What Is Prurigo Of Pregnancy

Introduction to prurigo of pregnancy 

Prurigo of pregnancy (PP) is a common complaint that around 1 in 300 women experience during pregnancy and in the postpartum period. Although this condition is itchy and uncomfortable it is treatable by your doctor and harmless to the foetus. 

So what is it?

• This condition presents as an itchy rash
• The area of affected skin will be dry and covered in small red bumps. It typically appears on the stomach area, arms, legs, or a combination of these areas
• Large areas can be covered by the rash making the condition very uncomfortable

Although the exact cause of this is unknown, it is thought that changes to the immune system and hormonal balance may make pregnant women more prone to conditions such as these. Fortunately, although the condition causes discomfort, it is not harmful to the mother or the baby. Home remedies, steroid creams, and antihistamine tablets can all be used to treat this rash. Before using any medication, however, make sure to consult with your doctor. After birth, it should disappear on its own after a few weeks as your body returns to its pre-birth state. 

Symptoms and presentation 

Prurigo of pregnancy presents as a red, bumpy, and itchy rash. It belongs to a family of skin conditions which all present in similar ways. These are called ‘Atopic Eruptions of Pregnancy’ and also include conditions such as eczema. 

Because of these other similar conditions, it is important to look for the defining features of PP specifically. These are as follows:

• Papules:
  • These are small raised bumps on the skin, less than 1 cm across
  • For PP they usually range between 5-10mm
  • These appear red and are firm to the touch
  • Compared to conditions such as eczema where the itchy rash appears in patches, without the small bumps
  • Sometimes they appear where there is a hair follicle but this is not always the case
• Redness and colour:
  • The small bumps will most likely present as red, pinkish or purplish on white or fairer skin
  • However, on darker skin tones they will most likely be a darker brown or purple
  • Itching may further darken them in colour due to damage to the skin
• Distribution:
  • The papules are often distributed on the trunk of the body (back, chest, and stomach), legs, arms, or a combination of these areas
  • The palms and soles of the feet are not affected
  • The distribution is usually symmetrical across the vertical midline of the body
  • The papules will be grouped together

Although these are the common features of PP, the distribution and severity will vary from person to person. While some people may only see a small area of rash with a minimal amount of itching, others may have a much larger affected area and more intense itching. 

Duration 

Although PP can manifest at any point during pregnancy, it is mostly seen to develop in the second (weeks 13-26) or the third (week 27 to birth) trimester. The condition may continue into the postpartum period after giving birth but will normally resolve itself within several months. 

Duration will vary from person to person but if you have any concerns with the duration of this condition, check in with your healthcare advisor. 

Causes and triggers 

Although the exact cause of PP is not known due to insufficient research there are some commonly held views as to what may trigger this condition in pregnant people. 

Physiological changes in pregnancy 

As you go through the process of pregnancy your body undergoes all sorts of changes to facilitate the development and growth of a new life. One of these transformations is the changes to your hormonal balance as both your levels of oestrogen and progesterone increase.¹ This is important for the babies' development but can also cause changes to hair, skin and nails. This is a completely normal occurrence. 

It is thought by some that these changes to hormone levels may be linked to PP and trigger the condition in those who are susceptible.² However, more research is needed to solidify this link.

Immune system responses

During pregnancy, the immune system changes to facilitate the growth of the foetus. This may make the body more susceptible to developing inflammation of the skin and therefore PP. 

However, the exact pathway in which PP develops is unknown at present.

Genetic predisposition

There may be an association with atopy. Atopy is when the immune system is predisposed to developing allergic diseases. Examples include hay fever, allergic rhinitis (runny nose due to allergies), eczema, and allergic asthma. 

Individuals who have had these sorts of allergic disorders in the past, or have family members who suffer from them, may be more prone to developing PP. However, this link is debated. 

Other factors

Environmental factors such as changes in season and diet may affect the development of PP, although not much is known about the exact causes and effects. 

If you experienced PP during your first pregnancy you are not guaranteed to develop it in consequent pregnancies but it may occur. 

Diagnosis 

If you suspect you have developed PP, the best route for diagnosis is to speak to your designated healthcare professional. They will be able to confirm this as well as differentiate it from other similarly presenting conditions in the Atopic Eruptions of Pregnancy group. 

Although PP itself is not harmful to the unborn baby, conditions such as intrahepatic cholestasis of pregnancy, can also present as intense itching. Therefore it is always worth having an examination by a healthcare professional. 

There are no specific diagnostic tests and a visual exam by a healthcare professional will be sufficient.

Treatment options

Although there are no absolute cures for PP, it can be treated to relieve discomfort. In most cases home remedies will be sufficient, but if not some topical treatments and oral medications can be used. 

Home remedies 

These can be used to relieve itching and therefore prevent any impact on day-to-day life or sleep. These include:

• Use non-irritating hygiene products and laundry detergents. Wear soft loose fitting clothing on affected areas
• Only shower once daily
  • Cool water can be soothing
• Try an oatmeal bath

Topical treatments

Check with a doctor before applying anything to your skin. These lotions can help soothe itching and include:

• Hydrocortisone cream/ointment
  • This is a steroid that can be used to reduce inflammation of the skin
• Topical benzoyl peroxide 
• Lotions that contain menthol 
• Calamine lotion 

Oral medication 

In severe cases, you can take oral antihistamines which should reduce inflammation and soothe the itchiness. 

It is important, especially if you are pregnant, to always consult with a doctor before applying products to your skin or using an over-the-counter medication. 

Overall, maintaining good skin hygiene, eliminating irritants, and using a soothing cream should help minimise itching and improve the condition of the skin. 

If you are finding the symptoms particularly stressful, or they are causing you to lose a significant amount of sleep, discuss this with your doctor who will be able to recommend the appropriate topical or oral treatment. 

Prognosis and complications

PP is a harmless condition, although annoying. The incidence of this condition does not pose any threat to the baby or mother. And, luckily, it will resolve by itself, usually a few weeks after giving birth.

It is still important however to treat the condition to ensure emotional well-being and proper sleep for yourself. 

Some sources say if you develop PP, your baby may have a higher risk of developing hay fever, eczema, or asthma later in life. However, there has not been enough research to confirm this.

Conclusion 

In conclusion, while prurigo of pregnancy (PP) may be an uncomfortable and itchy experience for expectant mothers, it is crucial to recognise that it is a common and generally harmless condition. Occurring in approximately 1 in 300 pregnancies, PP manifests as a red, bumpy, and itchy rash, often appearing on the stomach, arms, and legs.

Though the exact cause of PP remains unknown, it is believed to be associated with changes in hormonal balances and immune system responses during pregnancy. Genetic predisposition and other factors, such as environmental influences, may also play a role. The condition typically presents in the second or third trimester and may persist into the postpartum period, but it usually resolves on its own within a few months after childbirth.

Diagnosis of PP involves consulting with a healthcare professional, who can visually examine the rash and differentiate it from other similar conditions. While there is no specific cure for PP, various treatment options are available to alleviate discomfort. Home remedies, topical treatments, and oral medications, such as antihistamines, can be recommended by healthcare providers.

It is important for pregnant individuals experiencing PP to prioritise good skin hygiene, eliminate irritants, and use soothing creams to minimise itching and improve skin condition. Although PP itself does not pose a threat to the mother or the baby, addressing the symptoms is crucial for emotional well-being and ensuring proper sleep.

While there are suggestions that developing PP may increase the risk of allergic conditions in the baby later in life, further research is needed. For persistent symptoms or if you find the condition particularly stressful, consult your doctor for appropriate guidance and recommendations tailored to your specific situation. Remember, effective management of PP contributes to a more comfortable pregnancy experience without posing any long-term risks.In the meantime, the focus should be on managing and treating PP for the well-being of the expectant mother.