How often does PUPPPs reoccur??

In my perusal of what PUPPPs mommas are talking about on various sites, I've noticed that lots of us are concerned about getting the horrible rash again if they have more kiddos. It's a big deal! No one wants to face it again! I'm certainly not a good example, since I break all the typical PUPPPs "norms." (This is my 4th bout with PUPPPs for anyone not familiar with my story...)

But what does the research say? How likely is it really that you would get PUPPPs again with your next pregnancy? 

Well, mommas, be encouraged. It's pretty rare. Here's the scoop:

According to this study, they followed 19 patients for 6 years after their PUPPPs pregnancy, and none of them had a recurrence. 

In this study, only 3 out of 57 patients experience a recurrence. 

Those are the only articles I could find that cited actual numbers. However, I did read dozens more that simply stated that recurrence in subsequent pregnancies was rare. Mommas that get it again are the EXCEPTION to the rule. You can even see on the poll on the right side of my page (when viewing the web version, not the mobile version) that only 20% of voters have gotten it more than once. And that's NOT scientific data.

It would be great if we had more data to work with, but for now the research seems to show that you shouldn't be worried about getting it again. For most people, it's a one-time misery. 

Polls

I realized that everyone who views my blog via the mobile version misses my polls! If you scroll to the bottom and click on "view web version," you'll be able to see my polls on the right hand side of the page. I have a couple of questions about PUPPPs there, and while they aren't scientific, the results are really interesting! Thanks for stopping by!

Dermatology Article

Did you know PUPPPs used to be called "Nurse's late onset prurigo," "Bourne's toxemic rash of pregnancy," and "Toxic erythema of pregnancy?"

Neither did I! 

I found this write up on PUPPPs by the American Osteopathic College of Dermatology and thought it was a really great summary on the rash. It's thorough with tidbits of info I hadn't found before. 

(example of PUPPPs rash from the article)

Here the link to the article. Happy Researching, fellow itchy people! 

Boy or Girl? Does PUPPPs mean boy?

According to this scientific study, no, having PUPPPs does NOT mean you are having a boy.

I think we've all wondered at that statistic that 70% of PUPPPs babies are boys. I know for me personally, that's just silly. I've had THREE GIRLS so far.

Well, this study, published in a 2005 volume of the British Journal of Dermatology, was done in two big hospitals in Austria and London. It looked back at a group of 181 patients with PUPPPs and analyzed the data. Statistically, boys were no more likely than girls in the group.

Ha! Finally, a little piece of research that backs up MY story!

I think I'll do a little non-scientific study of my own and put up and poll about gender over on the right side of my blog. Please vote if you know the gender of your PUPPPs baby! By the way, if you're viewing the blog using the mobile version, you won't be able to see the polls. Click on the website version at the bottom of the page.

Here's the summary of the article: click here

PUPPPs & Epidurals

Here's a little something for those of you considering an epidural for pain relief in labor.

This 2006 case study from the Canadian Journal of Anesthesia follows the experience of one woman with PUPPPs. She had been on strong steroids for the rash, which lowered her immune system. Her lowered immune system allowed some nasty bacteria to take root at the site of her epidural. She got an infection that required surgery within a week or two of her baby being born!

Here's a visual of where an epidural is usually placed:

(image from pregnancy.about.com)

Keep in mind, this is just one woman, but the article makes the point that an epidural with a compromised immune system can have additional risks. So talk to your doctor about that before you decide!

Here's the article: link

Research Blurb: An Extreme Case of PUPPPs

I feel so sorry for this woman! It took THREE courses of steroids (prednisone, the strong stuff) to kick her PUPPPs well into her postpartum period. She must have been miserable!

The main thrust of the article is that the typical treatment didn't work for this woman, and she needed more extreme care. It also points out that it seems obvious that it was an issue with her immune system function.  The authors state, "While this study does not provide a definite answer, it lends evidence to the possibility of a subtype of PUPPP that clearly has an immunologic basis."

It's no wonder that allergy meds don't work! Evidence is showing that it's NOT a histamine (allergic) reaction!

Here's the full text of the article for those curious research fans out there...

full text article

Does Daddy Play a Role in PUPPPs?

Ok, I'm excited. No, I didn't find a cure. But I ran across some studies that might give clues to a possible cause of PUPPPs. And I'm a bit of a research geek, so this stuff gets me going.

I've heard websites suggests that the rash could be our skin's response to the father or baby's DNA before, but I hadn't found the research to back it up! Today, I found 2 articles that shed some light on the subject.

In the first article, reported in a 1992 journal of Dermatology, there was a case of a mom who developed PUPPPs for the first time in her 5th pregnancy. Not only was it weird for it to be her first time, but it was noteworthy that her 5th pregnancy resulted from a different father than the previous 4 pregnancies! The major change was the father of the baby! Fascinating! Here's the article if you'd like to read it in its entirety.

The next article from the Journal of the American Academy of Dermatology is also from 1992. I couldn't read the full text without paying $35 bucks, but the summary was fascinating enough! The article was an analysis of 4 cases of PUPPPs. The first two were twin sisters married to twin brothers! First of all, how crazy is that?? Secondly, both women got PUPPPs! The other two cases were two women married to brothers. They also both got PUPPPs! So their theory is that the rash is a response to "circulating paternal factors." In other words, something about the father seems to play a role! Here's a link to the article summary.

Both articles suggest strong links to something about Daddy bringing about this rash. My husband wasn't too pleased to hear that. I don't blame him. But I can't help but be excited to gain more insight!

Is that not fascinating stuff? I know, it doesn't really help us at all with the itching, but there's something therapeutic about learning more about this crazy rash.

Research Blurb

One of the things that is frustrating about PUPPPs is that there is very little research done on it since it is "harmless for mom and baby." Obviously, whoever decided this had never experienced it. We need answers! WHY does this happen?? If we found out why, then we could treat the root cause instead of trying to pacify the symptoms! 

I have a nursing background, so research fascinates me. Whenever I come across research, I'll post it here. But I'll also try to summarize it for the less nerdishly inclined. 

Here is a case report done by some folks at Columbia University:

Read the article here.

It tells the story of a PUPPPs sufferer who developed the rash in the 3rd trimester and had a COMPLETE healing before her pregnancy was over. It only took a week! It sounds like her relief came from a mild steroid lotion (fluticasone) applied a couple times a day. The author was eager to see more docs try Fluticasone, since it was not the typical drug most OBs prescribe for PUPPPs. Now, this was only helpful for one woman. Some doc out there needs to do a follow-up study seeing if it helps lots of women!

However, it might be worth asking your OB about it. 

The article also went into a summary of other research they had combined. Even the author admitted that these factors were "controversial." No one seems confident in them. Here are the high points:

• No relationship to mom's weight gain. (said one study)
• More common when mom gains too much weight. (said another study)
• More common in twins and triplets.
• More common in pregnancies where mom is carrying a boy.
• Possible relationship to high blood pressure in pregnancy.
• Rash is usually not seen on the belly button.

All those points are laughable to me, since NONE of them apply to me, but perhaps they are helpful for another PUPPPs sufferer out there.