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New mother wonders, "What IS this hideous rash?"

By Kavita Varma-White

We all know about embarrassing pregnancy ailments. The gas attacks. Memory lapses. Hemorrhoids. Don't even get me started on the backaches. But have you heard about the horrific rashes?

Luckily, my first pregnancy was pretty perfect.  I didn't have any problems – no morning sickness or gestational diabetes or excessive weight gain – and I delivered a beautiful, healthy, 7-pound baby girl.

But all hell broke loose a  few days after I came home from the hospital and was settling into the normal-but-exhausting routine of breast-feeding and not sleeping. Hell arrived in the form of a nasty rash that relentlessly spread over most of my body.  A small lesion on my lower abdomen, right at the stretch marks, blew up into huge, puffy hives.  Within days  the rash reached to just below my breasts and all the way down to my feet. The small, swollen bumps were hideous and itched like crazy.

My obstetrician was fairly clueless, so I was referred to a dermatologist. It was then I learned I had a "textbook" case of a condition called PUPPP — Pruritic Urticarial Papules and Plaques of Pregnancy.

PUPPP usually occurs in women who are late in their third trimester, around 35 weeks. It's estimated to affect 1 out of 160 pregnancies, according to Paula Zook, dermatologist at The Polyclinic in Seattle, Wash.  The cause of PUPPP is unknown, but studies have made a correlation to women who have rapid weight gain at the end of pregnancy, and therefore are more likely to have stretch marks. Women who are carrying multiples are also susceptible, for the same reason.

Image: Body Odd

In 90 percent of cases, the eruption of PUPPP starts where stretch marks appear on the abdomen and spreads across the body, including arms, buttocks, stomach and legs. It doesn't spread to the face and it causes no harm to the baby.  It is normally treated with topical steroids, but sometimes oral antihistamines are helpful for the itch component, Zook says. In really severe situations, oral steroids are prescribed.  In most cases, the rash goes away immediately after delivery.

In my case, I was in the rare 1 to 2 percent of women who get it postpartum.  It was a cruel birth gift — the southern Florida, late August heat only exacerbated the discomfort. Finally, after a month of using a steroid cream, it cleared.

Because I didn't want to be seen with the bizarre rash, I didn't leave my house. Even at home I was covered up like a nun. I was terrified the rash would spread to my nursing baby, but it didn't.

Whenever pregnant women ask for advice, I dispense it freely: Sleep a lot; don't agonize over sometimes supplementing breast milk with formula; don't sweat the pacifier. But I don't mention PUPPP because I don't want to scare them. Maybe other moms feel the same way and that's why many expectant mothers are unaware of pregnancy rash, even though we're bombarded with warnings about swollen ankles, burping and heartburn.

That said, there is one piece of good news about PUPPP. Once you get it, it is extremely rare to develop it in future pregnancies. As far as I can tell, this is the only bright side to a miserable, but mostly innocuous condition