PUPPP Rash: What to Do

Are you pregnant and is your skin starting to itch? Is a rash forming and is it spreading? You may be experiencing PUPPP and this is what you can do?

One: Get a diagnosis

The diagnosis of PUPPP is typically made based on the appearance of the rash and the patient's medical history. There is no specific test for PUPPP. However, your doctor may order some tests to rule out other skin conditions, such as scabies or allergic contact dermatitis. These tests may include:

● Skin scraping: A skin scraping is a procedure in which a small amount of skin is scraped off and examined under a microscope. This test can help to rule out scabies, which is a skin condition caused by mites.

● Complete blood count: A complete blood count rules out other skin conditions, such as allergic contact dermatitis, which is caused by an allergic reaction to a substance.

● Liver function tests: Liver function tests are blood tests that check the function of the liver. These tests can help to rule out other skin conditions, such as cholestasis of pregnancy, which is a liver condition that can occur during pregnancy.

Differential diagnosis is how medical doctors differentiate between conditions that present similarly. Here are some of the key differences between PUPPP and other common skin rashes that occur during pregnancy:

● PUPPP: presents as itchy, raised bumps that appear on the abdomen, often where there are stretch marks. These skin lesions then spread to other parts of the body, such as the breasts, back, and arms. PUPPP is a rash that typically surfaces in the third trimester of your pregnancy, but may occasionally appear earlier. PUPPP rash usually goes away within a few weeks after delivery.

● Stretch marks: these are pink or red streaks that appear on the abdomen, breasts, hips, and thighs. Stretch marks are not usually itchy and they are permanent. PUPPP may begin in the stretch marks of a pregnant woman.

● Scabies: These are small, red bumps that are itchy and are associated with a rash between the fingers and toes, and even on the nipples. Scabies is contagious.

● Allergic contact dermatitis: These are red, itchy bumps that appear at the site of contact with the allergen, which could be metallic jewelry, a plant, or even a site of physical trauma. The rash usually goes away once the allergen is identified and eliminated.

● Pemphigoid Gestationis (PG): PG also appears in the third trimester and causes itchy hives that can feel like PUPPP. PG is rarer than PUPPP rash, but it is more concerning. While PUPPP doesn't pose any health risks, PG can result in pregnancy complications in rare instances.

If your doctor is unsure about the diagnosis of PUPPP, they may refer you to a dermatologist. A dermatologist is a doctor who specializes in the skin. They will be able to examine the rash and rule out other skin conditions. A dermatologist will have the expertise to diagnose it as PUPPP rash.

Two: Understand and accept

In most cases, PUPPP is a harmless rash that goes away on its own within a few weeks after you deliver your child.

However, it is still a debilitating condition when you are suffering from it. Understanding that it is temporary helps you psychologically. You need to know that this is temporary.

You also need to know that skin conditions tend to cause irritability and reduction in sleep and rest in the person who is suffering from it. The itching associated with PUPPP can be very stressful. It can be helpful to understand that it is not that you are irritable for no reason. It is because you are under alot of stress and are unable to fully rest because of the itch.

If you are feeling depressed and very unhappy, it is closely related to the PUPPP rash condition you are suffering from.

Three: Decide what to do

There is no one way to cure this condition. You can only manage the condition, and you do so by managing inflammation and itch.

Below are some ways to manage Inflammation and itch:

Western pharmaceuticals: Your dermatologist may advise caution while prescribing you the two most common medicines for skin inflammation: antihistamines and topical steroids.

The action of antihistamines will reduce the burst of histamines that contribute to itch.

The action of the topical steroids is very direct - it puts a stop to the inflammation. However, it can be prudent to either apply these topical steroids minimally, or to seek less pharmaceutical alternatives.

Non-pharmaceutical interventions: these include micro acupuncture treatment and topical zinc oxide. Acupuncture is a well-kept secret when it comes to treating skin conditions, especially those where inflammation together with itch.

Acupuncture during pregnancy is safe when administered by a trained and experienced practitioner. involves the planting of microneedles at the level of the epidermis (surface of the skin). This is very different when compared to how needles are administered when you go to an acupuncturist for shoulder or back pain. Once the needles are planted on the skin, they are left there for a while, and then taken out. It is the microtrauma of the needle prick that causes a low level immune response from the body, which then reduces inflammation and itch.

Zinc Oxide is a known treatment for itch. It is better known as calamine lotion, which has zinc oxide as its main ingredient. It is also safe for use during pregnancy.

Cooling therapy: This means to stimulate your skin with a cooling stimulant, which then disrupts the sensory signaling pathways, resulting in your feeling coolness on your skin instead of itch. This temporary disruption of sensory signaling pathway can be very effective, because it does break up an otherwise unending itch-scratch cycle. Below are different versions of the same thing:

1. Menthol: Balms or creams may contain other soothing ingredient but the cool, minty sensation of menthol is very effective in suppressing the itch sensation

2. Cool compresses: this include putting a towel in a container of cold water, wringing it to squeeze out the water, and then place in on the area of inflamed skin.

3. Cooling showers or baths: needless to say, these reduce the inflammation by calming the skin. When the skin is calm, there is less itch.

4. Cooling ambient temperature: this means being in an airconditioned room in the hotter months.

Four: Mix and Match

Because there is no one-size-fits-all approach when treating PUPPP rash, it is best to see which of the above-mentioned treatments suit you best.

You will only know by trying and seeing how your body responds to the treatment.

We hope this article has been helpful, and that you will find relief from your PUPPP rash!