It is normal the stretch marks on body to be itchy, especially if this is your first pregnancy. This happens due to stretching of the skin or dryness of the skin, although both of these do not cause any harm to the baby. Changes in hormones can also be the reason for itchy stretch marks on the body.
However, if you have small, raised red bumps on your stretch marks and they are also itchy, you may have a condition called polymorphic eruption of pregnancy (PEP). It is also called purulent urticarial papules and plaques of pregnancy (PUPPP). Some people also call PEP a PUPPS rash or PUPPS pregnancy rash.
What are the symptoms of Polymorphic Eruption of Pregnancy (PEP)?
PEP often begins in the late stages of pregnancy, but it can also happen right after delivery.
The itching usually starts on the abdomen or on your stretch marks. However, even if there are no stretch marks, itchy rashes can occur.
Within a few days, these rashes can spread on the thighs, breasts, hips, back. They can also spread to the arms and legs, but this is rare. These rashes usually do not occur on the neck, face, hands and feet.
How do PUPPP rashes appear in pregnancy?
You may get rashes that look like this:
- Raised areas in the skin, as if stung by a scorpion.
- Large patches that look like hives.
- Small, red, raised lumps (papules)
- Reddened, swollen patches of skin (plaques)
If your complexion is fair, then these rashes may look pink or red and you may see a bright white circle around them. If you have a darker skin tone, these rashes can look similar to your skin tone.
Sometimes small blisters also form in the rash. If you itch on these blisters, then fluid may come out of them and later there is a scab.
What causes PUPPS rashes in pregnancy?
It is not yet clear what causes PUPPS rashes.
Some experts believe that due to the rapid stretching of the skin, the connective tissues are damaged, which increases the chances of itching etc. Since the skin is stretched more to make room for the baby in the late stages of pregnancy, PUPPS often occurs in the later stages of pregnancy. Women who have more than one baby in their womb are more likely to have it.
It is also believed that PUPPS is an allergic reaction to the presence of embryonic cells in the mother’s blood. If a boy is growing in the womb, his male DNA can be deposited in the mother’s skin and the mother’s immune system reacts to it. PUPPS often occurs in women who are carrying a boy.
What conditions increase the risk of getting PEP in pregnancy?
Some women who get these rashes do not have any conditions that increase the risk of PEP. But it is thought to be more common in women with the following conditions:
- who have more than one baby in their womb
- who have a larger than normal baby in the womb
- having their first child
- Those who have gained more weight than usual during pregnancy
- who has a boy in her womb
- Those who have hypertension (high blood pressure)
- who have had in vitro fertilization (IVF) with prolonged treatment with progesterone
- whose blood is Rh-positive
How is PEP rash detected in pregnancy?
There is no specific test to detect polymorphic eruption of pregnancy rash. The doctor can tell if they are PEP rashes just by looking at the skin rash.
If your doctor thinks there may be other reasons for the rash, she may ask you to have a blood test.
How is PEP treated in pregnancy?
Treatment for PEP rash is aimed at relieving severe itching. You can try the following steps:
- Coconut or almond oil massage before bath.
- Keeping the weather in mind, you can also take a bath with cold water mixed with emollients.
- Take a warm bath with oatmeal or baking soda mixed in.
- Applying aloe vera gel, emollient cream or cream prescribed by the doctor after bath.
- Apply a cool and wet cloth to the affected area.
Wearing soft, loose-fitting, cotton clothes may give you some relief from itching.
If itching and redness of the skin are causing you a lot of trouble, then the doctor may give an ointment to apply to the affected area. They may also ask you to take antihistamine medicine. In severe cases, you may also need to take a course of oral steroids.
Do not take any medicines such as antihistamines or ointments without your doctor’s advice.
You can still breastfeed your baby after birth, even if you are using a steroid cream or taking the pill. Only a very small amount of steroids pass into your breastmilk.
However, if you have applied steroid cream on and around your nipple, wash it off thoroughly before breastfeeding.
Can PEP rash cause harm to me or the baby?
PEP rashes are not dangerous for you and your unborn baby. But itching can cause a lot of discomfort and can make your skin look red and swollen.
Don’t worry even if you have PEP at the time of delivery as it will not affect your delivery. However, if the condition is severe, your doctor may recommend inducing labor.
The condition of PEP usually gets better on its own a few days after delivery. However, very often it persists for several weeks. The chances of it coming back in future pregnancies are very less.
Although PEP is not harmful, severe itching without a rash on the palms and soles can be a sign of obstetric cholestasis (OC). OC is a serious condition involving the liver. It occurs when bile starts collecting in the liver. If left untreated, it can lead to serious complications for the unborn baby. So if you really feel itchy stretch marks on your body, need to treat them.
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