So, all is going great guns…you’re well past your first and second trimester and heading into the final stretch. Then, a few spots appear, followed by a rash. Before you know it, your entire belly is covered with angry red, itchy bumps, and sleepless nights ensue.
“Welcome to the world of Pruritic Urticarial Papules and Plaques of Pregnancy, or PUPPP for short,” says Dr Dharshini Gopalakrishnakone from The Obstetrics and Gynaecology Centre, a Singapore Medical Group Clinic.
Affecting one in 160 pregnancies, the condition is marked by an itchy, bumpy rash that starts in the abdomen’s stretch marks in the last three months of pregnancy, Dr Dharshini explains.
“The actual cause remains unclear, though there has been suggested a relationship between the skin stretching and distention, and the development of PUPPP,” she says.
“It was the most horrible thing I’ve ever experienced ― I wouldn’t wish it on my worst enemy.”
Natalie Liow, mum to Jamie, 1, recalls her experience with PUPPP. The angry red marks first appeared on the sides of her belly after her babymoon in Japan. “We went when I was 28 weeks pregnant, and it was an amazing trip with nice, cold weather,” she says.
A day after she returned from her trip, the skin on her belly started feeling dry and itchy. “I thought maybe it was the cold and dry air, so I used lots of moisturiser,” she says. “When that didn’t help, I thought maybe all the woollen sweaters I’d been wearing there may have caused the itch.”
After enduring the itch for another week, she visited her gynaecologist, who diagnosed her with PUPPP. “By that time, the marks and streaks on my tummy were quite horrible ― no thanks to my scratching as well,” Liow says. By then, the rash had spread to her bum as well as parts of her thighs.
Liow was given a cream to soothe the itch and some oral antihistamines. She says, “Thankfully, it all cleared up once Jamie was born. But it was the most horrible thing I’ve ever experienced ― I wouldn’t wish it on my worst enemy.”
PUPPP usually appears first on the abdomen, often along stretch marks, and occasionally, the legs and arms, Dr Dharshini says. The face, the belly-button region, palms and soles are usually spared.
In fair-skinned expectant mums, the bumps may be surrounded by a “lighter halo”, she notes. And if blisters (fluid-filled bumps) are present, the rash could be due to other causes, such as a condition called pemphigoid gestationis (a rare pregnancy-associated autoimmune skin disease).
“It’s always important to never self-diagnose ― see your gynae first,” advises Dr Dharshini, who runs tests on her patient to rule out liver issues that might be behind the rashes.
Your risk of getting PUPPP is higher if…
* This is your first pregnancy;
* You’ve gained weight rapidly during pregnancy;
* You’re carrying multiples (twins or triplets);
* You’re carrying a boy.
To prevent getting this itchy condition, Dr Dharshini recommends a good, strong moisturiser. “If you start applying it early in the pregnancy and apply liberally, a good and simple moisturiser can protect you against stretch marks, compared to expensive stretch mark creams.”
For most mums, PUPPP persists till delivery, but stops within several weeks of baby’s birth.
If you do get PUPPP, she says she may prescribe a topical steroid cream, to be applied thinly twice daily to the red, itchy patches. For patients with a widespread, intense rash, she may prescribe a short course of systemic glucocorticoids (a type of steroid hormone).
“Oral antihistamine tablets are also safe in late pregnancy and can bring immense relief in a very uncomfortable situation,” she notes.
For expectant mums who prefer natural methods to soothe their discomfort, Dr Dharshini recommends oatmeal baths: Simply mix a few tablespoons of oatmeal with water and slather all over the rash, wait a few minutes, then rinse off with lukewarm water.
Other ways to soothe the itch include applying a cold compress, and wearing loose, lightweight clothing. “Never use soap, as it will cause more dryness and itching,” Dr Dharshini says.
She also encourages expectant mums to change their diet ― by lowering their acidic food intake. “The less acidic the food intake, the better. Some patients have also tried dandelion root tea and have found relief in that,” she says.
Thankfully, for most mums, PUPPP persists till delivery, but stops within several weeks of baby’s birth, although there are rare circumstances where the condition may linger. “This was related to parts of the placenta retained in the uterus, which then required a removal,” explains Dr Dharshini.
Even if you get PUPPP, the prognosis for the mum and her newborn are excellent. Nor does this condition tend to recur in subsequent pregnancies, Dr Dharshini notes.
“It’s all about finding safe and effective relief until the little one arrives,” she points out.
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