Shorts and Snippets

*Disclaimer: slightly graphic pictures of arms and legs ahead*

Mommy blogs saved me big time on this one. When I was diagnosed with PUPPP at 33 weeks pregnant, the only solution I was given by a health practitioner failed me miserably. But a wealth of information about this terrible rash existed on the interwebs from women who’d actually experienced it; so, I thought I’d join the line of those blessed souls in the hopes of helping someone else who has to deal with it. Be warned: long blog post ahead.

PUPPP, which stands for pruritic urticarial papules and plaques of pregnancy, is a terrible rash something like one in 200 pregnant women develop in their third trimester. It typically starts within the stretch marks on or around the baby bump but—as I found out the hard way—it can spread everywhere else. Think hundreds of huge, angry, red welts that itch and burn with the intensity of a thousand fire ants, ten thousand mosquitoes, and a few rounds of chicken pox all thrown into one. It is a living hell I wouldn’t wish on anyone.

The fun thing about PUPPP is that a) no one knows what causes it; and b) it doesn’t go away until after the birth of the baby. From what I’ve experienced, not a great deal of knowledge exists in the medical field about it. In fact, I read some blog posts from women who went to their doctors for a solution and witnessed them actually Googling the rash since they had no idea what to do. Literally everyone I told about PUPPP—many of whom had been pregnant themselves—said they’d never heard of it.

For me, it started innocently enough. The week before I was diagnosed, I saw my doctor and complained that the front of my baby bump had been red and itchy for a few days. He inspected the skin and said I had inflamed stretch marks, and that a regular strength hydrocortisone cream would take care of it.

Well, it did, for a time. Not a big deal, right? The skin has to stretch during pregnancy, so I didn’t think anything of it. But then a week later, in addition to the inflamed stretch marks on my stomach, the inflammation had spread to my hips and lower back. To top it off, I suddenly had weird bumps going up and down my arms and legs.

The next day, the bumps were starting to look kinda bad, and the itching got more intense. They were also spreading, rapidly.

I went back to the doctor. I was 33 weeks and one day along, and my doctor took one look at my arms and legs and said, “PUPPP.”

After explaining what the hell it was (in that no one knew what it was), he said that if I were closer to my due date he’d induce me to stop it. But, with that date being seven weeks away, he sent me to a dermatologist who could look at the rash and prescribe some kind of topical relief.

So downstairs in the building I went, where I had the fun experience of being asked a handful of questions by two beautiful, clear skinned medical assistants while I, the red bumped and sweaty whale, squirmed miserably in my gown. When the dermatologist walked in, she examined me, confirmed PUPPP, and did something that lifted some of the clouds over my head: she assured me that PUPPP does not hurt or affect the baby in any way.

She then offered to prescribe a topical steroid. Fearing the effects of a steroid on my baby, I asked about other methods and she told me I could try Benadryl, Zyrtec, calamine lotion, and sarna lotion, and to call back the next day if those weren’t successful in stopping the itching.

Long story short, they weren’t successful. By the next day, things had gone from bad to worse.

As we are all oft to do when things go from bad to worse, I called my mommy. While I debated with myself over whether or not to get the damn steroid (I was terrified it would hurt the baby, even though the dermatologist and my doctor had approved it twice-a-day use for ten days), she went on a Google search crusade for all-natural treatments. What she found ended up saving me: (tldr: Grandpa’s pine tar soap, black cherry juice, and milk thistle in addition to Benadryl and Zyrtec (and a few other odds and ends) to get me through the rough parts. I’ll go over all of this in detail below–promise!)

Meanwhile, in desperation I went ahead and got the topical steroid in addition to everything else and tried it only for it to make the rash worse.

By day five, I thought I was going to die.

Never in my life have I experienced agony like this rash. I didn’t eat. I didn’t sleep. I couldn’t do anything. I was taking seven, eight showers a day, scrubbing furiously with the magical pine tar soap so many other women had sworn by, but not getting instantaneous relief. I was taking antihistamines, doing the all natural methods others said had worked for them…. nothing. The pictures, mind you, only show my arms and legs. I didn’t take pictures of the rash that spread to my hands and fingers, feet and toes, lower back, hips, thighs, and baby bump.

I whined and cried a lot. I began to wonder if PUPPP was actually worse than the first trimester (now that the worst of it is behind me, I’ve concluded that it was not, but it came pretty close). I began to wonder if I’d make it to the end of my pregnancy with my sanity intact.

But by the 11th (day six), I was down to three showers with the pine tar soap a day, no Benadryl or Zyrtec, aloe vera gel and coconut oil, and the itching had lessened slightly… the natural cures had finally begun to work.

As bad as the rash looks here on day six (four days after my diagnosis), that was actually my turning day. Things had gone from horrifically bad to just pretty bad. I’d been using Grandpa’s pine tar soap for four days, taking milk thistle three times a day, had drunk enough black cherry juice to sustain a small country, and was slathering on coconut oil and aloe vera gel every hour like my life depended on it.

By the next day, things had gone from pretty bad to relatively bad.

The inflammation was starting to die down and I was actually starting to sleep for a few hours a night.

By August 16th (day eleven), nine days after my diagnosis, things had gone from bad to okay.

Which leads me to the main point of all of this: a topical steroid didn’t lessen the effects of PUPPP for me. Nothing any doctor or dermatologist could recommend to me worked. So let me tell you what did.

One last thing worth discussing first, and it has to do with my theory about what causes PUPPP based on what I did to reduce its symptoms (it won’t fully go away until after I give birth). It involves the liver.

The liver does many things. Among its jobs is to deal with substances in the body from nutrients and medicines as well as toxins: “Once [these substances] reach the liver, [they] are processed, stored, altered, detoxified, and passed back into the blood or released in the bowel to be eliminated” (source). According to the American Pregnancy Association, pregnancy hormones can negatively affect liver function in that they slow or can even stop the flow of bile: “The gallbladder holds bile that is produced in the liver, which is necessary for the breakdown of fats in digestion. When the bile flow in the liver itself is stopped or slowed down, this causes a build up of bile acids in the liver which can spill into the bloodstream” (source).

In a nutshell, during pregnancy, we are expelling not only our own toxins but the toxins of an entire other human being. So if my liver was already struggling to detoxify substances in my body due to pregnancy hormones slowing down my liver’s natural functions, it would have become even more overtaxed trying to detoxify substances from my baby’s body, too.

Now, because I’m not a doctor, I can’t say with 100% confidence that my rash and an overtaxed liver were connected. All I know is that the toxins had to go somewhere.

When my doctor first saw my rash, the first thing he did was poke at my liver and ask if it hurt. It didn’t, but what he was checking for was cholestasis, a liver disease pregnant women can get that involves very itchy skin and that does negatively affect the baby. What’s happening within the skin – our largest organ – can reflect what is happening on in inside of our bodies.

Hence my theory of why perhaps in my body, the toxins in my body tried to release themselves through my skin in the form of awful welts.

Do I know this for a fact? Of course not. All I know is that natural liver detoxifying supplements and foods I consumed during my week of PUPPP hell made my rash fade.

So without further ado, let’s dive into what worked for me and what didn’t.

One last disclaimer: I am not a doctor. I have never studied medicine, nor do I have any authority to give advice other than my personal experience. Please talk with your care provider about the following treatment options if you want to attempt any of them. 

Things That Worked For Me

Grandpa’s Pine Tar Soap

This stuff is number one. This stuff is a freaking lifesaver. When my mom googled PUPPP and said this soap was what had worked for a lot of women with PUPPP, I just went and bought it, no questions asked. I swear by it, worship it, have fallen in love with it and will vouch for it faithfully forevermore. Not at first though. Take note: it takes a few days to kick in. 

Also of note: You’ll also smell like you’ve been eating beef jerky by a campfire for three days and nights. Worth it, I promise you.

Anyway, during the worst of the rash I took something like seven or eight showers a day in cool water and scrubbed the hell out of my skin with this soap. This is important: make sure you let the soap sit before you rinse it off. (And at my mom’s advice, after each shower I’d put coconut oil on, too – more on that below.) As the rash died down and my need for showers became less frequent, I’d put the soap in a Tupperware container by my bed with a washcloth. When I woke up during the night due to the itching, I’d rub a little of it on the worst spots and it helped.

I found this magical goodness at my local Vitamin Shoppe but you can also find it on Amazon. If you do nothing else, y’all, get this soap.

Cool Water

Worth mentioning here is that warm or hot water absolutely destroyed me during the bad days. cold water, as cold as you can stand it, is your friend.

Coconut Oil

After each shower with Grandpa’s pine tar campfire-smelling goodness, I put coconut oil on my wet skin and pat myself dry with a towel. Coconut oil is a great antioxidant (it contains vitamins A and E) and soothed my skin immensely. You can find it at any grocery store in the baking aisle – I recommend just getting the cheapest one!

Aloe Vera Gel

Sometimes, even the soap wasn’t cutting the worst of it and the coconut oil didn’t help either. A little bit of this was so soothing. I found mine at CVS , though I saw it at Target and my local grocery store too, usually with the sun screens. Though if I could have found an aloe vera plant and chopped off part of it for personal use I would have.

Black Cherry Juice

My mom said with any kind of inflammation, it had to be treated from the outside in. In other words, just stopping the symptoms wasn’t enough. I had to treat the cause of the rash, which – as I mentioned above – we related to an overtaxed liver.

Black cherry juice, among its other properties, is supposedly drunk to reduce inflammatory diseases. During the worst of the rash, I probably went through a half a gallon a day in the hopes of reducing the inflammation in my skin. I found mine at my local Vitamin Shoppe as well as my grocery store.

Note: if you get the concentrate, make sure you dilute it with water and not pound back a small glass of it like you’re taking a shot only to gag and realize you’ve swallowed the equivalent of syrup like I—*cough*—I mean, like someone I know did. And if you find the regular juice too gross (like I did for one particular brand), dilute it with water, take a deep breath, and chug.

Milk Thistle

Milk thistle, for me, was very gentle in that I experienced no side effects in taking it three times a day. It is an all-natural supplement that is used to protect and strengthen the liver and studies have shown that it can reduce liver inflammation (click on the link to see the studies).

Now, as a precaution, I’m down to twice a day and I’m convinced it is helping to keep the worst of the rash at bay.

Benadryl and Zyrtec

Desperate times called for desperate measures. For a few days during the worst of the rash, I went hardcore on the antihistamines, taking two Benadryl in the morning, two in the afternoon, and a Zyrtec at night. They helped for sure. I know this, because I was actually able to sleep for a few hours at night because of them!

(I stopped taking them as soon as I could possibly bear to go without them. I hated that my baby didn’t move as much after taking them since they made her sleepy!)

To reiterate here: be sure to talk with your doctor if you’re considering using either drug. The dermatologist I saw confirmed both were safe for pregnancy, but your pregnancy could be very different from mine.

Things That Didn’t Work For Me (but might work for you) 

Triamcinolone

This was the topical steroid prescribed to me by the dermatologist and approved by my doctor. I was an emotional wreck deciding whether or not to use it because in my every Google search I came across the phrase that it should be used “only if the potential benefit justifies the potential risk to the fetus”. But, desperate, I tried it.

The very first time I used it, it seemed to help a tiny bit. But the second time, my skin literally felt like it was burning. It was so strong, that within minutes of me slathering it on I was in the shower desperately scrubbing it off.

That said – everyone is different. It may work for you! You do need a prescription though. A doctor or dermatologist should be able to call it in to your local drugstore. With my insurance, I think I paid like $12 at CVS.

Hydrocortisone Cream

This is technically another steroid cream, though over-the-counter and easier to get. For me, it just aggravated the itching. However, it did work for a short time on my inflamed stretch marks prior to my diagnosis, so there is hope that it would work for you!

Oatmeal Baths (and warm water)

Warm water was my arch-nemesis during my battle, but so was oatmeal, for some reason. I tried an oatmeal bath both in warm and cooler water and both times I only lasted a few minutes before getting out of the tub and jumping into the shower to scrub with my pine tar soap instead. Oatmeal, however, has anti-itch properties and it could a life saver for you! I tried both putting oats in a sock and letting it soak in the water and pouring oats directly into the bath.

Things That Kinda (?) Maybe Sort of Worked?

This is the big question mark category: a list of things that I tried in desperation along with the many other listed things. I’ve got inconclusive evidence to suggest that any of the following singlehandedly stopped my PUPPP from getting worse, but they are worth a mention here in the chance they help you:

Calamine Lotion

This was recommended by the dermatologist I saw. It’s hugely successful in combatting bug bites, but I’m not convinced it did a whole lot for my hives from hell. Worth mentioning is that for a few days, I was trying a thousand different things each day that probably just canceled each other out after a certain point. But calamine lotion is worth a try if you can leave it on your skin without adding anything to it. It may help! Any drugstore or grocery store should sell this.

Aveeno anti-itch concentrated lotion

Actually, this was the very first thing I bought for the inflamed stretch marks on my baby bump, the week before the rash spread and the crap hit the fan. For a few days, it did the job, until it didn’t. Still didn’t stop me from spreading it everywhere in the hopes that it would do something-anything-for the itching. I don’t think it helped during the worst of the rash, but if it brings temporary relief, then it’s worth it!

Ice Packs

These I will say actually did help a bit. When things were at their worst, in desperation I’d use ice packs on the really itchy places. For some reason during one of the bad days, my feet were the worst of all: they were red and nearly bleeding from scratching and for a few hours, making them numb with cold was the only thing that helped. As a whole, ice packs weren’t solely responsible for reducing the rash – but they sorta helped.

Things That I Didn’t Try But Might Work For You

• Dandelion Root Tea – another supposedly gentle method of boosting your liver’s function.
• Sarna Lotion – the dermatologist recommended this to me but I never tried it. 
• V8 Juice – okay, actually this I did try, for like a second. But drinking pure V8 juice was putting myself through another type of hell that I just couldn’t do (I switched to V8 Tropical Splash, which I’m sure isn’t as effective but you win some, you lose some). However – I’ve read in a few other blog posts about PUPPP that V8 juice really helped.
• Witch Hazel – somewhere I read that soaking a cotton ball with witch hazel and dabbing it on the itchiest parts of the skin actually helped, but I never tried it.

Other Random Bits of Advice

Here’s the big one, y’all: communicate with your doctor. Please don’t try to self-diagnose. Intense itching and rashes in pregnancy can mean a number of other things other than PUPPP such as cholestasis, which I mentioned above. And even though PUPPP isn’t harmful to the baby, my doctor still ordered a blood test to make sure everything else was okay.

Other Tips:

• Don’t wait. If the front of your bump itches – get thee to a doctor. For me, that was the first sign that PUPPP was approaching and I really wish I had known more in the off chance I could have started treating it sooner. In fact, if your bump is itchy I would recommend just buying the soap and scrubbing with it as a precaution, if nothing else.
• Eat lots of detoxifying foods. I tried to eat lots of walnuts and blueberries and drink my water with juiced lemons, all good methods of natural detoxing since a full blown liver detox while pregnant was out of the question.
• Drink lots of water!
• Try – very hard – to not put processed foods into your body during the worst of it. For me, this meant staying away from my beloved Pringles and cookies while trying to focus on fresh fruits and veggies and lean meats. Now, don’t get me wrong: if I had the odd craving for some kind of junk food during this ordeal, you bet your ass I got that and stuffed my faced with it. PUPPP sucks. Don’t make yourself more miserable than need be. But if you can, try to mostly give your body the nutrients it needs to fight the inflammation.
• Stay positive. This was hard for me, so I’m a bit of a hypocrite saying it. But take it from me: it gets better. I promise.

I’m now 36 weeks pregnant and while I’m occasionally itchy and have some splotches of welts here and there, the difference between a few weeks ago and now is night and day. I can function again. I can eat and sleep and go places. 

As of now, I wash with Grampa’s Pine Tar Soap once a day and stick to that one shower a day since I think any more would continue to really dry out my skin and make the itching worse. I still put on coconut oil but follow it up with St. Ives hydrating lotion. And I also still take milk thistle twice a day. And as I said – the difference is incredible.

So – I hope this is helpful and hopeful to you if you are in the midst of a battle with PUPPP! It sucks, and I’m sorry. At the end of the day though, the ultimate prize is a baby… and I would relive my worst day of PUPPP every day if it meant I got to hold my happy, healthy daughter eventually.

Best of luck to you! You got this, mama.

Tagged: pregnancy, PUPPP, third trimester