered in disgusting scabs, and still itching everywhere, people just don't know why it is. And the many nights of sleep I lost because I was up crying helplessly, not understanding why I couldn't be like all the other pregnant women who didn't suffer from this, and how was I to deal with this for so long... my poor husband was so amazing, and did everything he could to ease my suffering. He brought me fresh ice packs... rubbed oil on my skin when the itching got so bad that I was practically convulsing, and his awesome support really helped me so much.
Please ladies, if you are suffering from itching in the palms of your hands or the soles of your feet, and do not have a rash, go to the doctor immediately! There could be a problem with your liver! They can determine this with blood tests. The doctors checked my blood as well, to rule out that problem for me. And if you are suffering from this terrible rash, I understand. I hate reading the line 'it is harmless to the mother' as it does hurt, physically and mentally and emotionally. If you need support, or have any questions, please feel free to ask me.