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PUPPP Rash During Pregnancy: Prevention, Treatment And Remedies

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Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a typical hives-like skin rash that is extremely itchy and might cause discomfort to the mother.

It is also known as:

  • Nurse’s late-onset prurigo
  • Toxic erythema of pregnancy
  • Toxemic rash of pregnancy
  • 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 case of 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.

In this post, MomJunction gives you a detailed description of this skin condition, along with ways to prevent it.

[ Read: Itching Belly During Pregnancy ]

What Are The Symptoms Of PUPPP Rash?

Itching is perhaps the worst part of PUPPP. Along with the 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
  • Redness
  • 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 thighs. However, PUPPP rash does not spread to the face, palms, and soles of the feet. You will also never see a rash in the navel region (3).

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What Are The Causes Of PUPPP?

The exact cause of PUPPP is not known (4). 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 might put more stress on the skin, damaging the connective tissue. This begins with stretch marks and could later cause skin inflammation, and eventually, the PUPPP rash (4).

2. 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 that might cause a skin rash. The migration of skin cells is more likely to occur in male fetuses, but the cause for this is still under research (5).

Apart from the above-presumed causes, there are certain factors that increase the likeliness of PUPPP.

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[ Read: Causes Of Hives During Pregnancy ]

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)
  • The baby is overweight
  • Are pregnant with a boy
  • Are overweight

Some women might 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.

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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 could be a PUPPP rash (4).

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Can You Treat PUPPP?

PUPPP rash and itching might disappear within 15 days after your delivery, without any medical intervention. However, there are treatments to help relieve the symptoms (4).

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[ Read: Types Of Rashes In Pregnancy ]

Medical treatment

Medical treatments for PUPPP rash include (4):

  1. Moisturizers: They primarily relieve itching and remove the discomfort. You can use moisturizers containing vitamin E, cocoa butter, Shea butter, collagen, glycerin, and elastin. Avoid moisturizers that contain retinol, salicylic acid, vitamin A, tropic acid, and retinyl palmitate.
  1. Topical steroids: Topical steroid creams with one percent hydrocortisone is considered as the first-line treatment to reduce the itching. Oral corticosteroids are also prescribed when local corticosteroids fail to relieve pain and itching (7).
  1. 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) (7).

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. So, always go for medical treatments only if your doctor prescribes them.

However, there are a few home remedies that might help relieve the itching due to PUPPP. Discuss it with your doctor before going in for any of these remedies. Also, note that there is less scientific evidence to prove the effectiveness of natural home remedies.

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Natural Remedies For PUPPP

Herbal remedies, along with home care, could help relieve the PUPPP itching and rash.

1. Do not scratch

One of the annoying symptoms of PUPPP is the itch, but you need to refrain from scratching, rubbing, and touching the rash as this might expose it to additional microbes that might be present in the fingernails. It can pose an additional risk of infection too.

2. Oatmeal bath

Soaking in an oatmeal bath might relieve the itching, moisturize, and soothe the skin (4). 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 bathwater.

3. Apply a cold compress

Applying an ice pack for 15-20 minutes on the rashes could also help in relieving the symptoms of PUPP (8).

4. Peppermint oil

The menthol in the peppermint oil might help in reducing the itching and cool the inflamed area. You can dilute the oil or apply it directly to the rashes (8).

5. Clove oil

You can also consider applying clove oil for two weeks to reduce the itch and soothe the inflamed skin area (8)

6. Flaxseed oil

Flaxseed oil is said to have anti-inflammatory properties and might be helpful in relieving the itching due to PUPPP. Mix two teaspoons of oil to a cup of milk and drink (9).

7. Dandelion root or nettle leaf tea

Dandelion tea is said to have detoxification and liver supporting properties, which might help in reducing the symptoms of PUPPP. However, the safety of dandelion tea during pregnancy is not established, so always consult your doctor before trying this remedy (10).

8. Anti-inflammatory herbs

Calendula and chamomile are believed to have anti-inflammatory properties that might help in reducing the inflammation and itching of the PUPPP rashes (11).

They can be combined with aloe vera, witch hazel or any other mild lotion, and applied to the rash, three times a day.

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 might relieve the itching and keep the skin moisturized.

10. Other topical remedies

Anecdotal evidence suggests that applying the cornstarch-water paste on the skin might provide relief. You may also consider applying coconut oil or aloe vera gel, which are said to have soothing effects.

You can prepare baking soda-water paste and cornstarch-water paste and apply it 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 might not aggravate the rash further.

12. 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.

13. Practice good hygiene

Take a bath every day and stay on a healthy balanced diet. Regulate room temperature to prevent sweating, as moisture could trigger itching.

14. Vegetable juices

In addition to including fresh fruits and vegetables in your diet, you may also try to have a glass of vegetable juice that could help in detoxing the body and soothing the inflammation.

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[ Read: Symptoms Of Psoriasis In Pregnancy ]

Can You Prevent PUPPP?

It may not be possible to prevent PUPPP as the exact cause of the condition is not known. Make healthy choices to decrease the likelihood of a rash and remember that 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.

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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 a PUPPP rash when not pregnant?

PUPPP develops only during pregnancy, due to the stretching of the skin, functioning or migrating fetal cells.

3. Does having a PUPPP rash mean you are carrying a boy?

A study has found almost six male fetal DNA in skin biopsies of ten pregnant women with PUPPP but found none in any of the controls of pregnant women without PUPPPs (12). But this does not mean that having PUPPP is a sure sign of a baby boy.

4. Will PUPPP reappear in a second pregnancy?

The PUPPP rash could recur during the second pregnancy (13), but it is not a given.

PUPPP is a common 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.

[ Read: How To Remove Stretch Marks After Pregnancy ]

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.

References:

1.Silonie Sachdeva; The Dermatoses Of Pregnancy;; Indian Journal of Dermatology
2.Mario Sánchez-Borges, et al.; Diagnosis and Treatment of Urticaria and Angioedema: A Worldwide Perspective; WAO Journal
3.En Hyung Kim; Pruritic Urticarial Papules and Plaques of Pregnancy Occurring Postpartum Treated with Intramuscular Injection of Autologous Whole Blood; Karger- Case Reports In Dermatology
4.Pruritic Urticarial Papules And Plaques Of Pregnancy; American Osteopathic College of Dermatology
5.Anju S. Nair, George Kurien, V. G. Binesh; ; A study of pregnancy specific dermatoses and their effect on the outcome of pregnancy; International Journal of Research in Dermatology
6.Sophia Giatrakou, et al.; Dermatological disorders unique to pregnancy; Research Gate
7.Hagit Bergman, et al.; Pruritus In Pregnancy; Official Publication of The College of Family Physicians of Canada
8.What are some natural treatments for PUPPP rashes; Academia
9.Ankit Goyal, et al.; Flax and flaxseed oil: an ancient medicine & modern functional food; Journal of Food Science and Technology
10.Health Library; Winchester Hospital
11.Disha Arora, Anita Rani, and Anupam Sharma; A review on phytochemistry and ethnopharmacological aspects of genus Calendula; Pharmacognosy Review
12.Matthew Bremmer, et al.; 6 skin disorders of pregnancy: A management guide; OBG management; OBG management
13.Ellen Cathrine Pritzier and Carsten Sauer Mikkelsen; Polymorphic eruption of pregnancy developing postpartum: 2 case reports; Dermatology Reports

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