- What is PUPPP?
- What are the symptoms of PUPPP rash?
- What are the causes of PUPPP?
- What are the risk factors of PUPPP?
- How is PUPPP rash diagnosed?
- How is PUPPP rash treated?
- Can you prevent PUPPP?
Pregnancy can bring in many skin issues: from something as positive as radiant skin to annoying acne, unusual hair growth, and pigmentation. The most common and not-so-nice one among them is pruritic urticarial papules and plaques of pregnancy(PUPPP) or polymorphic eruption of pregnancy (PEP).
What is PUPPP?
Pruritic urticarial papules and plaques of pregnancy is a typical hives-like skin rash that is extremely itchy and causes severe discomfort to the mother. It is also known as Nurse’s late-onset prurigo, toxic erythema of pregnancy, toxemic rash of pregnancy and Bourne’s toxemic rash of pregnancy (1).
PUPPP rash affects about one in every 160 to 300 pregnancies, usually in the third trimester. It is most commonly experienced in the first pregnancy and multiple births (2).The itchiness lasts for one week, but the rash keeps appearing intermittently. Sometimes, the itchiness remains even after the rash is gone. PUPPP is not usually dangerous for the mother or the baby.
What Are The Symptoms Of PUPPP Rash?
Itching is the worst part of PUPPP. Along with distinctive red marks that cause itchiness in the abdominal region, these are the other signs and symptoms you should look for:
- Stretch marks, which are the initial signs
- Severely itchy rash
- Small blisters
- Eczema like lesions
PUPPP begins as tiny, itchy bumps and turns into red, more significant patches that welt over time. They initially look like stretch marks on the abdomen, and as time passes, they grow larger, spreading towards the extremities including stomach, chest, hands, armpits, back, and legs. However, PUPPP rash does not spread to the face, palms, and soles of the feet. You will also never see a rash on the navel region (3).
What Are The Causes Of PUPPP?
The exact cause of PUPPP is not known. However, studies suggest that a pregnant woman may get a PUPPP rash due to the following reasons:
1. Abdominal stretching:
Carrying multiples, heavy or large babies will put more stress on the skin, damaging the connective tissue. This begins with stretch marks and later causes skin inflammation, and eventually the PUPPP rash.
2. Overtaxed organ system:
The liver is the primary detox organ in the body. But when it is overloaded with toxins, it shows up symptoms such as discoloration of skin and rashes.
Kidneys purify the body’s blood and are known to play a crucial role in eliminating PUPPP rash. There is also evidence showing that cleansing of blood treats PUPPP (4). If the kidneys are unable to carry out of this potential function, it may cause a skin rash.
3. Migrating fetal cells:
Fetal cells migrate to different body parts of the mother, including the skin. Sometimes, your skin will treat these fetal cells as foreign substances, triggering a reaction and causing a skin rash. The migration of skin cells is more likely to occur in male fetuses. It was found that 60% to 70% women having PUPPP rash had male DNA in their skin rash (5).
Apart from the above-presumed causes, there are certain factors that increase the likeliness of PUPPP.
What Are The Risk Factors Of PUPPP?
You are likely to develop PUPPP if you:
- Are pregnant for the first time
- Are carrying multiples (6)
- Are pregnant with a boy
- Have hypertension (high blood pressure)
- Are overweight
- Are a Caucasian
Some women will experience this skin rash in spite of the above risk factors. And treating it in time is possible only when you are certain of the condition. Keep reading to know about its diagnosis.
How Is PUPPP Rash Diagnosed?
PUPPP is determined by ruling out skin infections after conducting biopsy or other tests.
Your doctor will suggest some tests such as:
- Complete blood count (CBC)
- Liver function test
- Serum hCG (human chorionic gonadotropin)
- Serum cortisol
If all other skin conditions such as rabies and fungal infections are eliminated, and the belly button is unaffected, it can be a PUPPP rash (7).
How Is PUPPP Rash Treated?
PUPPP rash disappears within a week or two after your delivery. However, there are treatments to help relieve the symptoms.
Medical treatments for PUPPP rash include (8):
- Moisturizers: They primarily relieve itching and remove the discomfort. You can use moisturizers containing vitamin E, cocoa butter, Shea butter, collagen, and elastin. Avoid moisturizers that contain retinol, salicylic acid, vitamin A, tropic acid, and retinyl palmitate.
- Topical steroids: Any steroid cream with one percent hydrocortisone helps reduce the itching. Oral corticosteroids are also prescribed sometimes to relieve pain and itching (9).
- Oral antihistamines: They also relieve the itching and are safe to use during pregnancy. Some of the more reliable antihistamines include cetirizine (Zyrtec) and diphenhydramine (Benadryl).
Problems with conventional treatments:-
Conventional medicine mainly focuses on managing the signs and symptoms, but not the actual problem. Most of the above treatments only relieve the itching and pain. Steroids are harmful in general, and there are no studies to suggest that steroids are safe to use during pregnancy and breastfeeding. Topical steroids are also linked with low birth weight in babies.
That brings us to the option of alternative remedies.
Herbal remedies can relieve the PUPPP itching and rash, with minimal side-effects. However, consult your doctor before trying any of these.
1. Vegetable juice:
Vegetable juices cleanse and detox the body. Though there is no clinical evidence that vegetable juice cures PUPPP, there are anecdotal theories. So drink fresh vegetable juices every day, especially in the third trimester. You may want to avoid beetroot juice as it is a highly potent detoxifier.
2. Dandelion root or nettle leaf tea:
Dandelion root and nettle leaf are traditional treatments for purifying the liver and the blood. Many women with PUPPP have been successfully treated with these herbal teas and dandelion root capsules (10). Dandelion root supports liver functioning while nettles possess antihistamine, anti-inflammatory, and anti-anemic properties.
You can use herbal tea bags, steep dandelion root or nettle leaf, leave them in boiling water for 10 minutes to one hour and then consume.
3. Anti-inflammatory herbs:
Topical application of chamomile, calendula, and Chinese skullcap extracts reduces skin inflammation (10). They can be combined with aloe vera, witch hazel or any mild lotion, and applied to the rash, three times a day.
4. Oatmeal bath:
Soaking in an oatmeal bath relieves itching, moisturizes and soothes the skin (11). Take one cup of rolled oats and one cup of organic chamomile loose tea and place them in a cheesecloth or old cloth and tie it. Drop it in a tub full of lukewarm water and soak in the bath for 20 minutes. Before stepping in, you can also squeeze the cloth to release milky liquid oat extract into the bath water.
‘Adaptogens’ is the modern name given to herbal tonics such as ginseng, licorice root, basil and so on. These herbal tonics strengthen the immune system (12). Maca root is one such adaptogen which can be combined with smoothies for consumption. Regular consumption can treat the rashes.
6. Flaxseed oil:
Flaxseed oil is known to be effective in soothing the rashes and reducing the burning effect. Mix two teaspoons of oil to a cup of milk and drink (13).
7. Gentle nervines:
PUPPP will get on your nerves causing restlessness, especially in the night. Chamomile and lavender tea can help you relax and promote a good night’s sleep. Drinking either of them twice a day helps (14).
8. Cold compress:
Cold compresses are soothing and help reduce the itchiness. Simply soak a cotton towel or cloth in cold water, squeeze off excess water and place it over the itchy skin for relief (15).
9. Olive oil:
After taking a shower, do not dry your skin. Instead, apply olive oil on your wet skin and then pat dry using a clean towel. It relieves the itching and keeps the skin moisturized.
10. Other topical remedies:
You can prepare baking soda-water paste and cornstarch-water paste and apply to the skin rash for relief. Also, applying coconut oil and rubbing a banana peel on the rash helps.
11. Wear comfortable clothing:
Wear loose and soft cotton clothes if you are suffering from PUPPP rash, as they do not aggravate the rash further.
12. Do not scratch:
Where there is a rash, there is an urge to scratch. But scratching just worsens the condition and must be avoided.
13. Stay away from harsh chemicals:
Stay away from shower gels with heavy perfume and harsh chemical formulations. Do not spray chemical-based deodorants and shower sprays on your body when you have PUPPP.
14. Practice good hygiene:
Take a bath every day and stay on a healthy balanced diet. Regulate room temperature to prevent sweating, as moisture can trigger itching.
Can You Prevent PUPPP?
Unfortunately, you cannot prevent PUPPP as the exact cause of the condition is not known. Make healthy choices to decrease the likelihood of a rash, and remember it is a temporary condition.
Women who are affected by PUPPP during their first or second pregnancy may not necessarily experience it in the subsequent pregnancies. However, there are chances of having a milder rash.
But is the rash contagious? Can other people get it from you? For answers to these and other common queries, read the FAQ section next.
Frequently Asked Questions
1. Is PUPPP rash contagious?
PUPPP rash is not contagious as it develops as a response to the changes in your body. Other people cannot develop a rash through physical contact.
2. Can you develop PUPPP rash when not pregnant?
PUPPP develops only during pregnancy, due to the stretching of the skin, overtaxed organ functioning or migrating fetal cells.
3. Does having a PUPPP rash mean you are carrying a boy?
You are more likely to carry a boy if you have a PUPPP rash. One study has found almost six male fetal DNA in skin biopsies of 10 PUPPP sufferers but found none in any of the controls of pregnant women without PUPPPs (16).
4. Will PUPPP reappear in second pregnancy?
Yes, the PUPPP can recur during the second pregnancy (17).
PUPPP is an uncommon pregnancy complication, which might last for a few weeks post delivery. All you need to do is use the medicines prescribed by the doctor and relax your nerves to control the itching and discomfort. The rash will eventually disappear and your skin will come back to its normal, comfortable self. But if you see any rash long after it should be gone, go to your doctor.
Did you have to deal with any skin conditions during pregnancy? If you know of any tips that helped alleviate the PUPPP symptoms, do tell us in the comments section.
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