Pupp – an itchy skin condition which appears in pregnancy.
What is it ?: PUPP stands for pruritic (itch) urticarial (like ‘hives’) papules (red pimples) and plaques (irritable flakes) of pregnancy. Some women develop itchy red bumps and welts on their bellies in the second half of pregnancy, usually in the last month or two. These irritations are called PUPP or polymorphic eruption of pregnancy. PUPP is the most common skin condition of pregnancy, and although it is extremely annoying, it is harmless to Mother and Baby.
What does it look like ?: PUPP is characterised by a typical rash, usually appearing in the later part of pregnancy. It occurs in less than one person in a hundred, and the rash usually develops on the abdomen near the umbilical area and spreads to the thighs and extremities. Sometimes itching can become very severe. It can spread to the rest of the body, but never involves the face. It is more common in first pregnancies and seldom recurs in subsequent pregnancies.
What should I do if I’ve got it ? : If you develop such a rash always consult your midwife or doctor for a diagnosis, as the rash is often similar to that of OC, which is a more serious complaint. Depending on your health professional’s experience of PUPP, suggested treatment can range from simple moisturising creams and calamine lotio, to (in worst cases) cortisone creams and oral steroids. You may also find long warm baths in sodium bicarbonate can also help alleviate the symptoms.
How long does it last ? : PUPP should disappear within a few days after delivery for most women. It seldom reoccurs in subsequent pregnancies. The condition is usually a familial one and can be traced back through the father’s side of the family – recent research in the US has linked it to male DNA.
Catriona suffered from PUPP and writes :
“I had PUPP, but luckily not for the whole of my pregnancy. I was pregnant with non id boys, and otherwise had a straightforward pregnancy. Around 30 weeks I developed a red itchy rash over my bump which got painfully itchy as my pregnancy progressed. Initially I thought it was just stretchmarks, but later the itchiness had spread all over my body, particularly my arms and hands.By 36-37 weeks I was covered in a really itchy rash, almost everywhere on my body. The rash on my hands was almost like blisters. The best thing I found was the emollient bath treatments, eg balneum that are often prescribed for excema. I tried E45 cream, but rubbing the cream in just aggravated the itching, so I gave up with that.
I was diagnosed with PUPP at 37 weeks and was prescribed anti-histamines by doctors. PUPP made the last few weeks of my pregnancy pretty unpleasant, so much so that I begged my consultant to induce me at 37 weeks as I was so uncomfortable, but he wouldn’t. Fortunately I went into labour naturally at 37.5 weeks and had the boys by C section as one of them was breech. One of the biggest things was that the itching stopped me sleeping at night so spent most of the night lying on the sofa watching TV. Must be one of the few people having twins who had more sleep after the birth than before!!! ”
Catriona
Jen K writes :
“I thought I had cholestatis (see Obstetric Cholestasis), but the blood tests came back negative. Nobody said it could be PUPP – it was like they didn’t know about it. To be honest I had never heard of it either, but having read about it since, I am convinced that it’s what I had.
I had a very straightforward pregnancy with my b/g twins. Around 30 weeks I noticed an intense itching developing on my stomach, with white marks which spread to my hands, feet and arms. I tried everything to relieve the itching, from creams like E45 and Lanacane, to bathing my hands and feet in cold water all the time. I phoned the hospital and was went in, they gave me Piriton. The last couple of weeks were just a misery due to PUPP, I was given a c-section 2 weeks early because I just couldn’t stand it any more. Although PUPP doesn’t impact on your babies, 18 months on and I still get white blister like bumps on my stomach that come and go.”
Jennifer. Proud Mum to David and Grace 30/9/03 7lb 3oz and 7lb 5oz at 36 weeks
Susan writes :
“I am sure this is what I had but I didn’t know the name for it until someone mentioned it on Twinsclub recently. My GP was very sympathetic but didn’t give the condition a name, just prescribed menthol gel which I couldn’t get hold of, and Piriton which was useless. Hospital staff were not at all sympathetic or interested once cholestasis was ruled out. Their view was “well not much longer now..” In fact it took 3 weeks after the babies were born to clear completely. I was enjoying a straightforward pregnancy with my id boys when the condition appeared at 35 weeks. I had a red itchy rash which started on my abdomen and eventually was everywhere from the neck down except my face and chest.
I tried lots of things to relieve it but nothing much worked. Calamine was suggested but not very practical over your whole body. Menthol gel was prescribed but one pharmacist actually laughed when I asked for it. The itching was worst at night and I found the best thing was to get up and read for a couple of hours to take my mind off it and stop scratching. Good practice for having twins! Hospital doctors were totally disinterested and unsympathetic.”
Susan Mum to Emily, Josh, and Ben & James id (born 7/12/03 6lb 15 and 7lb 2)
Emma K also suffered :
“I too had a straightforward pregnancy with my non id boys. I became aware of PUPP around 34 weeks and was diagnosed at 36 weeks (after begging to be checked out by the consultant). I had an awful red raised rash that started under my bump, then worked it’s way up and hit all the inside limbs, such as inner legs, under arms, boobs, etc. It burned when I scratched it, and felt sort of like a heat rash.
I found it really flared up whenever my skin warmed up (such as in bed). I used calomine lotion, a cooling gel and was prescribed a hydrocortisone cream after being diagnosed. I pleaded to be induced early because the last 3 weeks were just awful – I couldn’t sleep at all. However the hospital wouldn’t induce me, but thankfully my waters broke at 37 weeks and the boys were born happy and healthy.”
Emma writes :
“I seem to be the only one who suffered this while carrying girls! I was pregnant with non-id girls and was had no other complications apart from PUPP. I noticed the rash around 36 weeks, and realised myself what it could be. The hospital confirmed it was PUPP after testing for OC (Obstetric Cholestasis) at 37 weeks. The symptoms were extreme itchiness with a rash, mainly on my torso and arms. I tried cold showers and baths, wet towels, calomine lotion – all of which worked but only for a short time each. I was prescribed anti-hystamines after the diagnosis, but these didn’t really work at all. Fortunately, I was already booked in to be induced by the time it was diagnosed, and had my babies at 38 weeks”.
Emma, Mummy to Toby (6lb 12oz) and Benjamin (7lb 5oz) n-i twins @ 37+1wks on 27/03/04