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

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

Throughout my pregnancy, I was determined to be as natural as possible. This meant many things: a natural (painful) birth and breastfeeding – because natural is always best, right? Even though it may be the scariest, most painful moments in your life, it’s what’s expected of us as mothers. It’s the self sacrifice and unconditional love for our offspring that makes us push our humanly limits to do what’s best.

You would think that breastfeeding comes naturally – and it does. Breastfeeding is natural and is a naturally occurring phenomenon, but the process doesn’t occur as flawlessly as you would think – especially for first time mothers like myself.

When I gave birth to my baby girl in January, I had the worst time with latching and expelling my colostrum. It was the most painful sensation I have ever felt! Mind you, I had just given birth to her and was dealing with the aftermath of 3 tears and an agonizing 34 hours of labor, and I still believed that the sensation of my baby sucking at my breasts and the entire process of latching was worse than birth itself… I just had extremely sensitive breasts that just weren’t used to that sucking sensation – and I have to say, my newborns sucking strength was very strong! (Well, all newborn’s sucking should generally be strong…)

It took me 3 months to finally get my breasts used to my newborns sucking strength and by that time, I felt it was too late. (Or is it?…) Today, my baby is on formula and that’s ok.

To mothers and parents who feed their child formula, let me just say, you’re doing what’s right for you and your baby. I have no judgement for mothers who breastfeed, or use formula, or both. I say…

There is this immense pressure from society to breastfeed your child exclusively because that’s what’s best and most natural. Breastfeeding has benefits not only for baby but for mom too. It has all the vitamins, proteins, fat and antibodies that the newborn needs to grow. For mom, breastfeeding helps burn calories faster to lose all that baby weight, and it triggers the release of oxytocin to contract your uterus to return it back it its normal size. (Of course your uterus will never really be the same again after pregnancy, along with many other things…) But sometimes and for some families, breastfeeding really isn’t what’s best at all. I remember talking to my OBGYN about how I badly wanted to continue breastfeeding but how painful it was to not only to latch but to watch my baby “starve” and not get enough from me. I had tried everything from lactation consultants to breast massages and warm compresses and so forth… (Check out my post about breastfeeding tips here.) I felt that I had already failed as a mother, and she was only just a few weeks old. She assured me that breastfeeding isn’t always the right decision for every family and I had to do what was right for mine. She also said that I would be surprised by how many of us were formula fed, herself included!

Along with PUPPP (pruritic urticarial papules and plaques of pregnancy) and other conflicting postpartum issues, I had to set aside my unrealistic goals in order to do what was truly best for my baby, and that was to switch to formula feeds. Today, she is a vibrant and cheerful little 5 month old baby and honestly, if she were on my breast milk, she would still be just as vibrant and cheerful.

I had spoken to another mom about my failures of breastfeeding, and she reassured me that I was doing just fine. She said she had breastfed her first child exclusively because she wanted to be as natural as possible. And then, she had a second child who she tried to breastfeed exclusively as well. And then unexpectedly, a third child came. At this point, she couldn’t keep up with the crazy demand so she switched to formula for her last two children. She said to me, “…my oldest son who had my breast milk is just as weird as my youngest who is on formula…And I hope this makes you feel much better, because I know I did.

So to those who truly do want to breastfeed exclusively, here are a few tips I wish I had known while I was pregnant:

If you are going to be a first time mom and are currently pregnant, feel your breasts and try massaging them. If they feel tender or painful upon moderate pressure, then you may have a tough time with breastfeeding like I did. Of course, not everyone is the same and breastfeeding may come about more easily for some mothers compared to others. And if the pain is that excruciating, you may be experiencing breast engorgement or duct blockage. Always check with your doctor if you’re unsure. Massaging the breasts is the most important tip I can give to new mothers like myself who have no idea what they’re doing! I had to push through the pain of massaging and rubbing my breasts to “let down” the milk all while trying to make sure my newborn baby was getting enough. It was draining. Massaging those breasts helps them get used to movement and pressure so start early, even before baby arrives! And when it comes time to latch on your newborn, these sensations shouldn’t be so new to your breasts. Of course, it may still be painful at first but not as excruciating. That way, you’ll be able to better enjoy those precious moments of your first feeding with your newborn baby instead of focusing on the “why can’t I feed my newborn like other mothers do so naturally?! I have failed as a mother already…Nope, none of that!

Of course, drink plenty of water. This not only helps with your milk supply, but it also helps to reduce the pedal edema (swelling in the feet) by flushing out all the excess fluid that has developed in your body. (During pregnancy, our bodies produce and retains fluid to meet the needs for your developing fetus.)

Always try to minimize stress! That is a given. Stress contributes to so many health conditions in every aspect of life. Be kind to yourself! You are creating a new life and that’s pretty darn amazing! Take some deep breaths, think happy thoughts, and surround yourself with good vibes.

Also, continue to exercise! Avoid strenuous training but continue with those stretches or even take a scenic walk. Ask your doctor what is right for you but if your condition doesn’t warrant otherwise, then continue to be active throughout your pregnancy. Remember to rest when you are tired. Being active is great but don’t push it. Trust your instinct. Move when you want to, rest when you need to.

Lastly, ask for help. It’s ok to admit you have no idea what you’re doing. I mean, do we really know what were doing? I know I didn’t and everything turned out just fine. Another piece of advise to new moms is, no matter how bad you think it gets, it will always pass. It won’t last forever. Talk to someone – your partner, a family member, a friend, your doctor. Reassure yourself that everything is ok, and that you are doing great and you’re a good mom. Hopefully they will reassure you too.

To those having a tough time with breastfeeding and are considering formula feeds, that’s ok too. Modern science has created some amazing inventions, and now mothers struggling with breastfeeding don’t have to feel so defeated and alone anymore. Formula will not make your child any less of a person than those fed with breast milk. You have not failed as a mother. You are not a bad mom.