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Rash (PUPPP) During Pregnancy: How to Diagnose and Treat It

During your pregnancy, you will probably notice that the skin on your tummy has developed stretch marks. Sometimes, an itchy rash will develop in these stretch marks. This rash, known as pruritic urticarial papules and plaques of pregnancy (PUPPP), is not really dangerous but the itching is not really comfortable. Read on to find out how to diagnose and treat PUPPP during pregnancy.

What is PUPPP?

PUPPP (pruritic urticarial papules and plaques of pregnancy), also known as polymorphic eruption of pregnancy (PEP), is a rash that usually develops in the stretch marks on your stomach in the last stages of your pregnancy.

Though the rash is not a pretty sight to behold and causes a lot of itching, it does not pose any serious dangers to you or your baby as other infections during pregnancy.

The rash usually appears on the stomach, but it can also spread to the thighs. There are also instances of the rash on the hands but as yet no PUPPP on face.

What are PUPPP symptoms?

The pruritic urticarial papules and plaques of pregnancy usually show up on your belly when you are around 36 weeks (3rd trimester) into your pregnancy and rarely in the second or first trimester.

The rash typically begins with the skin around the abdomen as pink pimples in the stretch marks. These then aggregate and form wheals or plaques that are very itchy. These itchy plaques spread over your torso but rarely do they ever go past your breasts. This itchy rash also spreads to your thighs and you can also have PUPPP on hands.

Despite the considerable discomfort and ungainly sight of the PUPPP, it does not attack the mucous membranes and stays on the top layers of your skin.

The condition is more common in mothers carrying their first child or those who are carrying multiple offspring. This is because their skin is experiencing this kind of stretching for the first time.

How is a PUPPP rash diagnosed?

When you get an itchy rash during your pregnancy, you should see your doctor. This is because the rash might not be PUPPP at all but rather an autoimmune disorder known as pemphigoid gestationis (PG).

PG is an autoimmune blistering disease. Current research suggests that parts of the placenta tissue enters the mother's blood flow and causes her immune system to produce antibodies, which attack the skin.

The two conditions are similar in a way that they both present as rashes on your abdomen and surrounding areas. They also both occur during the latter stages of your pregnancy.

To diagnose PUPPP, your doctor will examine your belly to see just how the rash is spreading. Unlike the pemphigoid gestationis —used to be called 'herpes gestationis'— the PUPPP does not cover your soles or the face. The blisters are also not fully developed as in PG and don’t cover the area around the navel.

Your doctor will then take a skin sample from the affected area. This is subjected to laboratory tests like direct immunofluorescence to rule out PG and confirm PUPPP.

Though the skin examination is usually enough to detect the condition, the doctor —as part of your prenatal screening— can do some blood tests to rule out other diseases.

If you weren’t vaccinated and you have a rash, the doctor will use these tests to rule out the rubella virus which can spread to your child during birth.

How is a PUPPP rash treated?

The PUPPP rash usually abates in a few weeks after you have given birth. Most of the PUPPP treatment, therefore, is towards the relief of the discomfort due to the itching.

Doctors can provide some medication, or you can opt for a PUPPP remedy.

Here are a few treatments and PUPPP remedies:

  • Topical steroid creams

 You can apply steroid-containing creams onto the affected areas of your tummy. This will give you relief from the incessant itching of the PUPPP. These corticosteroids are usually mild.

If the itching doesn’t reduce, you need to ask your doctor before you can get a cream with a corticosteroid. These stronger and more potent corticosteroids can cause some pregnancy complications including low birth weight.

  • Antihistamines

If the itching is preventing you from getting some much-needed sleep, your doctor might prescribe some H1 antihistamines like diphenhydramine for you to swallow. This medication reduces the itching and also allows you to sleep peacefully. 

  • OTC moisturizers

 Over-the-counter moisturizers are very good at providing relief from the itching. Before you apply the moisturizer on your belly and other affected areas, you should make sure that it does not contain any ingredients that are harmful to your baby.

Such ingredients include vitamin A forms like retinol, retinyl palmitate and vitamin A itself. You should also avoid moisturizers that contain tropate and salicylic acid.

  • Aloe Vera leaf gel

When you cut the thick leaf of Aloe Vera along the edge, you expose the gel-like pulp within. Apply this gel on your tummy and affected areas at least two times a day. Aloe Vera has properties that make it suitable for providing relief from many skin conditions including pruritus—itching.

  • Baking soda

Sodium bicarbonate relieves pain and also soothes the itchiness. You can take a dip in a baking soda bath if the rash is spread over a wide area of your body. For a more localized rash, you can make a paste of the baking soda with water and apply it to the affected area. Wash it off with clean cold water.

  • Cold wet compress

 You can also soothe the itching of the PUPPP by applying a cold or wet compress on the affected area. This can be either a wet cloth or an ice pack.

What are PUPPP risk factors?

Not all pregnant women are affected by this condition. Some are more disposed to catching it due to a number of risk factors.

These risk factors include:

  • massive weight gain by the mother
  • multiple pregnancy causing great distension of the skin
  • being pregnant for the first time
  • carrying a male fetus
  • PUPPP is more prevalent in Caucasians

Summing up

Scientists are yet to find out what causes PUPPP during early stages of pregnancy.

However, as you see, PUPPP is quite a normal condition considering that it’s expanding at a fast rate. Visit your doctor to make sure you haven’t develop any serious condition and to get proper medication.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162253/
2. https://www.sciencedirect.com/topics/medicine-and-dentistry/pruritic-urticarial-papules-and-plaques-of-pregnancy
3. https://emedicine.medscape.com/article/1123725-treatment
4. https://www.bad.org.uk/shared/get-file.ashx?id=224&itemtype=document

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