Mamas on Bedrest: Soothing Belly Itches During Pregnancy

February 27th, 2012

As your pregnancy progresses, your belly will begin to itch. This is really no surprise. As your belly expands, your skin stretches and it is this stretching that causes the itching.

There are a variety of salves, lotions and antihistamine creams available on the market to relieve belly itching, many touting that they are “specifically formulated” to relieve the itching associated with pregnancy. Don’t be fooled. Most of the belly itching associated with pregnancy is not so specific that it requires any specialized type of cream or salve. Many products, readily available on the general retail market are sufficient to provide relief. Emollient creams, creams containing shea butter, cocoa butter, aloe vera or oatmeal and sometimes creams or lotions containing 0.5% or 1.0% hydrocortisone cream are effective in providing relief. Typically, keeping the skin on you belly well moisturized (applying creams or lotions 2-3 times daily or more as needed for itching. Be sure to consult with your health care provider if you are using cortisone creams and do not apply more frequently than the manufacturer or your health care provider recommends. ) and avoiding harsh chemicals, constricting clothing or clothing that rubs against your belly will provide relief. There are a few skin eruptions that cause itching specifically during pregnancy that may require more specific care and attention. They are described below.

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPPs)

Pruritic Urticarial Papules and Plaques of Pregnancy or PUPPPs is a common, intensely itchy skin condition that occurs typically late in the third trimester of pregnancy. PUPPP’s is characterized by red papular (bumpy) lesions on the belly, often around stretchmarks, that become so widespread that the bumps become grouped into large red patches on the belly, usually centered around the belly button. The patches often spread to include the thighs and buttocks and will occasionally spread to the arms and legs but this is less common. Seeing PUPPPs on or above the breasts is rare. The patches are extremely itchy and many women report that they can’t sleep due to the itching.

PUPPPs typically spontaneously resolves within days after delivery. For the intense itching, many health care providers prescribe low dose corticosteroid creams (0.5-1.0% hydrocortisone cream) to be applied 5-6 times daily. In some cases, patients are prescribed mild oral antihistamines for relief and to allow them to sleep. In rare cases, patients have to be prescribed a short taper of oral corticosteroids, but again, this is extremely rare.

Impetigo Herpetiformis

Impetigo Herpetiformis is a rare  form of pustular psoriasis which occurs during pregnancy and may be life threatening. While it has been documented in all trimesters, Impetigo Herpetiformis usually occurs during the last trimester and resolves shortly after delivery. However, it is crucial the impetigo herpetiformis be accurately diagnosed and treated as it can lead to placental insufficiency, stillbirth and increases in complications and even death for mothers and babies. Impetigo Herpetiformis is associated with low levels of calcium and women with hypoparathyroidism are at particular risk for developing the disorder.

Impetigo Herpetiformis begins as pus-filled bumps on reddened skin of the inner thighs and groin. The pustules join and spread to the trunk and extremities. The rash typically spares the face, hands, and feet but can spread to inside the mouth and into the nail beds.  Interestingly, the pustules are not filled with bacteria, but can become infected as the rash progresses. Some women will also experience generalized viral symptoms such as fatigue, nausea, vomiting, diarrhea, fever and chills. Treatment for Impetigo Herpetiformis is oral corticosteroids such as prednisone.

Intrahepatic Cholestasis of Pregnancy (ICP)

Intrahepatic Cholestasis of Pregnancy occurs when bile secretion in the liver is impaired. As the bile backs up in the liver, the level of bile acids increases in the bloodstream. These “backed up” bile acids are then deposited in the skin causing the intense itching.  The itching ranges from annoying to severe and tends to be worse at night. The itching typically begins on the palms of the hands and soles of the feet and them spreads to the rest of the body. Rash develops as a result of scratching. Jaundice occurs in 10% to 15% of cases and typically develops 2 to 4 weeks after the itching starts. All symptoms spontaneously resolve shortly after delivery.

Intrahepatic Cholestasis is rare and occurs in 0.3-5% of pregnancies overall. It is more common in women who have a family history of ICP,  and women who develop the disorder in a first pregnancy tend to develop it in subsequent pregnancies.  While the exact etiology of ICP is unknown, it has been determined that the increase in estrogen and progesterone during pregnancy play a major role. Estrogen interferes with bile clearance from the liver and progesterone interferes with estrogen removal from the liver.

The most important side effects of ICP on infants are preterm delivery, meconium staining (stool changes) at birth and still birth because the fetal liver cannot manage the additional bile salts from the maternal circulation. Treatment of ICP is aimed at lowering the bile salt levels and preserving the livers and health of both mother and baby.

ICP is diagnosed based on history and  blood tests showing elevated levels of bile acids and certain liver enzymes. There is rarely a need for a liver biopsy. Treatment consists of ursodeoxycholic acid (10–20 mg/kg/d) as well as antihistamines, Questran for elevated cholesterol and in severe cases of itching, phenobarbital. In some cases, high doses of oral steroids are needed to relieve the itching. Most mothers with ICP are delivered between 37 and 38 weeks once fetal lung maturity has been established.

Resources

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPPs)

MedScape

About.com

BabyCenter.com

Impetigo Herpetiformis

About.com

Intrahepatic Cholestasis of Pregnancy

Dr. Mona Ridgeway, MD The Austin Gastroenterology Clinic, Austin, TX

Itchy Moms

About.com

MedScape

Please share your experiences with itching during pregnancy below. You can also contact us on Facebook and on Twitter, @mamasonbedrest.

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