PUPPP

Pruritic Urticarial Papules and Plaques of Pregnancy

It’s not uncommon to feel itchy during your pregnancy – this will mostly be felt around your stomach and breasts and is usually caused by your changing hormones and your stretching skin.

If you do suffer from common issues, such as dry skin, eczema or food allergies then these may be made worse over the course of your pregnancy.

Some pregnant women may also experience more intense itchiness during pregnancy. This is often seem in conjunction with itchy, red bumps and larger patches of a hive-like rash on their bellies. This is known as pruritic urticarial papules and plaques of pregnancy (PUPPP) or polymorphic eruption of pregnancy and will affect about 1% of pregnant women.

PUPPP usually effects women who are in their first pregnancy, carrying twins, and is usually at its worst during the third trimester.

Appearance of PUPPP

PUPP usually starts around the stretch marks on the stomach and breasts, as small red bumps and the will grow to form larger blotches of red bumps. Once the PUPP rash makes its appearance it usually spreads to the thighs, buttocks, breasts, and arms

What Causes PUPP?

No one is certain of what may cause PUPP, as it is not associated with other complications such as preeclampsia, hormonal abnormalities or fetal abnormalities

There are however some theories, and we stress that these are just theories:

Theory One: Some investigators suggest that the rapid abdominal wall distension damages connective tissue and causes an inflammatory response

Theory Two: One study has shown that male fetal DNA can be found in skin biopsies of the rash. Since 70% of women with PUPPP give birth to boys, a new hypothesis is that male fetal DNA acts as a skin irritant

How is PUPP Treated?

In most cases treatment of PUPP involves high strength steroid creams or ointments, applied 5 to 6 times a day to relieve the itching and prevent any further spread of the rash. Once the rash is under control, changing to a lower strength steroid used less frequently is advisable.

In other cases oral steroids can be used to help control the itching.