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What Is PUPPS?

PUPPS (Pruritic Urticarial Papules and Plaques of Pregnancy), also known as PEP (Polymorphic Eruption of Pregnancy) is a fairly common skin condition seen in pregnancy.
It is estimated to affect approximately one in 200 women. PUPPS is a very itchy rash that typically starts on the tummy, spreading round the back and to the thighs and arms. It is most common in first pregnancies and usually appears in the third trimester (often around 36 weeks of pregnancy), though it can develop just after the birth. The rash appears suddenly, usually on the stomach and back (in 90% of cases) around the stretchmarks. It begins as red bumps that later join together and can vary from mildly itchy to unbearable.

The good news is that, while incredibly itchy and sometimes to the point of being debilitating, PUPPS would not appear to have any adverse long-term effects on either mother or foetus. It hardly ever spreads to the face and will usually clear up pretty quickly after the birth, at most within a matter of weeks. It doesn't necessarily recur with future pregnancies, so if you are suffering from it first-time round you may not get it again.

What causes PUPPS?

The causes of PUPPS are uncertain, though it may be a reaction to the cells of the foetus in the mother's skin. It often develops in women who put on a lot of weight in pregnancy and those expecting very large babies or twins, and may be more prevalent in women carrying boys than girls. A study, carried out at the Mater Hospital, Dublin, found that while PUPPS is reported to occur in 0.5% of singleton pregnancies, this increases to 2.9% of twin and 14% of triplet pregnancies.

How is PUPPS treated?

There are many different treatments to help relieve the itching – unfortunately, some work for some women and not others, so you may have to try a few. Though they will not make the rash go away, they may help make the itching more bearable.

  • Cool, wet compresses
  • Bread soda baths
  • Calamine lotion
  • Oatmeal baths
  • Topical steroids
  • Oral steroids
  • Anti-inflammatories
  • Antihistamines
  • Moisturising creams
  • Homeopathy
In some cases where scratching has caused an infection, antibiotics may need to be prescribed.
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