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

3 Easy steps to prevent and treat flat head syndrome

What is flat head syndrome?

Flat head syndrome is also known as plagiocephaly. (“plagio-” means slanted or oblique and “-cephaly” means head) It is also known as positional or deformational plagiocephaly.

It is where the back or the side of the baby’s head becomes flat, asymmetrical or slanted. Sometimes, the baby’s head may also widen and the forehead bulges out in more severe cases. This is due to prolonged external pressure on one spot of the newborn’s soft and malleable skull.

It is more common today because of the Safe to Sleep® campaign recommending that babies sleep on their backs in the first few months of life to prevent SIDS (Sudden infant death syndrome).

Other causes of flat head syndrome include the following:

  • Medical problems or delayed development which makes it harder for babies to move and change positions
  • Stiff or tight neck muscles limiting neck movement (Torticollis)
  • Premature babies have softer skulls than full term babies and also move their heads less
  • Plagiocephaly can also occur in the womb such as overcrowding with twins or the mothers womb has an unusual shape

SIDS

SIDS (Sudden Infant Death Syndrome) is the death of a healthy baby who is less than a year old during sleep (also known as crib death). The cause of death is unknown even after a complete investigation but is believed to be linked to defects in the baby’s brain that controls breathing and arousal from sleep. It is also said to be a combination of physical and environmental factors in the baby’s sleeping environment such as in the crib, however research is still ongoing.

I highly recommend mothers to visit this website, Safe to Sleep® campaign to learn about SIDS and how to reduce the risks.

Should I be concerned about plagiocephaly?

Experts have dismissed plagiocephaly as an aesthetic issue because not everyone has a perfectly round shaped head. Also, it is also believed that asymmetrical heads should resolve itself over time as the baby grows.

Because flat head syndrome is a fairly new concern, there is limited studies on the matter. There is a 2010 study from Seattle Children’s hospital that has found an association between flat head syndrome and developmental delays, specifically motor, language and cognitive delays. This means there is no actual cause and effect between flat heads and child development but there is some link between the two.  In fact, the study suggests that a flat head may be a marker to identify children who are at risk for developmental delays, not that flat heads actually cause such delays. Unfortunately, there is no clear answer at this time and research is still ongoing…

Learn more about this study at Seattle Children’s Hospital website here.

Plagiocephaly may also be mistaken with craniocynostosis which is very different! Craniocyntosis  is where the baby’s skull fuses too early preventing normal development of brain growth. Babies with craniocyntosis will have uneven head shapes and this may also look like flat head syndrome. Check with your doctor to make sure!

Treatment & Management

Treatment depends on your health care provider, the age of your baby, the potential cause and so forth. It is very important that you seek professional medical help if you are concerned!

Your baby’s soft skull will start to fuse together and harden at about 9 to 18 months.

If the cause of your baby’s flat head syndrome is due to how they sleep, nap and lay, treatment may include positioning your baby’s head in different ways and avoiding pressure on the flat spot. It is also important to limit the time your baby spends in their bouncers, car seat or anything that applies pressure to certain parts of their head.

If your baby is diagnosed with stiff neck muscles (torticollis), your doctor may recommend special exercises or refer you to a physiotherapist.

If after 6 months, there is no improvement after trying to reposition your baby’s head first, your doctor may recommend helmet therapy. The plastic helmet, lined with foam fits snugly on the round parts of your baby’s head, and loosely on the flat spots to allow the flat spot to expand and even out as your baby grows. Generally they are worn for about 23 hours every day from about 1 to 6 months but it depends on your child’s age and case. Also, helmets can be very pricey!…

Learn more about plagiocephaly at Seattle children’s hospital website here.

How we fixed our baby’s flat spot with 3 easy steps

A few months ago my baby started to develop a flat spot on the back of her head and I freaked out! I always put her down on her back for naps and at night (especially after reading about SIDS!) And I will admit that I put her in her bouncer when I’m busy around the house, and I let her finish her nap when she falls asleep in the car seat on our way home. I realized that all of these habits had contributed to her flat head syndrome!

I had spoken to my doctor about her flat spot and she said that I shouldn’t be too concerned because naturally, no one has a perfectly round head. Also, preventing SIDS far outweighs the concerns that comes with flat head syndrome. I mentioned that I had done some research about flat head syndrome and developmental delays but she assured me that more research is needed to conclude this hypothesis. After much discussion, she provided me with simple, at home measures that I could take to gradually mold my baby’s head naturally without a pricey helmet.

Today she is 6 months old and her head is as “naturally” round as can be.

With 3 simple steps, this is how we did it.
 

1. Repositioning

The first tip to try is to reposition your baby when he or she sleeps and naps. There are a couple of ways to reposition your baby without having to put them on their sides or stomach. Remember to always place your baby on their backs and for peace of mind, turn on that baby camera when your not in the room!

First, use interesting objects or toys that catch your baby’s attention such as a baby mobile. Position the mobile where you want your baby to turn his or her head when they lay on their backs.

Check out our post about the Top 5 Reasons why You Need a Crib Mobile.

Another tip is to place your baby the other way in the crib. For example, if your baby’s feet is towards to door of the room, instead place your baby’s head towards the door.

Lastly, you can also try rearranging your nursery in the room. Moving the crib to a different area in the room can help to move your baby’s head in a different direction.

2. Lots of Supervised Tummy Time

Tummy time is vital, not only for relieving the pressure off of baby’s head but also to help strengthen neck and shoulder muscles for crawling and sitting up. It also improves your baby’s motor skills.

Babies should be on their tummies for at least 2-3 times per day for short periods of time right from birth. As they get older, allow them to spend more time on their tummies with each session. Try not to leave your baby unsupervised when on tummy time! Also, never leave your baby on tummy time (or in any position) on a high area such as the bed or changing table. They may roll over and fall!

Tips for tummy time:

Lay out a blanket on the floor

Place their favourite toy within baby’s reach and help them learn to play and interact with their surroundings

Tummy time after a nap and diaper change is ideal

Avoid tummy time right after a feed, they may spit it all up!

Never leave baby unattended during tummy time

3. Head Molding Pillows

Right now, I’m using Babymoov Lovenest baby head support pillow when my baby sleeps or naps. She sleeps through the night for about 9 hours straight which applies a lot of pressure on the back of her head!

It is so important to put your baby down on their backs but this is probably one of the reasons why my baby developed a flat spot on the back of her head. So I did some research and found the Babymoov Lovenest pillow on Amazon for $19.99 CDN and had to give it a try. This pillow significantly relieve the pressure off of my baby’s head and I truly recommend it. I use this pillow every time I lay her down. It comes in a variety of colors. The fabric is soft, breathable and machine washable. If you don’t believe me, check out their reviews on amazon!

With these 3 simple tips, we saw a difference in just one month! Today, our baby is 6 months old and we continue to implement these steps when she sleeps. Her flat spot has evened out and we are very happy with the results!

Does you baby have a flat spot? Share your story in the comments below! We love to hear from you.