PUPPP Rash (Pruitic Urticarial Papules and Plaques of Pregnancy)
You’re 35 weeks pregnant. You feel like you’re ready to pop. Then one morning you wake up to see a few little red, pimple like dots on your tummy. You don’t think anything of it and just go on with your day. Then the next day you see more dots on your tummy. It kind of makes you scratch your head and you think about it the rest of the day. But the next day you wake up and your stretch marks are red, your tummy is almost covered in the little dots. And what’s worse; it ITCHES!
When I discovered this rash on my tummy, my first thought was an allergic reaction to Palmer’s Cocoa Butter cream so I stopped using it. But the rash didn’t go away and it just kept spreading. And I just wanted to scratch! It was so uncomfortable. I would wake up in the middle of the night so itchy and uncomfortable that I couldn’t sleep. I was already tired from being 39 weeks pregnant. I told my sister-in-law about it and she talked to one of the OB-GYN doctors who told her that it could be one of two things. A gall bladder infection or the PUPPPS Rash. So I did what most people do when they have a medical problem and don’t want to go all the way to the doctor. I turned to the internet. I looked at pictures and my rash looked identical to the pictures. My doctor confirmed it when I went for my 40 week visit. She took one look at my stomach and said “Let’s get you induced.”
PUPPP, also known as polymorphic eruption of pregnancy, is the most common rash in pregnant women. It normally occurs in the first pregnancy during the third trimester usually at 35 weeks. Thankfully, PUPPP does not usually affect subsequent pregnancies.
This article is for your information only. Be sure to consult a medical professional for diagnosis and treatment.
What causes PUPPP?
The cause of PUPPP is unknown. It is not associated with preeclampsia, autoimmune disorders, hormonal abnormalities, or fetal abnormalities. Investigators suggest that the rapid abdominal wall distension damages connective tissue and causes an inflammatory response. One study found male fetal DNA in a skin biopsy of the rash. Since 70% of women with PUPPP give birth to boys, a new hypothesis has found that male fetal DNA can act as a skin irritant.
The Diagnosis
The diagnosis of PUPPP is solely based on the appearance of the rash. There are no lab tests that detect PUPPP. Skin biopsies are not performed unless there is a question about the diagnosis.
Treatment
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 often relieve the itching and prevent the spread of the rash, see your doctor for the best treatment for you. 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 prescribed to control itching. Oral antihistamines such as atarax, benadryl, and zyrtec, are generally less effective for itching than steroids but can be useful at night to help with sleep.
The Appearance of PUPPP
The rash 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 (a firm elevated swelling of the skin) in the stretch marks that grow together to form larger wheals on the abdomen. Sometimes the rash can include small vesicles (a bubble of liquid within a cell). Over the next several days, the rash can spread over the thighs, bum, breasts, and arms.
The rash is very itchy, or pruitic, hence the name! This condition is thought to be harmless to mother and baby, but can be very annoying. It can last an average of 6 weeks and resolves spontaneously 1 to 2 weeks after delivery. The most severe itching can last for more than 1 week.
By: EA Walker
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