Pregnancy PUPPPS Rash: Essential Tips For Coping.

If you found this article through a search, then you’re probably pregnant, congratulations!...and suffering from Pupps, in which case you have my utmost sympathy.

Or you may have a loved one who is suffering with Pupps, in which case you have my sympathy too, as watching someone you love go through this condition is heart-breaking.

I’d like to use my blog today to highlight a pregnancy condition that most people have never heard of, is rarely spoken about and that the medical community in the most part are totally uninformed.

Pruritic Urticarial Papules and Plaques of Pregnancy (Puppps)

 ...is the unwieldy medical name for the intense, excruciating itching and burning of the skin that can happen in pregnancy. This hives like condition is also know as PEP (Polymorphic Eruption of Pregnancy) in the UK. Approximately 1 in 200 women will experience Pupps to some degree while expecting, with an unlucky handful descending into an all consuming hell of itching and burning, wanting to tear the skin from their flesh.

Read on for more information, my daughter's experience and those all important tips for coping and hopefully curing your Pupps

There is no known cause for this condition, which usually develops in the 3rd trimester around week 34 with itching in the stretch marks of the abdomen. The itching quickly becomes extremely intense, with redness and heat, and can spread across the buttocks, back, and down the legs and arms. Its one saving grace is that the skin on the face is not affected….oh for small joys!

The condition usually clears up immediately after the birth, but for some unlucky women, the condition can continue for months afterwards, even re-appearing years later during flare ups. Some women experience Pupps again with further pregnancies, although these tend to be a milder version than the initial condition.

Anecdotal evidence suggests the condition is caused by the mother’s body over-reacting to the histamines released by stretchmarks and causing an allergic reaction. And Pupps does seem more common in women with large baby bumps who have expanded rapidly or are having twins, in other words women who have developed a lot of stretch marks during pregnancy.

Other theories suggest the mother’s body is struggling to eliminate the increased toxins produced by herself and the baby, or that if the mother is having a baby boy, she is allergic to his DNA.

Pupps is not harmful to the developing baby and as such has not been given much prominence in the medical community, and not much research into cause or cure seems to be happening.

But while Pupps is not harmful to the baby….it can be devastating to the physical, emotional and mental well being of the mother! The lack of sleep caused by the horrendous itching towards the end of pregnancy can leave women at the end of their tether, emotionally exhausted wrecks just as they need to be gathering their strength for the approaching labour. Women are left with scars from scratching their skin to the point of open wounds, indeed I read of one poor woman who used a steel brush on her skin till she was raw….and I can understand this having seen how my poor daughter was affected.

A word of warning – Please note Pupps can be mistakenly diagnosed in women who actually have the pregnancy condition Cholestasis (ICP), a potentially serious complication involving the liver. Cholestasis symptoms also include intense itching but usually without a rash, and more intensely on the palms of the hands and soles of the feet. If you are suffering with itching in pregnancy, please insist on a liver function test to diagnose whether you may be suffering from Cholestasis, which requires immediate medical treatment.

Ree’s Experience

Last year my daughter Ree went through a pregnancy with Pupps and I’d like to share the experience and offer tips to what helped her and what didn’t work. 

My daughter Ree’s pregnancy progressed normally, with the usual morning sickness and heartburn causing some discomfort. But her baby bump did grow very fast and she did get a lot of stretchmarks. When she began complaining the stretchmarks were red and irritated we just assumed that was normal with the rapid increase in bump size.

By week 34 in August we went shopping for some baby items and after parking the car her baby bump brushed past the wing mirror of the next car, and she gasped in agony as it touched her stretchmarks. I remember thinking it was such a severe reaction to just a touch. Over the next couple of days the situation rapidly got worse and Ree was in agony with intense itching in the stretchmarks, that developed into the most bizarre looking circular red wheals around her belly button.

We had no idea what was going on and my first thought was an allergic reaction to something. She went to her GP who looked through various medical textbooks, didn’t know what it was and sent her away with the advice to mention it at her next antenatal appointment.

By now the rash had spread all down Ree’s legs, back, buttocks and arms. She was unable to sleep, and had to cut her nails to the quick to stop her scratching her skin raw in her sleep.

I went to see her about a week after her skin flared up and was totally shocked and appalled at her appearance. This strong and capable young woman collapsed in my arms in tears, completely exhausted and at the end of her tether. She was unable to stand any clothes on her skin and was dressed in just a large cotton sheet draped about her body. She hadn’t left the house all week. I was appalled.

After searching the internet we read about Pupps and other women’s experiences, and Ree seemed to have a textbook severe case. That evening she went to A&E where the doctor admitted he had no idea what it was, and sent her to the antenatal ward. The doctor on call there ordered a liver function test to rule out cholestasis, but had no knowledge of Pupps and Ree actually saw them conducting a Google search themselves. It doesn’t instil you with confidence when the medical staff have to Google your complaint!

Ree was sent away with some steroid cream, some anti-histamine tablets to try calm the itching and help her sleep, and left to get on with it. Neither of the prescribed items made any difference to the itching and the antihistamines reduced her to a zombie like state. The thought of trying to live like this until due date…or even 37 weeks to be induced…was soul destroying. I wasn’t sure how Ree would make it and what state she’d be in for the hard labour of labour!

We had no choice but to try and find alternative remedies ourselves. What I will stress here from all the research we conducted, is that no remedy fits all women. It was so frustrating to read about someone’s miracle cure and try it with such high hopes…only to find it didn’t help or even made the situation worse. After a week of trying various creams and baths without  much success, Ree began a detox regime that did provide some relief. And while the Pupps did not disappear, it became more bareable;

So please, read these tips with the hope they might help you, but with the knowledge they may not be right for you. It really is a case of trial and error. 

What Helped

What seemed to help most in Ree’s case were things that helped detox the body as a whole, tying in with the theory that Pupps is the body struggling to cope with toxins. And for temporary relief, ways of cooling the heat of the rash.

Dandelion Root tablets – First and foremost this natural detox supplement helped combat the condition from the inside. Try them, please try them!

We bought the tablets from Holland & Barrett in the UK, but the majority of health food stores carry them and also Amazon UK here and US here

Ree took 1 tablet 3 times a day.

Grandpas’s Wonder Pine Tar Soap – Yep this is a weird one, not sure how this strong smelling bar of soap works, but after reading numerous recommendations Ree gave it a go. Not a miracle cure but a very definite help, calming the rash for a few hours after use. Just be aware you’ll smell like a bonfire… but who cares if it helps! 

We bought it from Amazon UK here and US here.

Black Cherry Juice – Dark or black Montmorency (tart) cherries contain a variety of antioxidants, including anthocyanin, which are believed to help combat inflammation for a variety of medical conditions. Ree drank the juice as part of the detox regimen which fought the Puppps rash from the inside. Whether the cherry juice would work on it’s own we’re not sure, but it definitely helped in tandem with the other detox remedies. We bought the CherryGood Premium juice from Waitrose and also the Montmorency Cherry JuiceConcentrate from Holland & Barrett.

Calamine Lotion – good old fashioned calamine lotion, really helped calm the itch when applied but the effects are temporary, so just slather on some more after an hour or so. We used Boots own brand Calamine Lotion but all chemists and pharmacies should stock it, including Walgreens for US readers.

Cold baths/showers, Ice packs – Keeping the body cool helped a lot, ice packs wrapped in muslin and cool packs used for sprains draped over the hottest most irritated skin helped take some of the anger out of the rash. Also cool/cold baths gave temporary relief for a few hours.

Nettle Tea – A traditional herbal detox tea to support the liver and remove toxins. Ree had a couple of cups of this a day. We bought the Clipper Organic brand from Waitrose, but it’s also sold in most supermarkets, health food shops and Amazon UK here and US here.

Water – lots and lots of water to help cool the body and flush out the toxins. Detoxing won’t work without water.

Fresh Fruit and Vegetables – To support the body and help the detox process, Ree upped the amount of fresh fruit and vegetables in her diet, and cut back on processed foods. If anything, it won’t do you any harm and is beneficial to you and the baby anyway.

Electric Fan – using a fan to help cool the body helped, especially trying to sleep at night.

Lush Dream Wash – The only body wash/shower gel that did not  make Ree’s skin worse. Dream Wash by Lush is a liquid body soap containing aloe vera gel, calamine lotion, tea tree oil and rose, all known for their ability to calm irritated skin. Unfortunately Lush UK have discontinued this product, despite it being a huge help to thousands of people with Eczema, Psoriasis and Pupps and replaced it with a Dream Wash Roulade which doesn't have such glowing reviews. The original Dream Wash is still available in the US.

What We Also Tried

Ree didn’t have much success with the following remedies, in particular skin creams seemed to make the rash worse, holding the heat in the rash, rather than helping. Still worth a try though, as all these remedies were recommended by others who have had success, and they may well work for you.

Calamine Cream – has similar cooling properties as calamine lotion without being as drying or leaving the white powdery residue. Unfortunately didn’t work as well for Ree as the lotion. We tried Boots Calamine and Glycerin Cream.

Aqueous Menthol Cream – skin cream containing cooling menthol– we bought it from Ebay here but most chemists and pharmacies should stock it.

Salcura Bioskin Dermaspray Amazon UK here and US here plus Salcura Zeoderm Skin Repair Moisturing Cream from Amazon UK here and US here - great results for some Puppps sufferers from these skin creams, which are also used for eczema and other skin conditions, unfortunately they didn’t help Ree.

Caldsene Medicating Powder http://amzn.to/1X6De8J UK and Caldsene Protecting Powder http://amzn.to/28ZMWrJ UK and http://amzn.to/28ZYqat US – both talcum powders are traditionally used for treating nappy rash (diaper rash). A bit of an odd remedy that works for some but didn’t do much for Ree’s symptoms.

Virgin Organic Coconut Oil – much to my disappointment, my much loved Lucy Bee’s cure-all Coconut Oil didn’t help the Pupps rash at all. But amazing for so many other ailments instead! From health food shops, supermarkets and Amazon Amazon UK here and US here.

Oatmeal Baths –  to run a soothing bath, add porridge oats to an old sock or tights and run the hot water tap over it. Be careful, it makes the bath very slippy! Didn’t work so well for Ree as she couldn’t stand a warm bath.

Epsom Salts Bath – again a soothing bath that would normally be a real treat, add a handful of the salts to the running water of a warm bath. It didn’t really help Ree, as I think some of the beneficial qualities are lost if the water is cold. Buy at any chemist  or pharmacy, we bought ours direct from Westlab here .

Finally, after what seemed a lifetime of living with Pupps, but was in reality a couple of months, little baby Imogen was born 10 days early and weighing in at a healthy 7lb13oz. Ree’s symptoms eased within days, although did not go completely until she finished breastfeeding.

I was privileged to be present at the birth and watched in awe as my brave daughter had a natural birth standing up. That really brought it home to me what a strong woman she was, and how horrendous Pupps is if it brought this amazing woman to her knees.

We’ve had many conversations about her Pupps experience, and I know it’s left a lasting effect on my daughter, to the point of her worrying about future pregnancies. Indeed she’s even said she’d choose labour every time over having Pupps, a sentiment echoed by many women afflicted with this condition.

So my love and positive thoughts go out to any woman coping with Pupps, you are all amazing! You will emerge from this experience at the other end, and I hope the love and cuddles with your new baby will help dim the memories of Pupps.

Good luck and please let me know if any of these tips helped, what worked for you and what did not. Only by sharing experience and knowledge can we help each other, and help educate those around us.