Second pregnancy PUPPPs and what is working in battling my rash

Because I have suffered PUPPPs before, it seems both better and worse the second time around. It is better because I know what it is and I know where it is going and what to expect. It is worse because I know what it is and I know where it is going and what to expect. It doesn't help that I got it much earlier and worse this time.

The benefit of knowing what I was up against was that I had tried all manner of things before and I am able to treat it sooner. As soon as I felt the itch before the rash had blossomed, I talked to my doctor about what was safe. She recommended antihistamines and topical creams like moisturizer and hydrocortizone. 

As the rash did soon blossom, I used super moisturizers like Cetaphil. That provided relief and it only grew slowly. Then it started to pick up speed so I used Sarna, an anti-itch lotion I hadn't found much help last time but still had around. Some women swear by it. For me it increased inflammation and discomfort. I stopped using it after three or four days and the rash calmed a bit. However it was still progressing and starting to creep up my belly above my navel. 

So as much as I hate to take drugs, I knew how awful this could get and how quickly, so I took Zyrtec Allergy. I was pleasantly surprised that the rash became less inflamed and greatly reduced. It started to clear up under my belly after just a few days. Then the intensity of the rash picked up again and I lost ground but maintained a reduced rash, less raised and red. 

I use Cetaphil gentle clenser and Cetaphil moisturizer for best results. Being out in the heat too long or taking too warm of a shower can set me off to unbearable. I'm glad I've tried the Zyrtec. it is working for me. I've also introduced a dandelion root tea to drink at work and am going to talk to my doctor this week about the pill form. I'll keep you posted on what works. So far, it isn't going away, but it has slowed down and with 12 weeks to go, that is good news.

PUPPPs in my second pregnancy - the rare return

"Can PUPPP recur with future pregnancies?

This is very uncommon. If it occurs the PUPPP is likely to be milder."
-citation http://www.dermnetnz.org/reactions/puppp.html

Ha.

It is commonly cited that between .5% and up to 1% of pregnant women may suffer PUPPPs. According to the Center for Disease Control and Prevention there were 4,058,000 live births in the US each year (July 2013). I did not include pregnancies that ended in miscarriages nor terminations as those mostly occur early in pregnancy before PUPPPs is likely to occur. So using the high end of the range, 1% of 4,058,000 is 40,580 and on the low end that is about 20,000 women suffering from PUPPPs in a given year in the US. 

Once I told my PUPPPs story, I discovered a childhood neighbor who suffered PUPPPs in her first pregnancy and a college friend who suffered PUPPPs in her first full-term pregnancy. I had never heard of it before my diagnosis in my first pregnancy.

When I asked the doctors about recurrence, they said it usually only occurs in first pregnancies and with multiples. However, given my extreme case they would not give me any guarantees.

I took some hope in the overall odds, the law of averages and the fact the websites like those quoted above said if it did recur, it should be milder.

Ha.

Pregnancy number two, I looked over at my husband at week 18 and "uh-oh, I am starting to feel itchy." It didn't progress very quickly, but by 21 weeks bumps started to appear and by 25 I had the familiar wheels of itchy red raised streaks surrounding my belly button. And they grew alarmingly fast so that by 26 weeks I was aggressively seeking treatment to stop its spread.

Not only was I getting PUPPPs in my second pregnancy, I was getting it earlier and with more severity. What are the odds of that?

No really, I'd like to know. And I can't seem to find any information about how many women have recurrence. All I know is anecdotal evidence from others like myself exists on question boards and Facebook threads across the internet. It does seem rare but I have been unable to quantify that rarity.

I felt unlucky in the first pregnancy and now I feel afflicted. 

My introduction to PUPPPs

On May 22, 2012, I wrote the following:

Until a few weeks ago, I had never heard of PUPPS: Pruritic Urticarial Papules and Plaques of Pregnancy. Plague seems like the key word as it is basically a painful rash experienced by less than 1% of pregnant women in the last several weeks of pregnancy.  There is no cure and the best way to alleviate symptoms is to have the baby.

For me it started around week 36 as itchy raised red stretch marks around the belly. It stayed confined to my belly until week 38. Then, overnight, it spread across my body from neck to toes. It was alarming how quickly it spread. When I called the doctor’s office, the nurse told me this was quite common and to take some Benadryl and calamine lotion and then see my doctor at our appointment scheduled in two days. I did take some time to convince her of the alarming spread, but was left with reassurances that it was all quite common.  I spent the next two days in agony, the kind where you want to peel off your skin. That is when I googled pregnancy rash and first got the name for this condition - PUPPPs.

PUPPPs on my hand and arm

When I saw my doctor she was not happy with the nurse who spoke to me on the phone. From that point on, I never heard a practitioner who didn’t say severe or extreme before mentioning my PUPPPs. The doctor recommended immediate induction as the only way to combat the rash is to have the baby. A stress test showed that baby was still doing just fine. Other tests ruled out more alarming reasons for the rash. I wasn’t quite ready for the induction option as I wanted to make it to 39 weeks. So we made a plan to come back on Monday when we would reach 39 weeks. The new drugs from the doctors didn’t provide any more relief. Lukewarm baking soda baths were about the best I could do for temporary relief. This continued itchy pain meant that I was unable to really rest. Knowing that could not go on for long, we packed our bags and went to the doctor on Monday. They gave me the option to keep toughing it out, but highly recommended induction. However, the birthing unit was a bit busy so we were asked to come back to the hospital later that night. 

 

We were admitted at 6pm. I really liked the care I received at the hospital. It is a teaching hospital and my case of PUPPPs provided a teachable moment. Again all the doctors remarked how this was the worst case or one of the worst cases of PUPPPs they had seen. About 80% of my body was raised red and bubbly. I was more red than white.

 

Fast forward to our daughter being born on Wednesday just after midnight via emergency c-section (a story for another time).  It was a wonderful time as we celebrated the birth of our daughter, the beginning of a new chapter in life and the end of a long labor ordeal. As for PUPPPs, it immediately stopped spreading which made me very happy. In the first 24 hours after birth the rash receded with remarkable speed. It didn’t fully go away, but the difference was marked. By the second day, the doctors were coming back and very amazed at how the rash had receded.  By the third day, itching was not my most severe symptom and I finally became more physically aware of the fact I had major surgery. 

 

However, on the fourth day as we headed home, my milk came in and the rash reappeared with velocity. Fortunately the reach was not as severe, and with the baby out, I was able to take some stronger steroids and antihistamines to combat the rash. While the drugs have helped in coping, I remain quite itchy to this day.  I remain hopeful that it should clear up about 6-8 weeks after the birth.

*UPDATE - I had itchiness until I weaned my daughter around 7 months. It was not nearly as bad after the first couple months, but it was a factor in my decision to stop nursing. Thankfully, it cleared up as my milk dried up.*
One of the small nice features of PUPPPs is that it usually does not go for your face.  So with long sleeves I simply look like a version of myself who has an itch. 

 

To anyone else who has or had PUPPPs, I feel for you and can relate. I wish I didn’t know about PUPPPs, but all in all, I had a healthy pregnancy and we got the end result we wanted – a healthy baby. Can’t wait to put this PUPPPs chapter behind me.