PUPPP: It Began With Stretch Marks…

During my pregnancy, I developed stretch marks all over my body – my thighs, my knees, my butt, and my expanding belly of course. They were even around my chest and arms. I gained more than 40 lbs by the end of it all!

Once I had delivered my baby girl, my stretch marks began to get more intensely red with colour, as well as bumpy and itchy… And then it started to burn and itch even more, to the point where all I could think and do was itch and itch and itch

I didn’t know what was going on at the time. Caring for a newborn, barely sleeping, and dealing with the troubles of breastfeeding and hemorrhoids – and now this!

It was overwhelming to say the least.

Read more about my postpartum hemorrhoid experience here:

“Hemorrhoids – There, I said it!”

What is PUPPP?

I found out that I had developed PUPPPPruritic Urticarial Papules and Plaques of Pregnancy.

PUPPP may also be known as:

  • Polymorphic eruption of pregnancy (PEP)
  • Toxic erythema of pregnancy
  • Bourne’s toxemic rash of pregnancy

Normally, it develops along your stretch marks in the third trimester and disappears after childbirth but in rare cases, the rash develops after childbirth. PUPPP occurs in 1 of every 160 pregnancies and more often to first time mothers or mothers carrying multiple fetuses.

Photo by Kewei Hu on Unsplash

Causes of PUPPP

The cause of this rash is unknown but experts suggest that it may involve a combination of factors listed below:

  • Antigens that belong to the baby enter the mother’s blood circulation and invade her skin causing an immunologic response
  • Excessive and rapid stretching of the skin damages the connective tissue underneath leading to an inflammatory response
  • PUPPP may be passed down genetically and has been shown to trace back to the father’s side
  • 70% of mothers who are expecting boys develop the rash suggesting that the sex of the baby may play a role
  • Cesarean deliveries also have some connection to the development of the rash
  • Hormones related to pregnancy have also been shown to influence the development of the rash
Photo by Ignacio Campo on Unsplash

Prognosis

PUPPP is not dangerous to the mom or baby. And yes, it will go away in a few days to few weeks. Nonetheless, PUPPP contributes to further insomnia and stress of a new mother, and adequate relief is necessary for their well being.

I was struggling with breast feeding at the time of the rash. I felt guilty that I wasn’t producing enough milk to feed my baby and I had to supplement with formula. I felt like a failure already.

Read more about my breastfeeding experiences:

“Breastfeeding – It doesn’t come as naturally as you think…

“Increasing your breast milk supply: What worked and what didn’t for me”

I was desperate to get rid of this rash as soon as possible, so I asked my husband to pick me up some Benadryl from the drugstore. I needed relief, anything. Once he got home with the medicine, I took it right away and later discovered that I wasn’t supposed to breastfeed while taking this drug...

I continued to take the medication anyway because I was in agony. In the meantime, I fed my baby formula while I pumped-and-dumped to maintain my supply. I hoped to be done with the drugs by the end of the week so I could get back into breastfeeding and bonding with my newborn.

Photo by Lisa Hobbs on Unsplash

Treatment and Home Remedies

Although I was better after taking benadryl, the intense itching was still very much present. I still wanted to rip my skin off! So I looked up some home remedies online.

This is what I found:

Antihistamine Medication (Benadryl)

Antihistamines can be taken orally and purchased over the counter without a prescription or even on Amazon. It can also be in the form of a cream which you can directly apply to your inflamed stretch marks. It inhibits histamine receptors to reduce the inflammatory and immune response. In doing so, antihistamines reduce the signs and symptoms related to allergies and pruritus (itching). I used Benadryl (aka diphenhydramine) to help with the itching. Honestly, it did help a little but it wasn’t enough on its own. Also, if you are breastfeeding please make sure to consult your doctor! Some medications can pass through your breast milk to your little one.

Baking Soda or Oatmeal Bath Soaks

You can also try an oatmeal bath or add baking soda to soothe your inflamed and burning skin, aid in healing, and neutralize your pH. On Amazon, you can find the Aveeno Soothing Bath Treatment with 100% Natural Oatmeal that worked wonders for me! Adding baking soda to your bath water worked just as well. For the baking soda bath soak, I filled the bath tub with warm water (but the cooler the water, the better). Warm to hot water tends to irritate rashes and make them worse. Then I add about 1/4 cup of baking soda into the water and soak for about 30 minutes. Repeat at least 2-3 times per week. Whenever I had the chance to even take a bath, I made sure to soak myself thoroughly. Not only did it give my relief, but it was also relaxing and calming.

Topical Steroid Cream

Topical creams can be mild to potent and are often used in combination with oral antihistamine medication such as benadryl. They contain corticosteroids which reduces inflammation. I had to get my steroid cream from my doctor with a prescription. My doctor prescribed a very potent one for me because I had stretch marks nearly everywhere on my body. The cream provided some relief in combination with the benadryl.

Ice Packs Or A Cold Compress

This was by far the most effective home remedy for me! The ice packs helped to numb the area for immediate relief, but a nice cold shower worked just as well. Apply the cold compress to your stretch marks for about 5 to 10 minutes. Don’t leave it on the skin too long! Also, don’t apply the cold compress or ice pack directly to the skin. Cover it with a cloth first. I had 2 ice packs in the freezer and alternated the two whenever I needed them.

Moisturize Your Skin

When your skin is dry, it is prone to become itchy. Prevent dry skin by applying moisturizers as often as possible, especially after a bath or shower. There are also itch-relieving body lotions that can be used as well. I used GOLD BOND Medicated Anti-itch Lotion which contains dimethicone (skin protectant) and menthol to relieve itching. The Aveeno Anti-itch Concentrated Lotion worked very well too. Try to avoid moisturizers that contain the following:

  • Salicylic acids – A type of hydroxy acid (BHA) used in acne prevention products. It dissolves debris that clogs pores called keratin plugs and regulates skin cells. It is generally safe to use salicylic acid containing skincare products during pregnancy (once or twice a day) as long as the amount does not exceed 2%.
  • Retinol – made from vitamin A and is often added to skin care products for its anti-aging properties. It boosts the production of collagen in skin to reduce fine lines and wrinkles, evens out skin tone, improves skin texture, tightens pores, and stimulates blood flow.
  • Vitamin A – an essential nutrient that supports skin, eye and reproductive health and immune function. Often added to skincare products in the form of retinol. During pregnancy, it is recommended that mother avoid high levels of vitamin A intake in food due to the risk of birth defects and liver toxicity. Although the amount of vitamin A added to skin care products is low, doctors still recommend the avoidance of such products.
  • Retinyl-palmitate – composed of palmitic acid (fatty acid) and retinol (vitamin A) and is an effective antioxidant when applied to the skin. Natural enzymes in your skin converts retinyl-palmitate into retinol when applied to the skin producing anti-aging properties.
Photo by Hans Vivek on Unsplash

Other Anti-inflammatory Remedies:

The anti-inflammatory remedies listed below are tips that I heard of but haven’t tried myself. Let me know if these worked for you!

  • Chamomile and/or dandelion root tea – apply the tea directly to the affected areas with a cotton ball. Be careful not to burn yourself! Chamomile and dandelion root contains anti-inflammatory properties
  • Peppermint oil – mix a few drops of peppermint oil with coconut oil and apply directly to the affected areas. Peppermint oil has been shown to relieve itching
  • The Grandpa’s Company – Pine Tar Soap – antiseptic properties commonly used to treat psoriasis (autoimmune condition where your body rapidly overproduces skin cells causing inflammation and scaling) and eczema. Basically, the soap slows skin cell growth
  • Other cooling agents: menthol, calamine containing lotions
Photo by Christin Hume on Unsplash

Don’t Itch!

I’m sure this one is obvious but just to remind you, don’t itch that rash! It will just make it worse. PUPPP should not leave any scars behind once it has healed but you may have some hyperpigmentation or dark spots if you continue to itch. I know I did.

Seek Help

It is so important that you talk to your doctor when you suspect that you may have PUPPP. Sometimes your rash may appear as a PUPPP rash but it could be something much more concerning such as cholestasis of pregnancy or pemphigoid gestationis (PG).

  • Intrahepatic cholestasis of pregnancy (ICP) – Due to liver disease that occurs in the last trimester of pregnancy and causes severe itching. Basically, pregnancy hormones slow and stop the normal flow of bile needed for the breakdown of fats in digestion. The bile is then backed up in the liver causing seepage into the blood stream.
  • Pemphigoid gestationis – (pemphigus means blister of pustule) A rare condition that affects 1 in 50,000 pregnancies and is caused by the immune system mistakenly attacking your own skin.

Unfortunately my PUPPP rash lasted more than a few weeks but with the help of benadryl and the other home remedies, I was able to pull through. Today, the rash is completely gone with very minimal scaring. Of course, only the stretch marks remain.

Have you experienced this rash during your pregnancy? How did you cope with it? I would love to hear your thoughts. Thanks for reading.

xoxo

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