I was approached by a Public Health Nurse because she is following a pregnant mom whose skin has erupted in "eczema" all over - including the nipples. Her body is also edematous and the skin is very itchy and peeling. Of course I recommended seeing a dermatologist, as there are various possibilities, not just eczema, such as Pruritic urticarial papules and plaques of pregnancy (PUPPP) or even Cholestasis of pregnancy...but the nurse said the doctors are ready to give her steroids so they can deliver the baby (now at 34 weeks) soon... Benadryl brought no relief for the itching, but did make her very sleepy...
The PHN was wondering what she could/should do about helping the mom after the baby is born, as the skin will still be sloughing off (mom is dark-skinned African American), and whether the edema, itching and skin shedding would continue and be a barrier to breastfeeding.
I did have a patient years ago who shed black strips of skin into the baby's mouth...this looks awful, but did not seem to cause problems with the baby or soreness of the mother's nipple - although after the first time, she would first rub her nipples to try to get any loose skin off. However, this mom had no edema or itching...
In looking at the archives, I found some recommendations for dietary changes or soap/detergent changes, but this was for eczema - when you compound this with the edema and itching, it seems to be much more serious...
Thoughts on assistance now and anticipatory guidance for after delivery?
Jeanette Panchula, BA-SW, RN, PHN, IBCLC
California, USA
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