Symptoms
The first symptoms of PUPP syndrome begin around the second half of pregnancy and disappear completely after the birth of the child. Initially, reddish skin irritations develop in the abdomen area. These can be about the size of a cent coin, but can also be several centimeters in diameter.
After the plaques have formed, the itching also begins, which may be limited to the skin area, but may also spread to the surrounding, unaffected tissue. A few days later, the plaque begins to heal, and with it the tormenting itching disappears. A short time later, or even very often overlapping, one or more new plaque-like skin changes begin to develop on a usually different part of the body, which also have an accompanying itching.
These alternations of plaque formation and healing can last several weeks or months. As a rule, the symptoms disappear immediately after the birth of the child. During plaque formation and itching, there are no other accompanying symptoms such as fever, nausea and/or weight loss.
However, the psychological strain on the affected persons is not to be sneezed at. Untreated, the itching can be very severe and can lead to restlessness, aggression and concentration problems. It is also common for affected pregnant women to scratch the itchy skin, which not only increases the itching again after the first reduction, but also leads to skin effects and bleeding.In rare cases, especially if the itching is untreated and the affected person scratches heavily, scarring of the skin may also occur.
Since the cause of a PUPP syndrome is unknown, there is no therapeutic treatment but only a symptomatic treatment. This is based on a treatment of the symptoms caused by a PUPP syndrome. Since itching and inflammatory skin changes are leading in a PUPP syndrome, mainly anti-inflammatory and anti-allergic drugs are used.
Antihistamines and cortisone preparations in ointment form are mainly used to alleviate itching. Since both the mother’s body and that of the unborn child produce a large proportion of their own cortisone during pregnancy, a certain upper limit must be observed in drug-based cortisone therapy to avoid overdosing of total cortisone in the blood. Cortisone preparations used in PUPP syndrome are usually given to patients in ointment or cream form.
Systemic absorption in the body is relatively low and the cortisone has the strongest local effect on the skin. Antihistamines are usually given in tablet form and are intended to relieve severe itching. In most cases, one daily dose of one tablet a day is sufficient, although it should be noted that under an antihistamine, severe fatigue occurs.
For this reason, the tablet should only be taken in the evening. Also, the antihistamine (e.g. cetirizine known from the treatment of hay fever) should only be taken when needed or for a short time at a time. As a supporting treatment, skin-friendly creams or washing lotions can be applied to the affected skin areas. Envelopes soaked with chamomile can also help the skin to heal quickly and relieve itching.