Pruritic urticarial papules and plaques of pregnancy. That’s what PUPPP stands for. PUPPP a skin condition that only occurs during pregnancy, almost exclusively on a first pregnancy, and usually when that first pregnancy is a boy. In short, it’s a rash that develops on the belly and spreads to the legs, chest, and arms from there. It’s not just any rash, by the way. Apparently it’s the most ridiculously itchy rash that anyone has ever experienced, it’s extremely annoying, highly uncomfortable, and lasts until just after giving birth. There is no known cause or treatment for PUPPP. Other than driving women stark raving-mad, it’s completely harmless to the woman and the baby. Of course harmless is relative statement, as some women actually are driven to asking to induce at week 37 just to get the suffering over with.

PUPPP affects roughly 1 in 150 pregnancies and usually starts somewhere around week 37, meaning the misery is usually short-lived. My lovely wife, being the self described over achiever, started showing symptoms right around the middle of week 19. It started out as something like a heat rash on the upper part of her belly. After a couple of days the heat rash turned into dark red splotches with raised bumps, and the itching began. A phone call to the doctor’s earned an ominous “oh dear” reaction from the nurse. The subsequent visit with her doctor’s Certified Nurse Midwife went just as well. She took about .3 seconds to look at The Pregnant One’s belly and immediately took a step back while inhaling through her teeth making that “yikes” sound. Yep. It’s PUPPP’s. And a really early case of it too. But, you know, it does go away after pregnancy. 22 weeks from now.

Here’s where we take a little sidetrack. Before we went in for her appointment, I had spent the prior couple of days doing a ton of online research into PUPPP, as I was pretty certain that’s what she had. My search led me to this excellent resource which sent me off in a million different directions. Two things I found pop up everywhere where dandelion root extract (a liver detoxifier, as most skin rashes are actually liver related) and Ranier Soap Works PUPPP Relief Soap and Cream. Acupuncture has also mentioned as a possible aid in treating PUPPP.

As it turned out, the nurse also being a midwife worked for us. While she was not familiar with the use of dandelion root during pregnancy, she uses herbs in her other practice and didn’t freak out on us when we asked about it. Instead she pointed us in the direction of an acupuncturist and herbalist that specializes in women’s reproductive health. If he says that we’re cool, then she’s fine with it (unofficially, of course). After a phone conversation with the herbalist, we’re given the green light on dandelion root and give it a shot.

Now here’s the thing… at this point we’re kind of throwing the whole kitchen sink at the thing. We’re using the soap, a soothing cream that makes the bathroom smell like Doublemint Gum, and the dandelion root (organic, even) extract pills, so it’s hard to really narrow down what is or isn’t working. The only clue we have is this: in places where I’d read about the dandelion root extract it says you won’t notice any affect until about the 5th day of taking it. Low and behold, on the 5th day she wakes up and the rash is fading. By about the 10th day the place where it started has returned to almost normal, the places it had spread to are fading, the signs of spreading have stopped in their tracks, and the itching is gone. The stuff freaking works!!

We just had our 20 week appointment with her doctor and both quietly decided we would just keep this to ourselves. It works, it’s safe, and frankly that’s all that matters.

p.s. A special bit of husband/fatherly angst to the ultrasound tech who went into the “oh, your baby is still breech and you know that’s an automatic c-section if he doesn’t turn” routine yesterday. Here’s a concept: We’re only at 20 weeks. You’re not a doctor or a nurse. You’re an ultrasound tech. The nurse told us not to worry about it as we’re pretty early along, and yet, you just had to throw that little nugget of information in there to add to the normal everyday worries that come along with being pregnant. How about you just take your pictures and STFU. Thanks.

So this is what the books mean by going into “protective husband mode”.

edit (4/29/08): This post has received a fair amount of traffic (primarily from Google searches), so I thought I’d update for anyone that’s at all curious. We are at 29 weeks now and everything is going swimmingly as far as the PUPPP is concerned. The Pregnant One actually stopped taking the dandelion root extract about 3 weeks ago as the PUPPP rash has entirely vanished. Really. Much to the wonder of a medical practitioner. She still uses the Ranier Soapworks PUPPP soap on occasion, just to make sure and because it smells nice and leaves her skin soft (albeit a bit dry). So, in our instance the dandelion root really seemed to be just what was needed. I hope this helps anyone that is reading this looking for treatment ideas.

Post Script: While I haven’t updated this blog in some time, I am receiving a lot of traffic, and quite a few comments on this post in particular. Most of the comments are questions about the dosage. This is where I have to be frank and honest… I’m not a doctor, herbalist, mid-wife, or any other sort of certified expert in that field. The fact is, I don’t feel comfortable sharing that information, because I don’t want that responsibility. I’m sorry for those that may not think that’s right, but the information is out there. My advice? Find an herbalist or midwife that can answer those questions for you. Don’t just take the word of some dude on the internet. I was lucky enough to find one for my wife that specialized in women’s reproductive issues and was kind enough as to take a little time on the phone and offer some free information. Call around and see what you find.

Best of luck.

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