Why am I itchy?

Itchy Skin in PregnancyWhy is my skin is itchy in pregnancy is not an uncommon question. It is often related to hormone changes in pregnancy.

With the considerable abdominal stretching, it is not unusual to be aware of itchy and dryer skin. In advanced pregnancy, it is not unusual for new stretch marks (“striae”) to be itchy.

A very uncomfortable pregnancy cause for the itch is “pruritic urticarial papules and plaques of pregnancy” (“PUPPP“). PUPPP is a common cause of rash in pregnant women. The rash of PUPPP almost always begins in abdominal wall stretch marks of the abdomen and appear as small, red wheals in the stretch marks that grow together to form larger wheals on the abdomen. Sometimes the rash can include small vesicles. In a short time, the rash can spread to other parts of the body. The rash is very itchy, or pruritic, hence the name. While this is harmless to mother and baby but is very uncomfortable. The cause of PUPPP is unknown.

Sometimes an itch can be a manifestation of a pregnancy complication called “cholestasis of pregnancy” (also called obstetric cholestasis). This is thought to be due to sex hormones in pregnancy affecting normal liver function and in particular of bile secretion in the liver. As the bile backs up in the liver, the level of bile acids increases in the bloodstream. These bile acids are deposited in the skin causing the intense itching. It can run in families and so there appears to be a genetic component. It has an impact on a mother’s wellbeing and causes abdominal liver function and can rarely affect her blood clotting. It also increases the risk to the baby of meconium staining of liquor, preterm delivery and intrauterine death.

A pre-pregnancy skin condition such as dermatitis and eczema is usually less in pregnancy of concern on pregnancy though occasionally it can be worst.

What can be done about it?

The cause of your itch needs to be established. Bile salts and liver function tests are needed to exclude cholestatic jaundice of pregnancy. Cholestatic jaundice affects about 1 in 100 pregnancies. If cholestatic jaundice is diagnosed then a drug called ursodeoxycholic acid can help. Ursodeoxycholic acid at a daily dose ranging from 600-2000 mg helps decrease the level of bile in the mother’s bloodstream, relieves itchiness, reduces the bile salt, bilirubin and liver enzyme levels and so can help prolong the pregnancy. Because of the potential risks to baby, there will need to be careful monitoring and possibly earlier delivery around 37 weeks.

PUPPP is very uncomfortable and can only be managed with symptomatic relief. Often a dermatologist help is requested because of the severity of the itch. Oral steroids sometimes needed for PUPPP management. PUPPP resolves spontaneously one to two weeks after delivery. Because of this and the discomfort of PUPPP, it is not unusual for a woman with PUPPP to request early induction of labour.

If it is a pre-existing skin complaint such as dermatitis then topical steroid treatment should help.

Symptomatic treatments of itch include

  • Drink lots of water to hydrate your skin.
  • Liberal application of Sorbolene with Vitamin E.
  • Pinetarsol bath oil, solution, soaps and gel. Pinetarsol is a special antiitch range from pine tar.
  • Antihistamines such as Telfast.
  • Both staying cool and soaking in lukewarm water can help.

See also

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