PEP or PUPP – could you have it in pregnancy?

What are the signs and symptoms and what causes this itchy rash?

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It may sound like a weird underground drug but in fact PEP (polymorphic eruption of pregnancy) or, as it’s also known, PUPPP (pruritic urticarial papules and plaques of pregnancy), is a very irritating pregnancy symptom. Luckily, it’s not usually harmful for you or your baby.

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PEP is an itchy, red, bumpy rash (think stinging nettles or sunburn) that starts in the stretch marks of your tummy, usually in the last three months of pregnancy. It makes your bump look a bit monstrous and can cause you to itchy like a cat with fleas! Enough to drive you crazy…

Itching is pretty common in pregnancy but PEP only causes irritation on your bump. If you’re tearing strips off your skin all over your body (and you haven’t got the unsightly rash) there’s a chance that it could be Obstetric Cholestasis (OC), in which case you need to see your G.P. 

What is PEP and why does it happened in pregnancy?

The PEP rash can cause small blisters to form on your skin. If you scratch and burst them straw-coloured fluid might leak out and cause crusts to form, just like in some forms of eczema.

The rash is thought to be an ‘allergy’ to the stretch marks and spreads quickly to other areas of the body such as your buttocks and thighs, and sometimes even your arms and legs. Yet another truly undignified pregnancy health complaint!

Mum of one, jennybean chatting on our forum suffered from PEP, “I was diagnosed with PEP and my rash started on my stretch marks and spread like wildfire to my arms, legs and buttocks. It was the most irritating itch I have ever experience, at night especially. I had to resign myself to staying up all night, so now I not only look like a zombie, but a lizard too!”

MFMer Moominmummy also suffered from PEP. “It started on my bump at the bottom, under my belly button, and slowly spread above my belly button. I even had a few bits on my arms and legs. It was really really itchy and if I scratched it, it blistered and was very sore”.

Will my baby get PEP?

Your itchy rash will not harm your unborn baby. “Polymorphic eruption in pregnancy occurs in the third trimester and doesn’t affect your unborn baby”, explains GP, Dr Kerensa Lightfoot. “It disappears within days or weeks after delivery and is treated in very much the same way as eczema”.

Winnie1981 suffered from severe PEP during the last few weeks of her pregnancy, but it cleared immediately after giving birth. “Two days after being referred to a dermatologist for some very strong steroids, my waters broke and my PEP cleared up pretty much while I was in labour.

“By the time Olivia was born, I had forgotten all about it! It took a few days to go completely, but it stopped itching which was a real relief”.

Why have I got PEP when other pregnant women I know haven’t?

PEP is relatively common, but you are most likely to get it during your first pregnancy because your skin is at its tightest. You will also be more prone to it if you’re pregnant with twins, or if you put on a lot of weight during pregnancy. But the good news is that it’s highly unlikely that you’ll get PEP during your next pregnancy if you had it first time around. 

Agh! How can I stop the itching?

The only actual cure for PEP is delivery, but the itching can be reduced and made more bearable. Dr Lightfoot recommends treating the itching with emollients (simple moisturisers) and topical steroids (these are applied once or twice a day), which she says are entirely safe. You may also be prescribed antihistames.

Cool baths, wet soaks and wearing cotton clothes can also help to reduce the itching and soreness.

jennybean found some alternative treatments that really helped. “I took cold showers and broke into my baby’s toiletries bag, using Johnson’s top to toe wash as it’s gentle to use. I also used Sudocrem which I found really soothing”.

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“When my skin was hot and itchy at night, I used cold packs or filled hot water bottles with ice cold water. That felt good!”

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