What is the Difference Between PUPPP and Cholestasis

The key difference between PUPPP and cholestasis is that PUPPP is a condition that causes an extremely irritating hive-like rash, while cholestasis is a condition that causes the slowing of bile flow through the biliary system.

PUPPP and cholestasis are two medical conditions that often can take place during pregnancy. However, these are different conditions with different aetiologies.

CONTENTS

1. Overview and Key Difference
2. What is PUPPP 
3. What is Cholestasis
4. Similarities – PUPPP and Cholestasis
5. PUPPP vs. Cholestasis in Tabular Form
6. Summary – PUPPP vs. Cholestasis

What is PUPPP?

Pruritic urticarial papules and plaques of pregnancy (PUPPP) refer to an itchy rash or hive that sometimes appears during pregnancy. However, this condition is usually harmless to both the baby and the mother. This condition usually occurs around week 35 in the pregnancy but can also appear shortly after delivery. PUPPP rashes appear around every 1 in 160 pregnancies. The symptoms of this condition may include intensely itchy, small, red swollen papules or bumps in and around stretch marks, which are typically painless and do not form blisters. PUPPP is caused by stretching and hormone changes during pregnancy. The risk factors for PUPPP include being white, carrying a male fetus, having first pregnancy, and carrying twins or triplets.

PUPPP can be diagnosed through physical examination, complete blood count, liver function test, metabolic panel, serum cortisol test, serum hCG test, and skin biopsy. Furthermore, PUPPP can be treated by taking oatmeal baths, taking cool baths or showers, applying fragrance-free moisturizers, wearing lightweight, cotton clothes, anti-itching creams, antihistamines, and corticosteroids.

What is Cholestasis?

Cholestasis is defined as a decrease in bile flow due to impaired secretion. This can be due to problems in the liver or bile ducts. It can be a temporary problem or an ongoing, chronic worsening one. Cholestasis is caused by a problem with the liver that inhibits its ability to secrete bile into the bile ducts or a problem in the bile ducts that is physically restricting the flow of bile through these ducts. Moreover, the symptoms of cholestasis may include jaundice, dark urine, light-colored stool, pain in the abdomen, fatigue, nausea, and excessive itching. The risk factors for cholestasis include personal or family history, history of liver damage or disease, including hepatitis C and gallbladder stones, being pregnant with multiple babies, and pregnancy at an older age, such as 35.

Cholestasis can be diagnosed through blood tests, imaging tests such as ultrasound, CT scan, MRI, and ERCP (endoscopic retrograde cholangiopancreatography). Furthermore, treatment options for cholestasis may include lifestyle changes, such as diet, exercise, and avoiding alcohol, dietary changes, medications such as ursodeoxycholic acid, naltrexone, cholestyramine, surgery, and endoscopy procedures.

What are the Similarities Between PUPPP and Cholestasis?

• PUPPP and cholestasis are two medical conditions that often can take place during pregnancy.
• Both conditions are characterized by itching.
• They can be diagnosed through blood tests.

What is the Difference Between PUPPP and Cholestasis?

PUPPP is a condition that causes an extremely irritating hive-like rash, while cholestasis is a condition that causes the slowing of bile flow through the biliary system. Thus, this is the key difference between PUPPP and cholestasis. Furthermore, the risk factors for PUPPP include being white, carrying a male fetus, being the first pregnancy, and carrying twins or triplets. On the other hand, the risk factors for cholestasis include personal or family history, history of liver damage or disease, including hepatitis C and gallbladder stones, being pregnant with multiple babies, and pregnancy at an older age, such as 35.

The infographic below presents the differences between PUPPP and cholestasis in tabular form for side-by-side comparison.

Summary – PUPPP vs. Cholestasis

PUPPP and cholestasis are two medical conditions that often occur during pregnancy. However, cholestasis can also occur if people have a disease or infection like viral hepatitis, alcoholic liver disease, and inflammation of the bile ducts that hurts cells. Itching may be a symptom of both these conditions. But they are different medical conditions with different aetiologies. PUPPP is due to an extremely irritating hive-like rash, while cholestasis is due to decreased bile flow due to impaired secretion. Furthermore, PUPPP is caused by stretching and hormone changes during pregnancy, whereas cholestasis is caused by a problem with the liver that inhibits its ability to secrete bile into the bile ducts or a problem in the bile ducts that is physically restricting the flow of bile through these ducts. So, this summarizes the difference between PUPPP and cholestasis.

Reference:

1. “Pruritic Urticarial Papules and Plaques of Pregnancy.” AOCD.
2. Christiano, Donna. “Cholestasis: Symptoms, Treatment, in Pregnancy, and More.” Healthline, Healthline Media.

Image Courtesy:

1. “Cholestasis Diagnosis” By Nadees1 – Own work (CC BY-SA 4.0) via Commons Wikimedia