How to Cope with PUPPPs (pregnancy update)

How to Cope with PUPPPs

With still a few more weeks to go in this pregnancy, I’m already measuring past 40 weeks, can hardly leave bed and am ready surender. And just when I thought this twin pregnancy couldn’t get any more difficult, I came down with a case of PUPPPs—pruritic urticarial papules and plaques of pregnancy.

In regular speak: a terrible, horrible rash that happens to pregnant women.

PUPPPs occurs towards the end of the third trimester, mostly to those carrying multiples and those carrying boys. Double whammy for me!

There’s no known cause for it, although theories abound that it has to do with hormones, or with the expansion of the belly (the rash tends to start on the belly in the form of innocuous stretch marks) or toxins in the liver. And the rash tends to spread to literally every part of the body.

The upside (if you can call it that) is that the rash poses no harm to me or the babies. The downside is that it’s one of the worst rashes around. As in, I look like I’ve been bitten by every mosquito on the planet, and each bite erupted in a red blistering welt. Not pretty, or comfortable, or exactly what you need during pregnancy.

Still, I’m taking my comfort measures, mostly with my arsenal of lotions and potions, oatmeal baths, cold showers, bars of soap, supplements, ice packs, even lemon water—these cures that others have sworn by and I’m hoping will perform a miracle on me.

Because here’s the thing: the only “cure” for PUPPPs is delivering the babies. And even then, there’s no guarantee that the rash will ease up; some have gone on for weeks or months with it, potentially because of the hormones that may still be lingering in the body, such as with breastfeeding.

If only delivery were but a few days or weeks away for me, I might be able to shrug this off as an unfortunate discomfort, but I have several more weeks to go, and I’m ready to tear my eyes out from the pain and itching. I’ve had rashes before, I’ve had pain before, and this is by far the worst one.

So instead of being productive on my blog, my home or anywhere else in my life, I’ve been holed up in my bed, being emo about all this. Today though, I’m trying a new attitude: I’ll take it a day at a time and ignore the itching. I’ll try not to get down when I see a previously smooth patch of skin now blotched with bumps. And I’ll watch a ton of comedies. Heck, I’ll even change from my pajamas.

Because I’ve got to live with this darn thing for a while, and while I’ll allow myself my daily cry, I’ll do my best to take it day by day, even hour by hour.

And hopefully I’ll be able to be productive again and use my blog and other aspects of my life to distract me from this madness. At least keep my hands on the keyboard and away from the itching.

Have you had PUPPPs or other uncomfortable complications during your pregnancy? How did you cope?


Nina is a working mom to three boys—a five-year-old and toddler twins. She blogs about parenting at Sleeping Should Be Easy, where she writes everything she's learning about being mom and all its joys and challenges. She also covers topics like how kids learn and play, family life, being a working mom and life with twins. Download her free ebook, "Time Management Strategies for the Overwhelmed Mom" for more tips.


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  1. says

    Oh, no! I had it too, but I got it after I had my baby girl! After trying different lotions and soaps, I went to a specialist and was prescribed a cream from the pharmacy and it worked like magic. The rash went away within a week. It was the most frustrating thing I’ve ever experienced, I was already completely exhausted from childbirth and this was an extra nuisance to disrupt any chance of rest I got. I hope it goes away for you soon! Hang in there!
    Queenie recently posted..The importance of time managementMy Profile

    • says

      Queenie, I’ve heard that it can come post-partum too. Sorry that you had to go through it! Now that I think about it, I may even have had it with my first pregnancy post-partum because I had a terrible itch that I attributed to hives and stress. And that was the pits, because just when life is so difficult with a newborn (or pregnancy) we now have to deal with this terrible itch. Glad yours went away pretty quickly!
      Nina recently posted..PUPPPs: The most cruel trick on pregnant women (pregnancy update)My Profile

  2. Karen says

    I am so sorry, Nina! That was one I had never heard of, but it sounds horrible. Taking it just one day (or hour) at a time sounds like a good approach. For a comedy I’d recommend Waking Ned Devine. It’s maybe 15 or so years old so perhaps you’ve already seen it. It is pretty good as a “feel good” film though.

    Today Eli said he wanted me to go to the doctor. I asked why think he just likes running around the lobby there or because we sometimes see a garbage truck there. He looked at me incredulously and said in a very patient voice “because to take the baby out!” he’s sick of waiting for his sister to get here. (Or he’s sick of having me in bed all the time…or both.)

    • says

      Haha Karen, I bet Eli is eager to meet his baby sister already. Nine months is a long time to wait, and especially towards the end when we’re pretty much useless sloths lying down on the couch. That’s one of the worst aspects of this pregnancy and PUPPPs is that I can’t be there for my three year old as much as I would want to. Even being able to sit down next to him as he writes and colors, or taking him out for a walk. I’m sure kids sense that something is up and just want it to change already.
      Nina recently posted..PUPPPs: The most cruel trick on pregnant women (pregnancy update)My Profile

  3. Kerry says

    Hang in there girl! I got eczema break out on my hands after my second (a boy) – right after he was born. Very strange. Aveeno baby lotion (with the oatmeal) was the only thing that saved me.
    But, dear friend, I know that is NOTHING compared with what you’re experiencing. I will say a prayer for you every time I think of your misery with the rash. Hopefully yours will go away quickly when babies are out!! You’re strong – and when you don’t feel strong we’ll listen to you vent whenever and encourage you some more. Friends don’t let other friends vent alone!!!
    Kerry recently suggestions?My Profile

    • Kerry says

      Also, I was just chatting with my hubby about this and, while we are no experts, beans are sooooo beneficial with eliminating the extras in your body AND especially liver issues. Eating black beans (my fave, and best for you) everyday has helped so many issues for me. Check out Karen Hurd’s website sometime. She is a nutrition lady, but her story is amazing. Her site is her name with (dot)com after it. Look under the beans category, too. Docs won’t tend to advise a nutritional route to go with issues like your rash, normally. But it def couldn’t hurt anything. It’s the frequency that you eat the beans, not mass quantity. So we were thinking maybe try a half cup five-six times a day for a week and see if you notice a difference. Can’t hurt.

      Just a thought! And it’s a low cost option to try!!

    • says

      MaryAnne, I also had some weird rash/hives post pregnancy with my first pregnancy, and it actually might have been PUPPPs. I dread the evenings when I know I’ll be scratching subconsciously, knowing I should stop but too lazy to do anything else about it lol. Today for some reason felt better as far as not scratching while I was awake, so hopefully all these things I’m doing is helping.
      Nina recently posted..PUPPPs: The most cruel trick on pregnant women (pregnancy update)My Profile

  4. says

    Oh my lovely Nina,
    that sounds awful, you poor love!!
    What the hell kind of cruel joke is that???
    Doctor Holsby prescribes a big tub of ice cream with those comedies. You must keep up your strength, after all.
    I hope time flies, and your gorgeous twinnies are in your arms in the blink of an eye and all this is forgotten.
    Love and light xxx

  5. says

    Oh Nina, sending you a gigantic hug. Like carrying twins isn’t tough enough, you poor thing. A good friend of mine had PUPPPS at the end of her (singleton) pregnancy and I saw how awful it was for her. Hope you find some relief (or distraction) soon.

    And totally agree with the prescription of ice-cream.
    x Laura
    Laura @ The Monster & Me recently posted..Stills: A weekly collectionMy Profile

    • says

      Thanks Laura! I just came back from the doctor and dermatologist who say my case is severe! She prescribed stronger creams to help with comfort measures while I wait out this pregnancy. It’s pretty difficult emotionally too, as I feel like a hyena with all my spots, and only getting an hour of sleep a night doesn’t do too well with how I function during the day. Hopefully the new meds will help me somewhat!
      Nina recently posted..10 children’s books about a new babyMy Profile

  6. says

    Oh Nina, I’m so sorry! I had PUPPPs too at around 36 weeks and was prescribed creams but it still was uncomfortable. I remember the sleepless nights trying to ignore the strong urge to scratch. I had to wear really soft cotton t-shirts by the end as I felt everything else was causing more friction and itchiness.
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  7. Hana says

    Hi Nina,
    I know this post is over a year old! But I had to share my experience with you. I was actually looking for ways to sleep train my twin boys, which led me to this site. And then I saw this post, and I had to read.
    I ended up with PUPPPS as well, and it was the worst thing that I have ever had to endure, EVER! Like you, i tried everything, absolutely anything i could find. I was up all night googling any remedy anyone could ever suggest. And the weird thing was, I was most itchy on my hands and feet, which weren’t usually supposed to be affected by PUPPPS. I ended up having PUPPPS and cholestasis of pregnancy, which unfortunately does pose a risk to the babies, so I had to be induced at 37 weeks. Thats why my hands and feet were so unbearably itchy. Anyway, I had my boys 9 months ago, and I just wanted to share some remedies i found helpful for anyone who comes across this.
    -Pine tar soap..i found this dried out particular spots, especially my belly. I took cold showers and baths about 3 to 4 times a day and lathered that stuff up like nobody’s business! I found a difference in a day or so.
    -COLD SHOWERS…they provided the most relief..but didn’t last very long. But when itching is consuming your mind, any amount of relief helps, even if its temporary.
    -submerging my hands and feet in ice cold water. I’d sit for hours and do this, a bowl for my feet, one for my hands.
    -olive oil/coconut oil. I found i could get a 2 hour stretch of sleep after taking a shower and slathering olive oil all over the place, and sleeping with as little clothes as possible with a fan blowing on
    -this is going to be the oddest one…i came across a suggestion to try extremely hot water. I thought it was nuts seeing as how warm water irritated the rash more…but again, desperate times call for desperate measures. I gave it a try, and it. felt. heavenly. It felt like I was scratching the heck out of the rash, i couldn’t believe it. mind you, it had to be extremely hot water, and it would stop the itching for about 6 hours. I discovered this during my last 4 days or so, and i did it! I know, its insane, but it really did help. I read that it releases the histamines and it takes time for them to return, thus driving the itchiness away. im not telling you all to scald yourselves, but it worked for me!!!!
    -finally, don’t scratch. I know, its the hardest thing in life to do. But just dont, or else you blister like crazy.

    I’m prepared for round 2, seeing as how my ob warned me at my 6 week check up that it tends to resurface in following pregnancies. :( it’s awful…i also would take liver cleansing capsules next time around…i’ve read that helps!! Mine magically cleared after delivery..thank god!!
    Anyways,hope all is well with your boys!

    • says

      Wow Hana, we had nearly the same experience… PUPPPs *and* cholestasis of pregnancy… *and* twins! It’s good to know we’re not alone :)

      I agree—all those remedies helped. They bought at least an hour or two of relief at a time. I remember buying that soap and lathering like crazy. I also did oatmeal baths and cold showers, and yes waking up in the middle of the night to plunk my hands and feet in ice cold water. The only thing I didn’t try was extremely hot water, but yes I can imagine it’d feel so good too! I totally took the capsules too. I was taking so many pills after a while!

      However I did scratch haha. Sometimes my hands found a life of their own and scratched even if I didn’t want to. It probably made me swell up and contributed to even more itching.

      It’s kind of nuts thinking back on it now. I do think that the cholestasis does come back. I swore I had the same symptoms just last week: I had rashes on the soles of my feet and palms of my hands right after I had the stomach flu. I did get my liver tested and it came back normal, but who’s to say… I got it tested when I was already feeling better so who knows! Maybe there are unknown triggers we don’t know about yet.

      What makes these complications and even the remedies so miserable is how short-term they are. I mean, yeah the creams help a bit and so does the ice but it still made me so miserable knowing there was no permanent relief—the itch would resurface in a few hours.

      I’m so much better now. Even the mysterious resurfacing of cholestasis (if you want to call it that—I’m still not sure what’s causing it) is nothing compared to being in the thick of it.

      So glad you wrote in, Hana. We’re not alone, and hopefully anyone else reading our comments won’t feel the same either. And know that it’ll get better.

      Anyway, so glad that ours cleared up right away! Doesn’t it feel so good to know that’s all behind us now? 😉

      Now, good luck with sleep training! Let me know how it goes.