pruritic rash on chest and back

  1. Hello!

    I'm a public health nurse and visit pregnant moms referred for Healthy Start services. I visited a patient today who has a pruritic rash over her chest and lower & upper back. Nothing on her face, arms, abdomen, etc.

    Her OB provider is aware (per pt) and not concerned. She said it has gotten better over the past few days--that a few days ago the bumps had little white heads. The rash started about a week ago.

    My first thought was it was an allergic rxn, but she denied the use of new detergent, denied eating any seafood or new type of food. Basically, she denied doing anything different, including wearing any new clothing.

    I looked in my Maternity text from school, and it states that "pruritis is a relatively common dermatologic symptom in pregnancy, with cholestasis of pregnancy being the most common cause of pruritic rash." Her EDC is 4/11/05, so she's 36 weeks along. Has anyone seen this before in pregnant women?

    OK--another question about this pt if you have time: She has a hx of rapid progression during labor. She told me her last baby was delivered in less than 2 hours. Her first baby took 13 total, and the current pregnancy is her 3rd. She's 36 weeks, already 1 cm dilated and is having some irregular "cramping". Her provider told her to call as soon as she starts experiencing any signs of labor, but she's afraid she won't make it to the hospital on time.

    I have not had a lot of experience with this, so I reviewed the basic signs of labor and reinforced her provider's instructions to call at the first sign of labor. She still seems really worried about not knowing when her labor begins and not making it to the hospital on time. Anyone have experience with this type of situation?

    Thanks in advance,
    novice PHN
  2. Visit Jayla profile page

    About Jayla

    Joined: Dec '04; Posts: 130; Likes: 5

    10 Comments

  3. by   happthearts
    Quote from Jayla
    Hello!

    I'm a public health nurse and visit pregnant moms referred for Healthy Start services. I visited a patient today who has a pruritic rash over her chest and lower & upper back. Nothing on her face, arms, abdomen, etc.

    Her OB provider is aware (per pt) and not concerned. She said it has gotten better over the past few days--that a few days ago the bumps had little white heads. The rash started about a week ago.

    My first thought was it was an allergic rxn, but she denied the use of new detergent, denied eating any seafood or new type of food. Basically, she denied doing anything different, including wearing any new clothing.

    I looked in my Maternity text from school, and it states that "pruritis is a relatively common dermatologic symptom in pregnancy, with cholestasis of pregnancy being the most common cause of pruritic rash." Her EDC is 4/11/05, so she's 36 weeks along. Has anyone seen this before in pregnant women?

    OK--another question about this pt if you have time: She has a hx of rapid progression during labor. She told me her last baby was delivered in less than 2 hours. Her first baby took 13 total, and the current pregnancy is her 3rd. She's 36 weeks, already 1 cm dilated and is having some irregular "cramping". Her provider told her to call as soon as she starts experiencing any signs of labor, but she's afraid she won't make it to the hospital on time.

    I have not had a lot of experience with this, so I reviewed the basic signs of labor and reinforced her provider's instructions to call at the first sign of labor. She still seems really worried about not knowing when her labor begins and not making it to the hospital on time. Anyone have experience with this type of situation?

    Thanks in advance,
    novice PHN
    You may want to check this site about the rash I had never hears of this either.
    http://dermatology.about.com/cs/pregnancy/a/puppp.htm

    Happy
  4. by   camay1221_RN
    It sounds like a PUPPPs rash:

    Pruritic Urticarial Papules and Plaques of Pregnancy

    Another wonderful experience for some women in pregnancy.
  5. by   Jayla
    Thank you both! This is helpful to know.
  6. by   BBFRN
    PUPPS is probably the answer, but it could also be pityriasis. Was there a christmas tree-like pattern on the pt's back?
  7. by   SmilingBluEyes
    PUPPS or Varicella came to mind. (shingles).
  8. by   Jayla
    Quote from lgflamini
    PUPPS is probably the answer, but it could also be pityriasis. Was there a christmas tree-like pattern on the pt's back?
    I don't remember seeing a christmas tree pattern, but it was on her upper and lower back. It was also on her chest What is pityriasis?
  9. by   Jayla
    Quote from SmilingBluEyes
    PUPPS or Varicella came to mind. (shingles).
    She said she'd never had chicken pox before, and no vaccination. The rash was only on her chest and back...there was nothing on her face, arms, etc.

    Do you have any suggestions regarding her past experience of rapid progression? Is there anything you would tell a patient who is afraid they won't make it to the hospital on time because the last baby was born so fast?

    THanks!!
  10. by   BBFRN
    Quote from Jayla
    I don't remember seeing a christmas tree pattern, but it was on her upper and lower back. It was also on her chest What is pityriasis?

    Pityriasis starts out red and scaly, then spreads from the trunk to the face/arms. Then it turns a tan color. It can go away on its own. I had never seen it until this month, but we have started seeing multiple cases of it here- no one knows why. You can see a definite christmas tree pattern on the back with it, though. Try Googling it under images, and it may pop up so you can get a picture of it.
  11. by   SmilingBluEyes
    Quote from Jayla
    She said she'd never had chicken pox before, and no vaccination. The rash was only on her chest and back...there was nothing on her face, arms, etc.

    Do you have any suggestions regarding her past experience of rapid progression? Is there anything you would tell a patient who is afraid they won't make it to the hospital on time because the last baby was born so fast?

    THanks!!
    I missed that part about not having had varicella before chalk it up to 36 hours w/o sleep I guess. Sorry!
  12. by   BETSRN
    Quote from Jayla
    Hello!

    I'm a public health nurse and visit pregnant moms referred for Healthy Start services. I visited a patient today who has a pruritic rash over her chest and lower & upper back. Nothing on her face, arms, abdomen, etc.

    Her OB provider is aware (per pt) and not concerned. She said it has gotten better over the past few days--that a few days ago the bumps had little white heads. The rash started about a week ago.

    My first thought was it was an allergic rxn, but she denied the use of new detergent, denied eating any seafood or new type of food. Basically, she denied doing anything different, including wearing any new clothing.

    I looked in my Maternity text from school, and it states that "pruritis is a relatively common dermatologic symptom in pregnancy, with cholestasis of pregnancy being the most common cause of pruritic rash." Her EDC is 4/11/05, so she's 36 weeks along. Has anyone seen this before in pregnant women?

    OK--another question about this pt if you have time: She has a hx of rapid progression during labor. She told me her last baby was delivered in less than 2 hours. Her first baby took 13 total, and the current pregnancy is her 3rd. She's 36 weeks, already 1 cm dilated and is having some irregular "cramping". Her provider told her to call as soon as she starts experiencing any signs of labor, but she's afraid she won't make it to the hospital on time.

    I have not had a lot of experience with this, so I reviewed the basic signs of labor and reinforced her provider's instructions to call at the first sign of labor. She still seems really worried about not knowing when her labor begins and not making it to the hospital on time. Anyone have experience with this type of situation?

    Thanks in advance,
    novice PHN
    My first thought is PUPPPS.

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