PUPPS: Pruritic urticarial papules and plaques of pregnancy

Layla had an itch that couldn’t be scratched

One of the joys of being pregnant is experiencing all the idiosyncrasies your body develops throughout the gestational period.

Some women crave food they have never liked before, swollen ankles and stretch marks are common while some experience a heightened sense of smell.

But not all of these new experiences are what you could describe as ‘enjoyable’.

During her 37^th week, Layla was developing an itch that a simple scratch could not possibly suffice.  Layla did not know it at the time but she was developing a condition known as Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPS).

This condition manifests itself as an extremely itchy and irritating rash that usually starts around the tummy but can spread over the whole body.

No sleep for the itchy

We spoke to Layla about her experience with PUPPS and how she dealt with the itching that comes with it.

“The itching first started on and around my stretch marks,” she said.

“I knew from talking to friends and family who have been pregnant that you should try to avoid scratching them.

“But one night I couldn’t stand the itching anymore and I started to scratch all over my belly and breasts and around my thighs.

After her first sleepless night Layla discovered it wasn’t just her stretch marks that were itchy, a bumpy red rash had developed all over the areas she had been scratching.

Layla tried every soothing cream in the cabinet but nothing seemed to work.

“I tried applying sorbolene cream to the affected areas and keeping the rash cool with wrapped up ice packs,” she said.

“I even tried it in combination, washing my skin with sorbolene in a cold shower but the itching was relentless.”

Not quite realising what she was up against at this stage Layla dismissed the rash as one of the many weird and wonderful nuances of being pregnant.

“My GP was fully booked for the next few days so I got some advice from a pharmacist,  they gave me some hydrocortisone cream and some antihistamine tablets that were safe to take while pregnant but this only provided very slight relief,” said Layla.

What is this strange rash?

After three completely sleepless nights Layla and her partner decided something was definitely not right and they took a drive down to the hospital to get some advice.

“By this stage the rash had spread down my legs and up to my arms, it was pretty much all over my body,” she said.

“The midwife didn’t know what the rash was and sent me up to the ward for blood tests.

“The tests returned a high blood pressure reading and a very low platelet count which led them to believe that I might be developing preeclampsia,” Layla continued.

“It wasn’t until the attending doctor examined me later in the day that it was decided that I had PUPPS.”

The doctor that diagnosed Layla with PUPPS told her that there isn’t much you can do treat it.

“They told me the PUPPS would leave of its own accord once my baby was born,” she said.

“They would have liked to induce me as I was past 38 weeks by this stage but the midwives found my babies’ head was too high and it was too risky to induce.

“This made the situation even more testing. Being told you are about to have your baby and then being told you’re not causes great emotional stress,” says Layla.

Hang on, help is on its way

In the meantime, Layla was given a couple of treatments to try and make her more comfortable.

“The doctor recommended I take an antihistamine called Phenergan [promethazine hydrochloride] before bed to help me sleep through the night and regain my strength in case I went in labour. I found these worked well for me,” she said.

“One of the midwives gave me a bottle of calamine lotion which turned out to be a God-send.  I never thought to try it earlier. I stripped out of my gown and put that stuff all over me.

“It was the first time I had any relief since the itching began. Once I started using the calamine, even though it was a bit messy, it was a lot easier to cope with the itching.

“My baby was born about 10 days later and the issue resolved itself.”

Layla said that after only a couple of days most of the rash had all but disappeared and the intense itchiness was just a distant memory.

“I still have my normal stretch marks on my belly but the PUPPS rash didn’t leave any scaring or marks,” she said.

“I’d like to think that it was because I was extremely disciplined and didn’t scratch it but to be honest it was impossible not to scratch.

“The itching was 1000 times worse than chicken pox.

We asked Layla if she had any advice for women who may experience PUPPS during their pregnancy.

“Calamine lotion!” she shouted.

“It is impossible to not scratch, but the calamine was by far the best, it was the only thing that really provided any relief for me.

“If you do start to feel any itchiness around your belly there is no need to worry or panic.

“Have your doctor examine you to establish whether or not it is PUPPS,” Layla says.

“Don’t wait four days like I did to see the doctor, I was completely exhausted from the lack of sleep which made coping even more difficult.

“No matter how bad the itching seems or how frustrated you get trying to stop yourself from scratching it all disappears into a barely recognisable memory once you have your beautiful baby in your arms.”