PUPPS Pregnancy Rash - Help!!!
July 5, 2013 11:15 AM   Subscribe

On Monday I was diagnosed with PUPPS, a horrible pregnancy rash that is supposed to last for the remainder of my pregnancy. I was given a prescription for Prednisone because it's so severe (pretty much everywhere from my neck down). I've almost finished my dose, but I'm still covered in hives and absolutely miserable. Everything I'm reading about this online is freaking me out. I have a follow up appointment next week, but I could really use your help.

I'm 33 weeks pregnant. I'm not eligble for FMLA at my job and only have 6 weeks off for disability. If I stay home it will drastically cut into my time with the baby.

Honestly, this feels like torture. I can't sleep, am embarrassed to go anywhere, and can't imagine seven more weeks of this hell. Anything touching the rash irritates it, so I spent most of this week working from home lying naked on my bed in a benedryl daze. I absolutely have to be back at work next week, so somehow I need to dress professionally and make it through the entire day on Monday.

Here's what I've tried so far:

Benedryl - knocks me out so I can't scratch. Not very good for getting work done.
Aveno Lotion - nothing
Oatmeal Baths - makes me even itchier
Cold Showers/Ice Packs - Feels great, but clearly not an all-day solution
Gold Bond Lotion & Aloe with Lidocaine- Works for 20 minutes or so.
Cortisone cream & Calamine Lotion - burns

I've read online about pine tar soap, and went to every health store in town, but couldn't find it. I've ordered it online with rush delivery, but it won't be here until tomorrow. Apparently it only works if you take 4 showers a day, so that should be interesting.

The pregnancy forums that discuss this are full of stories of early and induced labor, itching that lasts months beyond the pregnancy, and recommendations to take dandelion root extract (which my OB will not allow me to take). Plus, they make me feel horrible for taking oral steriods.

Any advice/suggestions or words of encouragement would be greatly appreciated. Have you had this or something similar? Did anything work for you? How were you able to function like a normal adult while dealing with this?
posted by galvanized unicorn to Health & Fitness (26 answers total) 1 user marked this as a favorite
I developed PUPPS in my last pregnancy. It is believed to be caused my an overtaxed liver.
I remember filling a spray bottle with witch hazel and keeping it in the fridge to mist myself with for temporary relief.
If you make an herbal infusion (basically a strong tea that you let steep for hours instead of minutes) out of nettle, dandelion roots and leaves (both of which support the liver) and drink 1-3 cups a day, the rash should improve considerably.

My rash disappeared completely within 2 weeks using these herbs.

Omega-3 rich oils (taken internally as a supplement) are supposed to help too.

Why will your ob not let you take dandelion? My midwife actually recommended it. In fact, most pregnancy teas and herbal blends contain dandelion.
posted by tenaciousmoon at 11:55 AM on July 5, 2013 [1 favorite]

First, do not feel horrible for taking the prednisone, I took it through all of my past pregnancy and it's fine. I took it for thyroid antibodies and it's not an uncommon prescription. I'm actually curious about what happens when your prescription runs out, as you are NOT supposed to go off prednisone cold turkey. Talk to your doctor about that if it has not already been mentioned.

For the itch, have you been to a dermatologist? Maybe your own obgyn has a doctor they can recommend to help you out. At 33 weeks, the remaining time of your pregnancy can feel like an eternity, so do consider getting a second opinion from someone who actually sees more rashes than just those caused by pregnancy.
posted by CrazyLemonade at 11:57 AM on July 5, 2013

Oh and it's very simple but worth a try: chamomile tea is a good natural (and doctor approved) way to calm inflamation and itchyness. You can dab it on yourself with cotton, or spray it on, and it couldn't hurt to drink a cup of it once in a while.
posted by CrazyLemonade at 12:04 PM on July 5, 2013

My guess is that the OP was prescribed a "burst" course of steroids, which is a pre-determined tapering schedule of prednisone (e.g. "Take 40 mg on Day 1, 30 mg on Day 2, 20 mg on Day 3, 10 mg on Day 4, now you're done.") OP, would love to hear the details of your prednisone use if I'm off the mark. Honestly, my best guess is that you weren't given a high enough dose for long enough. I'll be the first to rail against steroids (I'm 26 and have bone loss in my spine from longterm prednisone use) but the state you're describing is unacceptable.

Get on the phone to your doctor, or your doctor's on-call service if they're on vacation, and demand something be done about this. Just because something isn't going to kill you and you can "tough it out" doesn't mean you have to or even that you should.
posted by telegraph at 12:08 PM on July 5, 2013

Find out if you can use Dermaplast. It's an aerosol anesthetic (lidocaine, probably) they gave me for my ladybits after I had my daughter. Might provide temporary relief? I'm so sorry.
posted by chesty_a_arthur at 12:11 PM on July 5, 2013

try benadryl gel. it was one of the few things that took the edge off when i had hives for 2 years. it wasn't PUPPS, it was an autoimmune thing, but at the point i was and at you're at full body hives are full body hives.

i know the misery you're in and you have my absolute sympathy.

some general tips:
  • take cool showers instead of hot showers.
  • see if your doc feels that a second generation antihistamine would be safe during your pregnancy (i don't know the rules on all that, but 2nd gen aren't generally sleep-inducing). for me 3 antihistamines plus prednisone plus time finally got that shit under control, so maybe an antihistamine that you tolerate better will help. and none of that otc shit either, get a script.
  • instead of itching, which can break the skin and lead to other issues, when you just can't bear it, tap/slap the itchy area. just as satisfying!
  • try to stay out of heat/humidity. for me at least it made me even more prickly.
      good luck!

posted by misanthropicsarah at 12:33 PM on July 5, 2013 [1 favorite]

I had PUPPPs with my 1st pregnancy. I know the hell that you are in right now. I know how frustrating it is that NO ONE (except the OB of course) you talk to has ever even heard of this. I was the only case my OB had seen in 10 years. I know how it feels to get no sleep because of the unrelenting itch. I know how crazy it is making you feel. I am so sorry you are going through this. It is just awful. My OB gave me nothing, not even prednisone. He recommended cold showers and benedryl. He finally induced labor with me at 39 weeks because I was in his office literally crying "You have to do something. I can not take this anymore." His answer was that the only thing to stop it was to have the baby.

Pine tar soap gave me great relief - sadly only about 30 mins of relief.
Sarna lotion - same relief
Hydrocortisone cream - the OB did not condone this - in desperation I used it anyway - it too gave a short period of relief
Loose clothes - hopefully your office will give you a pass on the dress code until this is over?

Mine was always much worse at night. After I gave birth the PUPPPs slowly dwindled away over a period of about 2 weeks. And then it was gone, I was so happy. I hate to tell you but 4 weeks later (when my daughter was 6 weeks old) it CAME BACK. This time I went straight to my dermatologist. I was breastfeeding so he would not give me any prescription medication. He gave me some in house anti-itch lotion that he mixed up himself. I don't even know what was in it but it helped somewhat. After about another 2 weeks it was gone again. This time for good. So, yeah, try a dermatologist now, he may have a secret potion. If I think of anything else I'll come back to post. I am 16 weeks preg with Baby #2 and terrified I will get it again - but not enough that I didn't want to have another one.
posted by ZabeLeeZoo at 12:35 PM on July 5, 2013

I'd check in with a dermatologist. I have not had PUPPS, but I did have a crazy allergic reaction to something a few years ago that a GP undertreated. I suffered for a few weeks taking subtherapeutic doses of prednisone and some other ineffective treatments until I saw a dermatologist who knew exactly what to do. There are other prescription antihistamines (besides benadryl) that may be more effective. I am so sorry that you are going through this.
posted by stowaway at 1:11 PM on July 5, 2013

One of my close friends had PUPPPs. Don't be embarrassed about being seen; people understand pregnancy is terrible and weird. My friend had a REALLY bad case, and after the first, "oh my gosh, are you okay?" we stopped noticing it because (like anything else) it faded into the background after a while.

You may need to push for a referral to another ob or to a specialist; there are options beyond benadryl but OBs don't see that many cases of PUPPPs and many are unaware of further options or (as OBs often are) are reluctant to prescribe beyond the most basic help.

My friend was given a night-time sleep aid so she could sleep through the itch. She also was sent to a dermatologist for a particular cream, though I don't know what it was specifically. Those two things made her able to get through the workday as a functional human, but yeah, mostly she was just kinda miserable until the baby arrived. (I tell you that not to be depressing but to let you know it's survivable.)
posted by Eyebrows McGee at 1:11 PM on July 5, 2013 [2 favorites]

I'm so sorry. I had PUPPPs with my pregnancy, and it was so horrific I begged to deliver (I was pregnant with three, and I had other issues that made it the right time to deliver, so out they came.) I was also around 33 weeks when I developed it. I was on hospital bedrest at the time, and I remember getting a tiny tube of steroid cream. A tiny tube meant to cover my huge belly AND arms AND legs? Ugh.

Delivery didn't even really help. It didn't go away for 6 weeks, when my MFM finally prescribed prednisone.

Anyway, not to make this a complete horror story for you...I was given benadryl to help with the itching and Ambien to help me sleep. Meh. Cold washcloths helped more than anything. I really hope you can find a solution to get you through the next 7 weeks.
posted by pyjammy at 1:17 PM on July 5, 2013 [1 favorite]

I had what I think was a mild case and was still miserable. My midwife did say that anecdotally cutting out wheat and sugar can sometimes help. Of course, this was right at the start of the Christmas/new years holidays. I did try to cut back and it did eventually go away, but I'm not convinced my dietary changes made any difference. Hang in there and I hope you can find some relief soon!
posted by snowymorninblues at 1:28 PM on July 5, 2013

For my allergic reactions, I was able to get off drugs like benadryl by taking adrenal and thyroid support. A former RN told me once that if your adrenals are stressed consistently/long term, it stresses your thyroid. I found it did help to take nutritional or herbal support for both. She also clued me that adrenal support might be an alternative to taking antihistamines and steroids, which did work for me.

Things I took for adrenals: licorice, sea salt, lysine, wild yam extract, bought and cooked whole yams (grilled or lightly fried with butter, cinnamon, and ...some other spice, I don't recall..plus a hint of brown sugar if necessary). I also sometimes ate sweet potatoes. I was told they don't help but I felt like they did help modestly, just not as much as actial yams.

For thyroid, I took coconut oil. There are other options but I never found it necessary to pursue other options. That worked for me. If that doesn't work for you, you can look for other options to suppport the thyroid.

I also began reacting allergically to eggs when my system was just on overload from too many chemicals and other stressors. Removing other chemical exposures and taking milk thistle for liver support helped clear up my temporary egg allergy. I have issues with sulfur, which runs in the family, so I have to limit eggs anyway but I no longer react allergically to them with itching and hives.
posted by Michele in California at 1:40 PM on July 5, 2013

Best answer: OMG, PUPPS is so awful... I had it post-pregnancy and it was torture. Eventually it went away... after weeks and weeks. UGH. NOTHING worked for me, including all sorts of steroids.

Aside from commiseration, all I have for you is a suggestion not to worry about dressing professionally. If your workplace is at all humane, explain to the people you work with that you have a severe skin condition related to pregnancy, and wear anything that makes you feel the least bit comfortable (something like a dress with very smooth material could be OK). I agree with the spray bottle suggestion. Just spray yourself down as often as you can, bring ice packs and switch them out in the office freezer, and do whatever you have to do to make yourself as comfortable as possible. Vicks balm and aloe burn gel are two other things you could try that I'm not sure have been mentioned already. Sending good wishes your way that this passes soon!

(And tangent: My kid has food allergies and eczema, and I wonder if anyone has studied whether these could be related.)
posted by chickenmagazine at 1:52 PM on July 5, 2013 [1 favorite]

I had it after birthing my boy, and while Benadryl did nothing for me, Clairitin worked like a charm. Check with your OB to see if you can try that instead.
posted by esmerelda_jenkins at 3:37 PM on July 5, 2013

I have no experience with PUPPS, which sounds totally horrifically not fun, and I am so sorry! You should be calling your OB back and asking for more to be done, because this sounds intolerable, and no-one should be in this much agony, third trimester is hard enough work as it is.

I do have horrible allergies and asthma, which got worse during my first pregnancy. Benadryl makes me incredibly sleepy too, see if you can try Claritin or Zyrtec instead. Both are available OTC and are non-drowsy, and I safely took Claritin through both pregnancies, so your OB should approve the change.

I did have to take prednisone during my first pregnancy, so please don't feel bad about taking it. Your OB wouldn't prescribe it lightly! The only downside for me with the prednisone was that I failed the Gestational Diabetes tests, because steroids make your blood sugar go crazy. If you are already past taking the GD test (I can't remember), then don't worry about it, you are scot free!

Finally, if your OB is unhelpful, consider calling around town to find one who has experience with PUPPS and is more sympathetic. There's no shame in switching OBs if you are finding this one to be unhelpful. Its during times like these that you find out if this doctor is a good match for your needs. You need to feel confident that your OB is looking out for you and the baby, and you feel confident going in to deliver that this person has your best interests in mind.
posted by Joh at 3:50 PM on July 5, 2013

Best answer: Some people find relief from itching by immersing in very hot water, which intensifies the itch, then cool water. Something about the hot water causing a release of histamine, which is then not available afterward, so the itching stops. I've tried this and it works for me. However, it may only be workable for a smaller skin area.

Here it is on the People's Pharmacy web site.
posted by amtho at 5:06 PM on July 5, 2013 [2 favorites]

Seconding the hot water then cold water shower or bath. It works for like 8 hours at a time for poison ivy & other dermatitis.
posted by toodleydoodley at 5:46 PM on July 5, 2013

For my allergic reactions, I was able to get off drugs like benadryl by taking adrenal and thyroid support.

PUPPS is not an allergic reaction, and I would strongly avoid doing anything that might upset your thyroid or adrenal systems while you are pregnant unless you first consult an endocrinologist who specializes in treating pregnant women.

Zyrtec was considered safe in pregnancy when I was taking it two years ago; ask about that. I used to get dermographia, and would take up to 2 zyrtec every morning AND a 180 mg Allegra every night. It was not fun, but it helped.
posted by KathrynT at 6:17 PM on July 5, 2013

This may seem like a weird suggestion, but for patients with itch I recommend a good long soak of at least 10 minutes in a bath with a capful of Selsun Blue in the water. The ingredients in this anti-dandruff shampoo can really calm the itch, and some patients report that it helps- a lot. The itch I recommending this for is a medication-caused itch, but it may be worth a try -- this remedy seems very benign and totally topical. I can't imagine your OB could object, but beware - it makes the tub very slippery, and you are pregnant and probably prone to lose your balance! Some patients tell me it provides several hours of sweet relief, but it doesn't help everyone. I hope it helps you! I also advise avoiding any moisturizer with perfume or alcohol, which can dry and irritate the skin. You're probably already doing that.

FWIW, using Selsun blue instead of soap in the shower doesn't seem to work as well. I think the prolonged contact a soaking provides is probably critical.
posted by citygirl at 6:35 PM on July 5, 2013

Best answer: To add to my comment above, I looked when I got home and the cream my dermatologist gave me during round 2 of my PUPPP was called "triamcinolone compound".

My method for getting to sleep at night was to take a Benadryl then get into a shallow bath of lukewarm water. Take Grandpa's Pine Tar soap and lather it up good on all affected areas. Leave it sitting there in a lather for a couple minutes. Rinse. Repeat. After getting out of the bath just dab dry with a towel (no rubbing). Massage in the Sarna lotion on all affected areas. By this time the Benadryl had me drowsy and the pine tar + Sarna gave enough relief that I could get to sleep. I'd still end up awake at 2, 3, or 4am itching to death but that was the best sleep I could get.

Sorry about recommending hydrocortisone earlier, I re-read your question and see that it caused your skin to burn. Everybody's different so you just have to keep trying different things to see what works for you. I've noticed that everyone above who is recommending that you change OBs or call yours and demand that they do something about it are all people who have never suffered from this. The reality is there's no cure. It's pretty rare so there is just not much information out there. I'm certainly not a Dr and maybe there is more your Dr could be doing. But while suffering from this I spent MANY hours reading many women's anecdotes about their own experiences and not once did I see any woman say that her OB was able to do something or give her something that made a remarkable difference.

I've been experiencing some pretty bad pregnancy nausea the past 10 weeks. I've been asking myself why WHY would mother nature cause an expectant mom to suffer so? Much like PUPPP there is no cure, just things you can do to make it more bearable while you trudge through it. I came across a phrase that in some weird way makes me feel a little better.

Things will get better. If they didn't the river would be full of mothers.

I tell myself this and it helps. One last thing. It was 4 years ago that I had PUPPP and about a year ago I was talking with an acquaintance who was telling me about her easy pregnancy. She asked me if I had any problems during my pregnancy. Oh no, I said, everything went fine. A little later I was thinking to myself, why in the world did I say that when in actuality I had that awful PUPPPs. Even though I will never forget how miserable it made me, it is not the first thing that comes to mind when I think of my pregnancy. It will go away, it will become a blip, I hope you can find enough relief to not go crazy! Please update here, if you can, to let us know how it plays out for you. Your words will help other women in the future who will be going through this same thing.
posted by ZabeLeeZoo at 7:08 PM on July 5, 2013 [2 favorites]

Neutrogena T-Gel and Denorex dandruff shampoos both contain pine tar, for what it's worth.
posted by jferg at 8:01 PM on July 5, 2013

Actually, the ingredient in T-Gel and Denorex is coal tar, not pine tar.

Please be very cautious about topical products containing topical anesthetics like lidocaine, tetracaine, or benzocaine. As these active ingredients absorb through your skin, if they are applied over a large area of your body, they can cause toxicity and even death. They are meant to be applied to a small area rather than used over the whole body. Check with your OB before using these.

If you are using topical steroids over a large area of your body (i.e. hydrocortisone or triamcinolone), it would seem to make more sense to take oral steroids like Prednisone that work systemically. Please do not feel bad about taking prednisone. There is nothing to feel bad about! People who try to make others feel bad about using "chemical" medications often have a very poor understanding about the fact that "natural" remedies also contain chemicals and are poorly regulated in comparison to actual prescription drugs, and that "natural" does not mean safe, many natural remedies can kill too - toxicity is about the dose you receive, not about how "natural" or "unnatural" the drug is.
posted by treehorn+bunny at 9:52 PM on July 5, 2013 [1 favorite]

This is a super nutbar suggestion, but when I developed PUPPPs, acupuncture cleared it up. I had tried 15 different lotions, baths, soaks, not bathing, not soaking, etc. Cortisone didn't work. Super-duper OB prescribed steroids didn't work. Went to an acupuncturist, she said something about liver and blood and heat and something something, stuck some needles in me. 2 sessions and I felt like a human being again.
posted by bluebelle at 7:40 AM on July 6, 2013

I would go to a dermatologist rather than having my OB manage this. Obviously coordinate, but the OB may be under treating you. FWIW I took prednisone when I was pregnant (prescribed by a crunchy midwife, no less) and baby was absolutely fine. I also had great success with a topical steroid when I had a drug reaction rash (tho not pregnant at the time). But you need the specialist to give you the low down.

As for work - you are going to be miserable at home or at work, so might as well work. Go to the office on Monday and let them see how horrible you look. They'll probably let you work from home!
posted by yarly at 6:21 PM on July 6, 2013

Response by poster: Thanks to everyone for the helpful advice! PUPPS is such a horribly frustrating thing, so I really appreciate all the ideas and commiseration. It finally seems to have subsided for me, but I was trying so many different things that I couldn't tell you what did it.

I went to a dermatologist. He prescribed me a topical steroid and it was a total bust. It made my skin burn and the rash worse within seconds. When I called to see if they could give me something different, he basically declined and told me to follow-up with my OB. I have super sensitive skin normally, so your results may vary.

My OB gave me a prescription antihistamine to help me sleep at night without scratching. It really knocked me out, but I'd wake up every day less red and itchy. I'd still get up a couple times in the night to go to the bathroom, but found myself way too exhausted to scratch.

I also used Grandpa's Pine Tar soap twice a day. Boy does that smell gross. I would shower with hot water, switch to cold, and then get out and cover myself with Gold Bond lotion and lay down on the bed under a fan. This was the best feeling in the world (like being in a giant icepack) and I would feel better for at least an hour afterwards.

My work was super understanding. I came in in not very appropriate clothes, spent a lot of time lotioning up and ice packing it, and left early if it got really bad. Once they saw how bad it was, no one gave me any grief.

Two days ago I woke up without any bumps. I'm still red everywhere, and occasionally itchy on my belly/thighs, but I feel like a whole different person. Now I'm just keeping my fingers crossed that there isn't a reoccurrence!
posted by galvanized unicorn at 8:48 AM on July 17, 2013

I'm glad you updated about the rash finally subsiding. The last weeks of pregnancy are hard enough as it is!
posted by CrazyLemonade at 4:35 PM on July 17, 2013

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