Also known as polymorphic eruption of pregnancy (PEP), PUPPS (Pruritic Urticarial Papules and Plaques of Pregnancy) can be extremely uncommon and only affects around 1% pregnancies. It doesn’t hurt the mother of the baby. However, it can cause quite a bit of discomfort for women. The rash is small bumps that erupt near the stretch marks, sometime in the third trimester. Some cases may appear earlier and cover more than just the abdomen. In normal circumstances, the rash goes away just after delivery. A few of the cases may last as long as two weeks after the baby is born.
Symptoms
Typically, the PUPPP rash will appear during the third trimester of pregnancy. Your baby’s growth rate is very rapid during this time, especially during the last five weeks of pregnancy. It’s most likely to occur during a first pregnancy and during a multiples pregnancy, where the skin stretches even more. During your pregnancy, sometimes your skin stretches faster than your skin cells can keep up with. This can cause stretch marks to appear.
PUPPP usually begins on the abdomen and spreads to other extremities within a few days. The rash appears as small, pink spots that appear in the stretch marks. Eventually, the rash may start to come together and form large, red, plaque-like areas. Blisters can sometimes form around the rash. These plaques can then spread from the stomach to the:
- buttocks
- thighs
- arms
- legs
Causes
No one’s really sure what the causes are. Unlike most other symptoms of pregnancy, PUPPP doesn't appear to be the result of increased hormone levels. One theory suggests that fetal cells invade the mother's skin during pregnancy, causing an itchy belly to develop. Another theory says that it is genetic and can be traced through the father's side. In any case, PUPPP usually appears in the third trimester and disappears after childbirth.
Diagnosis
Many women get skin discolorations or rashes of some sort during pregnancy. So how do you know if it’s actually PUPPS? There aren’t any lab tests that will diagnose PUPPS, so it’s usually determined by a process of elimination. Your healthcare professional can conduct a biopsy to rule out more serious skin conditions.
Some women are more likely than others to experience a PUPPP rash. Risk factors include:
- being Caucasian
- being pregnant with a boy
- a first pregnancy
- multiples pregnancy
- rapid weight gain in pregnancy
Treatment
There’s no cure for PUPPP. Usually, the rash lasts until several weeks after birth; it then disappears, leaving no scars. To treat the symptoms, sufferers can:
- try calamine lotion, aloe vera gel or an oatmeal bath
- speak to their doctor or chemist about pregnancy-safe topical steroids or oral antihistamines
- wear cotton clothes
- avoid warm baths, soap-based cleansers and excessive exposure to the sun – these can all aggravate the rash.
For more severe cases, stronger steroids may be recommended. If the sufferer takes oral steroids, careful observation – including monitoring foetal size, maternal blood pressure and blood tests – may be necessary. Alternatively, an early induction may be suggested, based on maternal and foetal health. Doctors rarely recommend a C-section based on this condition alone. After birth, it’s generally okay to breastfeed the baby, even if the rash is still present. It’s unusual for the woman to develop the rash in subsequent pregnancies.
