# Difference between cholestasis and PUPPP?



## craftymcgluestick (Dec 31, 2009)

Hi all,

I am pretty sure I have PUPPP, ridiculous rash all over my body that began with stretch marks on my abdomen, intolerably itchy, want to take my skin off, etc. I look like a lot of the photos I've found online. My MW said it sounds like I have PUPPP and to make myself comfortable, but basically offered no other ideas on how to do that.







I am currently drinking nettle tea, taking dandelion root, milk thistle, and nettle extracts also and washing frequently with pine tar soap. I also use Sarna to tame the worst of it for a short-lived period.

Now, as I read these other threads about itching though, I am scared I might have cholestasis. I went to a GP in town and he told me that despite the culture coming up negative, I had scabies. (I do not have scabies; I got that when I was 10 and it was totally different. Also, he prescribed a highly toxic pesticide.) I could get any of the 5 OB/GYNs I called to see me because of being an 8-months-along homebirth heretic and/or they were on vacation/not seeing new patients until September. So basically I can't get anyone to take a look at me, but I need to know that I'm not putting Baby at risk before I just proceed with comfort measures and try to make it through the rest of my pregnancy (I am 35 w 3 d) and get to my planned homebirth. Any thoughts on this?

Thanks for your help!


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## Ellen Griswold (Feb 27, 2008)

Another itchy mom here and I have gotten some good advice on this board. You might check out the website itchymoms.com to see if that sounds like you. How are your hands and feet? That seems to be the main difference - cholestatis seems to really effect the bottom of your feet and your palms. Your doctor should run a blood test to check your liver to determine if you have this (I'm still waiting on my results since I have the itchy feet but not the itchy palms.) Are you certain that it really started in your stretch marks and not simply on your abdomen? Because I have something called herpes gestationis which is very very similar to PUPPP, but not quite the same. I'm currently on a dose of steroids and taking benedryl. I have had *some* relief but am still pretty itchy. You have my every sympathy on this. I have never felt so awful/crazy in my whole life as I have with this. If it is PUPPPS I really don't have any good advice on what you can do - it really sounds as if very little is effective. I have tried oatmeal baths with some mixed results. Hang in there and let us know how you are doing.


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## mediumcrunch (Dec 10, 2009)

PUPPS and cholestasis are completely different aside from the itching symptom. Cholestasis is a liver condition and the itching does not come with a rash. PUPPS is dermatological and has a visible rash. Cholestasis can be ruled out with a blood test (liver function tests)

If you have a compounding pharmacy nearby and have any kind of physician (internist, GP etc...) or CNM that will write a prescription.
This is a good remedy for PUPPS:

Lidex 60grms
menthol 240 ml
lubriderm 420grms


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## karen1968 (Oct 2, 2006)

I'm SO glad I have an appt. with my MW on Wednesday, because I have a rash on my abdomen







It started in the middle of last week (so right around the w22/w23 change over) with just itching, and yesterday I noticed it is an actual rash. It is right where the waistband of most of my capris hits, and kind of looks like a heat rash. But it hasn't been hot here. Now I'm going to go do some research on PUPPS...


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## Llyra (Jan 16, 2005)

I have had both. The difference, as far as symptoms, is that PUPPP is a rash. Cholestasis doesn't come with a rash, except for maybe some irritation from if you've been scratching a lot. It also usually starts in your hands and feet, although you will itch all over as it progresses. But there is no rash with the cholestasis, so if you have a rash, it is likely not that. Plus, with the PUPPP rash, you will sometimes get some momentary relief by scratching. Scratching doesn't help the cholestasis itching.

I coped with my PUPPP rash with a hydrocortisone cream, ice packs, and scratching gently with a boar-bristle hairbrush.

If you think you might have cholestasis, the itchymoms site is the best resource I know of.


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## Dahlea (May 15, 2008)

If you have a rash and tested negative for cholestasis its pupps. There's a great yahoo group for support. I had this with my first and it got so bad I begged to be induced so I know how miserable it can be. If you need any ideas on things to try message me. And good luck!


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## jcr92901 (Apr 9, 2008)

Ow I had puppps with my first and it was BAD. I luckily found some soap and lotion from a great mama that had it 9 TIMES!! It's homemade by her and works amazing. Mount Ranier Soaps was the name of her company I believe....might be worth a shot for anyone suffering.


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## Love Wins (Oct 25, 2009)

I too had PUPPP and the only relief I had was from dandelion root capsules. I literally wanted to scratch myself raw, it was horrible. I wrapped myself up in loads of fabric so it was more difficult to scratch until the DR kicked in. I hope you get some relief!


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## craftymcgluestick (Dec 31, 2009)

Thanks everyone for the responses. I have been looking at the itchymoms site and even though I haven't had a blood test to rule out cholestasis, I am very confident I don't have that, especially since I am presenting like a classic case of PUPPP--35 week onset, pregnant with a boy, began in stretch marks (I just thought everyone's were itchy, at first, until the pustules began appearing and then it was on my arms...), rash all over abdomen, legs, arms, shoulders, thighs.

I have to tell you, having this has REALLY tested my commitment to natural childbirth since all I can think is "when is this baby going to come so the itching can stop?" But all of you that have suffered with it or are suffering with it are an inspiration to me and I thank you!

I cannot IMAGINE having PUPPP nine times, but I have ordered the Rainier Soap/Cream. If nothing else, I want to make a donation to that woman's campaign to be a saint.







In the meantime, I have really noticed a significant reduction in the hives/pustules by having painted my body in cornstarch paste (to dry it out) and then frequent baths with pine tar soap.

I am also taking the herbal supplements I mentioned above. I'm not sure what it is that's working, but I am going to keep doing all of it because this is absolutely ghastly and miserable. Oh! I also found that by taking a benadryl last night before bedtime, I was able to get about 4.5 hours of restful sleep before getting up to bathe/scratch/writhe again.

Good luck to you all!


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## Kari Hannon (Oct 2, 2012)

im currently 29 weeks pregnant and have been dealing with an itchy sensation for 2 months... at first i thought well its summer maybe a mesquito got me or since my mother in law has 3 cats (that have yet to be flea dipped) i thought it might be flea bites..... its hard to say where it started cause my legs had it my belly had it so idk but the rash is on my belly, my legs. my arms.. and now its on the sides of me feet iv looked at photos of PUPPS and it looks like its what i got but then when i read articles about scabies i start freaking out and hoping its not scabies... i have an appointment tommorow to see my primary care giver since my obgyn cant see me til monday which sucks cause idk what this doctor is going to say about my rash... with pupps there isnt much of a cure except be patient and wait it out or take herbal remedies or steriods and risk poising the baby.... is it possible that PUPPS and scabies are often confused for each other? it cant be scabies cause my toddler sleeps in the bed with me and he has no signs of scabies and like i said iv had this rash for 2 months now does anyone have any thoughts?


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## craftymcgluestick (Dec 31, 2009)

Kari, I am ultra-sympathetic to your case! My sister is the one who noticed that my original two-year old thread had come up again and all I could think was "oh no! That poor lady!"

I saw a local GP who told me I did have scabies when I had PUPPP. However, I have had scabies (when I was 10; caught it at summer camp) and I while it's a nuisance for sure, it"'s NOTHING compared to PUPPP. That said, so e of the itching can cause the rash of PUPPP and scabies to present similarly, especially around areas near arm pits, between fingers, ankles, and so forth where scabies mites typically cluster. The GP who thought I had scabies prescribed an extremely toxic dermal pesticide; I am really glad that I followed my intuition and skipped it. Here are my very best PUPPP coping tips:

-Take a scalding hot shower- as hot as you can stand! When it gets too hot, turn the water off and scrub your entire body with pine tar soap (available at any health food stores and sometimes even Walgreens or CVS). Rinse with scalding hot water. It kind of numbs your skin in that hurts-so-good way.

-After drying off, cover all your itchy spots (whole body?) in Sarna lotion.

-Take a Benadryl and go immediately to bed.

-When you can't constantly shower, get plenty of the blue re-usable ice packs and hold them to the worst spots.

For the pustules:
-make a paste with cornstarch and water and paint it all over them until it dries. This is a huge mess, but it helps.

Daily:
Take dandelion root, drink nettle tea, and take as many liver-boosting, pregnancy-friendly vitamins as you can (can't remember names off the top of my head, but you should be able to google them pretty easily).

I hope this helps! PUPPP is something I wouldn't wish on my worst enemy, but you can live through it! Good luck!


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