PUPPS

[hamilali]

Sorry, I've only been a lurker up until now, but the itching is urgent.  I am 32 weeks along with identical twin boys.

Was anyone diagnosed with PUPPS, and did you find anything natural to control the itching?  I don't want to resort to a steriod cream or allergy medication but I'm not even sleeping it itches so bad!

I thought about taking a baking soda bath, and then wondered how I would ever submerge my big belly in our little tub! lol

[kjoy2]

Many think PUPPS is related to liver toxicity.  If your diet isn't already cleaned up, do it now.  I ate very well during pregnancy but got PUPPS twice - once around 34 weeks and then again around 40.5 weeks.  It is awful!!!  

-Eliminate all sugar. 

-In hindsight, I wonder if I actually was eating too much protein for my body (too much protein can be toxic).  I know they say protein, protein, protein for a twin pregnancy, and I was aiming for 125 grams a day, for reference.

- Try to keep your skin moisturized will veg oils

- Take liver cleansing herbs in capsule or tincture and tea form - dandelion, nettles, and milk thistle - very important!!! 

- This soap helped: http://rainiersoapworks.com/cart/category/9/puppp-relief (cream wasn't available when I was pregnant)

I hope it clears up for you soon.  It was the most uncomfortable I'd ever been in my life, and the lack of sleep was horrible!

[Sfcmama]

Mama to a singleton but had bad pupps at the end. Didn't have time (or energy) to find the cause but witch hazel was the only thing that really worked to relieve itching. I also used cold wet washcloth to reduce swelling (but avoided anything colder to decrease chances of my somersaulter from turning back to breech!). Mine was gone within a week or so of delivering. Hth!

[~Adorkable~]

i thought it was Obstetric Cholestasis that was about liver toxicity, that is another itch altogether and is usally treated very differerntly. im i wrong? casue im struggling with a itch starting up on me as well and doing a lot of reading.

[hergrace]

Originally Posted by ~Adorkable~ 

i thought it was Obstetric Cholestasis that was about liver toxicity, that is another itch altogether and is usally treated very differerntly. im i wrong? casue im struggling with a itch starting up on me as well and doing a lot of reading.

Yes. They are very different and it is important to know which one you are dealing with. Cholestasis is treated with medication and is a serious risk to the babies. PUPPS is hugely irritating to mom but not a risk to the babies. 

[hamilali]

Thanks for all the great suggestions.  In reading, it does seem like PUPPS is something different than liver toxicity, but there's nothing wrong wtih cleaning up my diet as best as I can anyway :)

I have also heard dandelion menioned in other threads I've looked up about PUPPS.

Adorkable, I hope you can keep your up and coming rash at bay.  I wish I would have started working on it before it spread as much as it has!  Good luck!

[~Adorkable~]

yeah mine has no visible rash , witch is actually what makes me a bit worried, cause it seems so strange. got tested today for Cholestasis, but test takes nearly a week to come back. i think i may test out a night of benadyl mostly as a way to diagnose, if it helps a lot i have heard it is probably is not Cholestasis, since that frustratingly does not respond to antihistamines. 

time will tell, good luck with yours

[lesliesara63]

I had suspected cholestasis with dd2 in 2007. It was horrible and there was no treatment offered. My blood tests didn't confirm cholestasis - I wonder if they did the wrong test. It is indescribable though and nothing helped. I took benadryl because it knocked me out for a few hours, but it didn't take the itch away. The only thing that helped a little was ice packs on the worse spots. With this pregnancy I started itching literally two days after the iui. Not the same intensity, but still pretty bad. The last week has been better though. I've been going for acupuncture so maybe thats helping. I would definitely see your MW or OB though.

[suddenlyamama]

Hey Mama,

So sorry you are dealing with the nasty Pupps. Seriously it was horrible for me. 

So, Grandpas Pine Tar Soap did wonders. So did taking a piping hot shower and then sud'sing up, then rinsing with cool water.

Swear, I did this at least 6 times a day, but it gave me relief so I didn't care. Also, went to the dermatologist and got some intense cortizone cream. This worked too and allowed me to sleep.

Good luck, hope it clears soon.

[~Adorkable~]

Well I just DX'd with cholestasis based on a very high liver test, the confirmation bile test will take a few more days to come back. Now I sit here and crazy enough wish I had a huge visible rash and it was only me and not my babies that were at risk.

Hope you find relief Hamilali, you might make sure no matter how you choose the treat it, to get some clear tests and make sure your addressing the right thing

[hamilali]

Thanks everybody.  I have scheduled an appointment with my doctor tomorrow (don't we see them enough already?).  I need to find out exactly what is causing the itch!  I'm not sleeping again tonight :(

[Ellie'sMom]

I had PUPPP with my twin pregnancy 5 yrs. ago. I am going to paste a response I wrote to another thread about this, just a few weeks before I delivered. I overcame PUPPP. I am a nurse practitioner, and generally a pretty skeptical healthcare consumer, but I was miserable and willing to try ANYTHING. (I sound like an infomercial! )

 

This is what worked for me!

PUPPP is the worst!!!! I am 38.5 weeks pg with twins and started having symptoms at about 35 weeks. This is more than just an itchy belly. It starts with the stretch marks on your belly and then spreads almost everywhere. Not only is it the kind of itching that make you feel like you are losing your mind, but it is an ugly rash. I had little blisters and hives on my arms, legs, tops of feet and hands, hips, butt...it sucked! Over the counter steroid cream was useless, and Benadryl helped me sleep a bit, but did nothing for the rash. Oatmeal baths were useless. I have, however, been completely cured. This may not work for everyone, but it did for me!

1. On the advice of my midwife I took Dandelion Root extract tincture. This seems to have variable results, but my midwife put me on a huge loading dose and I think this made a difference. I took a half a dropperful every hour for the first day, four times a day on the second day and went to twice a day by the third day. She said I would see results within 48 hours and sure enough, I started to get some relief right at 48 hours and within 5 days I was totally better. 

2. She also recommended I take Milk Thistle and Choline. I am blanking on the doses she recommended, but I took less...I am wary of taking anything in pg, esp. starting a bunch of new stuff at once. I ended up taking 350 mg of the Choline and 300 mg of the Milk Thistle twice a day. All these herbals are liver tonics. 

3. On the advice of another MDC mom (Thanks Shannon0218!!) I had dh paint my body in a water and cornstarch paste with just a few drops of tea tree oil. I left it on for 30 minutes. I think this really paved the way for the rash to start drying out. 

I don't know what, if any of these measures worked. I have read in at least one place that the first week is the worst and that the symptoms can resolve on their own, but most of what I have read indicates that delivery is the only real cure. I feel soo lucky to not have PUPPP anymore. It was like torture. People are induced early because of PUPPP or put on high doses of systemic steroids. 

For symptom relief I also found that ice packs were really helpful. I would put them in the worst spots instead of scratching. 

This is a really helpful website as well:Naomi's PUPPP page 

Best of luck and please feel free to PM me if you have other questions. This is all very fresh in my memory!!

Hope this helps!!!!

[Ellie'sMom]

And, I want to agree with others that it is important to differentiate this from cholestasis. I did have blood work done. The way I describe the onset of PUPPP above (starting on the abdomen, especially in the stretch marks) is really characteristic of PUPPP, but not cholestasis, fwiw. Cholestasis can be widespread, but is associated with itchy palms of hands and soles of feet. 

[~Adorkable~]

just a bit of info on how each person  and case can be different, my cholestasis started 2 weeks ago as a very mild intermittent itch on my very upper chest collar bone area and then slowly spread down the front and back of my torso from there, i can itch anywhere on my body now, but my upper torso has always take the brunt of it, including my neck and upper back. it only sometimes get to my palms or bottom of feet for me and is certainly not worse there.

of course one big thing that helped me want to look farther than pupps is that i have NO RASH and that is a big difference. i do however have what looks like little marks, but since i have been tracking these things i know they are from me scratching rather than the cause. this was an important thing for me to know.

strangely since cholestasis is a liver thing first and foremost, I'm on the same Milk Thistle and Dandelion Root as well.

[hergrace]

I also had atypical pattern of itching with my cholestasis, it was my lower legs that itched.  The doctor was pretty confident it wasn't cholestasis - until the test results came back. Thank goodness she ran the tests, "to rule it out".

Adorkable:  My cholestasis was managed very effectively with medication, and the itching passed quickly once I started the meds. The OB did move my date of delivery up a week after the diagnosis, but it ended up being a non-issue as there were other reasons I needed a c-section even earlier (a completely unrelated complication).  Good luck.

Hamilali:  I hope you find some relief soon.

[hamilali]

There is so many great contributors here!  Thanks so much!  It's all been about said, as a side note, my doctor also recommended Sarna lotion, which seem to soothe the itch, much like the ice packs already mentioned might.

[WaltFive]

I have PUPPS, currently 32 wks with b/g twins, and I have been using vanilla essence that I just rub right out of the bottle onto the rash.  It gives relief.  I have also received 2 corticosteroid injections for the twins' lung maturity last week, and this has taken the rash away completely, however it's acting up again now a week after.  Also try Aloe Vera, however I have found the vanilla to be better. 

[Llyra]

I had cholestasis, from about 31 weeks, with my twins. The itch was incredible. At one point, on a Sunday afternoon, I was on the phone with my OB in all seriousness threatening suicide.

My best coping strategies (other than the prescribed medication) turned out to be:
1. a natural-bristle hairbrush, to scratch with-- it's less damaging to the skin than fingernails
2. Sarna lotion
3. immersion in cold water-- I spent half my life in the bathtub
4. Ice packs
5. a really strong antihistamine/sedative--- it doesn't help the itch, but it knocks you out enough that you can sleep through the itch (I was prescribed Vistaril).

Good luck. The good news is that cholestasis is almost always completely cured by delivery. So that just a few hours after birth, I was no longer itching.

The real kicker for me was that four days before delivery, I got hit with PUPPPS too. The rash and everything, and it lasted until two weeks postpartum. So I got it coming AND going. Isn't multiple pregnancy a joy?

For the public good: it is important to distinguish between the two conditions that both cause itching, because cholestasis left untreated and unmonitored carries a greatly elevated chance of late-term fetal death. If you're pregnant, and itching, PLEASE do your research.

[LittleOsMom]

Ugh, I'm sorry. 

Here's what worked for me:

http://seekingsibling.wordpress.com/2010/11/17/puppps-pustulent-unslightly-putrid-pimples-of-pregnancy-suck/

Unfortunately, probably due to my oversensitive skin not being able to deal with some of the soaps and stuff, oral steroids were the only thing that worked for me.  I barely took Tylenol the whole PG, but it was steroids or jump off a roof by the end there. 

Since then I've heard great things about Dandelion Root Extract.  Cleared it up completely for a friend of mine.