All About PUPPP Rash in Pregnancy

Pruritic uticarial papules and plaques of pregnancy (PUPPP) is a skin condition that can be pretty miserable. But is it dangerous? Find out the symptoms, risk factors, and treatments for this common pregnancy rash.

Pregnant Woman Scratching Belly With Stretch Marks
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It's not uncommon to be a little itchy when you're pregnant. But what if you have intense itching, along with streaky hives spreading across your belly (and perhaps the rest of your body)? That may be a PUPPP rash.

PUPPP—which stands for pruritic urticarial papules and plaques of pregnancy—is the most common rash of pregnancy, affecting about 1 in 200 pregnant people. Thankfully, PUPPP poses no harm to your baby and no long-term or dangerous consequences to you. But it's still important to understand the condition as well as treatments that can make you feel more comfortable while you wait it out.

What Is PUPPP Rash?

A PUPPP rash is an extremely itchy rash, featuring raised, hive-like bumps and streaks on the abdomen that may spread to other body parts, says Jessica J. Krant, MD, a board-certified dermatologist and assistant clinical professor of dermatology at SUNY Downstate Medical Center and a physician at the Laser & Skin Surgery Center of New York.

It tends to first appear on your belly—specifically, on and around developing stretch marks—during the third trimester of a first pregnancy. But it can also affect the thighs, legs, hands, arms, breasts, back, or buttocks. It generally spares the face, Dr. Krant adds.

PUPPP usually comes on in the third trimester or immediately following delivery, but goes away soon after you deliver your baby.

Causes of PUPPP

If not surging pregnancy hormones, what's to blame for PUPPP? "Some studies suggest a relationship between skin distention (stretching) and the development of this condition because the rash usually starts in stretch marks," says Ray Kamali, MD, New Mommy Media Contributor and Department Chair at Sharp Chula Vista Medical Center in Chula Vista, California. "Other studies suggest a possible immunologic response to the circulating fetal antigens."

Other Pregnancy Rashes to Look Out For

While PUPPP is the most common pregnancy-related skin condition, it's important not to assume that any itchy rash you get during pregnancy is PUPPP. There are other pregnancy skin conditions that can be harmful to pregnant people and babies. Extreme immune system abnormalities can bring on blister-like rashes from pustular psoriasis or pemphigoid gestationis, conditions that can put your baby at risk for health problems or premature delivery.

Another rashy condition called cholestasis of pregnancy, a liver disease that typically develops in the third trimester of pregnancy, also causes intense itching. Cholestasis of pregnancy may increase the risk of preterm birth, stillborn birth, or fetal distress. "That's why it's important to immediately seek help from your obstetrician or dermatologist with any rash during pregnancy," Dr. Krant says.

PUPPP Rash Risk Factors

While experts haven't definitively determined what causes PUPPP, it only develops during pregnancy and the most common theory is that excessive stretching of the skin's connective tissue leads to inflammation in the skin, which causes the rash, says Lauren Ploch, MD, a board-certified dermatologist in Aiken, South Carolina.

Some risk factors for PUPPP are linked to stretching skin, while others aren't. Here are some things that may make you more likely to develop PUPPP rash in pregnancy:

  • First-time or multiple pregnancy: The skin tends to stretch more in these instances, which is linked to the rash.
  • Genetics: You may be at risk if other people in your family have had PUPPP.
  • Male baby: Most pregnant people who have PUPPP are carrying males, which leads some experts to believe that the development of PUPPP may be related to hormones from the male fetus.

PUPPP Rash Diagnosis and Treatment

An OB-GYN or dermatologist can likely diagnose the condition with a clinical exam, but some patients may require a small skin biopsy for definitive diagnosis, says Dr. Ploch. They may also order some blood tests.

There's no way to predict who will get PUPPP, and there's nothing you can do to prevent it. Since there is no cure (other than delivering your baby), all you can do is try to manage it as best you can. The itch can be severe, but it usually clears up within a couple of weeks after delivery.

Home remedies like soaking in a lukewarm bath with colloidal oatmeal and applying a fragrance-free moisturizer can help temporarily relieve itchiness. Some people also swear by using cold compresses on the rash to dull skin discomfort. Be sure to discuss any treatments you try at home with a health care provider.

Dr. Kamali notes that health care providers may also suggest one of the following treatments for PUPPP while you're still expecting:

  • Non-sedating antihistamines such as Benadryl (diphenhydramine)
  • Topical corticosteroids like over-the-counter hydrocortisone creams
  • Systemic corticosteroids such as prednisone (by prescription and used only for severe cases)

The good news: There are no long-term effects of PUPPP, and Dr. Kamali notes that research suggests that the risk of recurrence in future pregnancies is low. Soon after delivery, you should be able to focus on your baby, not the itch.

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Sources
Parents uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Pruritis in PregnancyAmerican Journal of Clinical Dermatology. 2022.

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  4. Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of PregnancyDermatology Research and Practice. 2015.

  5. Intrahepatic Cholestasis of PregnancyBMJ Best Practice. 2022.

  6. Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through in vitro fertilization. Anais Brasileiros de Dermatologia. 2021.

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