Medical News Today: PUPPP rash treatment options

A pruritic urticarial papules and plaques of pregnancy rash is a common skin condition. Natural remedies, including oatmeal, chamomile, and peppermint, can help.

This type of rash usually starts in stretch marks on the abdomen and spreads to the legs and chest.

It causes itchy, red, hive-like bumps to form in the creases of stretch marks, and the rash can develop into larger red, swollen patches. In lighter-skinned people, the rashes may appear to be surrounded by a thin, white halo.

Pruritic urticarial papules and plaques of pregnancy (PUPPP) often develop in the third trimester of pregnancy. In most cases, the rash resolves within 15 days of giving birth.

While some medications can reduce the symptoms of a PUPPP rash, there is currently no cure.

What causes a PUPPP rash?

PUPPP rash <br>Image credit: Heykerriann, 2007</br>
Stretching of the skin or an immune response to fetal cells may cause a PUPPP rash.

The medical community is still unsure why PUPPP develops.

The rash usually forms first in stretch marks, or striae, and tends to develop in the third trimester of pregnancy, when the baby is growing the fastest.

Stretching of the skin

When the skin is stressed or stretched, the connective tissues can be damaged, causing inflammation that can result in a red, swollen rash.

PUPPP may be linked to the intense stretching of the skin that happens during pregnancy, particularly in the last few months.

Immune response to fetal cells

Another theory is that an immune response to fetal cells causes PUPPP. Some cells from the fetus migrate throughout the mother’s body. These cells can spark an immune response that causes the rash.

This theory may explain why PUPPP occasionally persists after birth, as fetal cells continue to circulate for a short amount of time in the mother.

More research is needed to establish a clear link between fetal cell circulation and PUPPP.


What are some natural treatment options?

Natural treatment options for PUPPP include:

1. Refrain from scratching

One of the best ways to treat a PUPPP rash is to avoid scratching it.

Irritation worsens PUPPP symptoms. Touching, rubbing, or scratching the rash also exposes already compromised skin to bacteria and other microbes on the hands and under the fingernails. These microbes can cause infection or further irritation.

2. Apply cool compresses or ice

Apply a cool, wet cloth or towel to the affected area whenever it feels itchy or swollen.

Applying an ice pack wrapped in a cloth for 15–20 minutes a few times a day may also help improve symptoms.

3. Oatmeal

Oatmeal baths treat many allergic or inflammatory skin conditions, and they may also help reduce PUPPP symptoms.

Colloidal oats contain a group of phenols called avenanthramides, which have anti-inflammatory and antioxidant properties. Oats also contain vitamin E and ferulic acid, which are antioxidants.

Research, including a review paper from 2014, indicates that oat-based body washes and rinses reduce itching and other skin complaints in people with conditions such as atopic dermatitis and eczema.

4. Moisturizers

Itchy skin can easily become dry. To prevent further irritation, apply moisturizers, or emollients, to itchy, inflamed, or dry skin as needed.

Glycerine-based moisturizers are typically the most-recommended natural moisturizing agent. Glycerine is a type of sugar alcohol.

5. Chamomile

The soothing properties of chamomile are widely used to treat skin conditions, and many over-the-counter (OTC) anti-itch creams and lotions contain extracts of the plant.

In a 2016 study, 30 people with lichen planus who applied chamomile gel to affected areas of skin experienced a reduction in itching, burning, and pain.

The gel had a 2 percent concentration of chamomile, and they had applied 0.5 milliliters (ml) of the gel three times a day for 4 weeks before reporting results.

It is important to remember that some people are allergic to chamomile, especially those allergic to:

  • daisies
  • ragweed
  • chrysanthemums
  • marigolds

Anyone in doubt should talk to a doctor before trying a product that contains chamomile extract.

6. Peppermint

essential oils such as peppermint are good for sore throat
Studies suggest that peppermint oil applied to the skin can decrease itchiness.

Peppermint contains high doses of menthol. Most research shows that menthol can reduce itching when consumed in a diluted mixture or applied directly to the skin in topical products.

There is no one set way to use peppermint to reduce PUPPP symptoms.

In a 2012 study, however, 47 pregnant women with moderate to severe itchy skin who took a preparation of peppermint oil twice daily experienced a decrease in itchiness without side effects.

The preparation was in 60 ml doses and comprised peppermint oil with a 0.5 percent concentration in a base of sesame oil.

Menthol is also a mild analgesic, which means that it can numb the skin. Many itch and pain-relieving ointments and creams contain menthol to numb the skin and prevent itching.

7. Clove oil

Cloves contain high doses of antioxidants and antimicrobials, particularly the phenol eugenol. These compounds may help soothe some inflammatory or damage-based skin conditions.

There is no single best way to use cloves for itchy skin.

In a 2017 study, 25 people who applied petroleum jelly, then clove oil to areas of itchy skin daily for 2 weeks experienced reduced symptoms, compared to a similar group, who only applied petroleum jelly.


Risk factors and prevention

The underlying cause of PUPPP remains unclear, so it can be difficult to identify risk factors.

Many women who develop PUPPP share some characteristics, most importantly being pregnant for the first time.

Most women who experience PUPPP during their first pregnancy do not develop it again, and if they do, it tends to be much milder.

Other possible risk factors for PUPPP include:

  • excessive, rapid weight gain
  • carrying twins or more than one baby
  • being white
  • carrying a male fetus


Diagnosis

Doctor discussing with a pregnant lady
If a doctor suspects other causes, they may order additional tests.

The only way to diagnose PUPPP is by ruling out the other potential causes.

The following factors can help to distinguish the rash from similar skin issues:

  • PUPPP does not usually cause blisters.
  • PUPPP does not usually affect the face, palms, or soles.
  • PUPPP almost never impacts the belly button itself, though it may surround it.
  • PUPPP usually goes away within 15 days of giving birth.

A doctor may also order tests to rule out other conditions. They may ask for a:

  • complete blood count test
  • liver function test
  • comprehensive metabolic panel
  • serum bile acid test, to rule out cholestasis of pregnancy
  • serum cortisol test
  • serum human choriogonadotropin test
  • indirect immunofluorescence test

A doctor may also take a small tissue sample of the rash for further examination.

This could involve a direct immunofluorescence test, which involves applying dyes to the tissue sample to check for antibodies that damage skin structures. Most women with PUPPP have negative results.


Takeaway

Doctors have yet to determine the cause of PUPPP, but several natural treatments can soothe and eliminate the rash.

If the rash is only present in a small area, topical corticosteroids can also help to reduce itching.

PUPPP is most common during a first pregnancy, and it usually disappears around 15 days after delivery.

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