PUPPP is an extremely irritating hive-like rash that can affect you during pregnancy. It’s harmless to both you and your baby, but it can be a pain to manage in the meantime. Your healthcare provider can recommend treatments to relieve the itching. PUPPP usually goes away on its own after your baby is born.
PUPPP is an itchy rash that sometimes appears during pregnancy. The letters PUPPP stand for pruritic urticarial papules and plaques of pregnancy. In simpler terms, PUPPP rash is a patch of itchy, hive-like bumps that form in the stretch marks on your belly and spread to other parts of your body when you’re pregnant. PUPPP is a pain, but it’s harmless to both you and your baby. It usually goes away once your baby arrives.
PUPPP rash can look like a skin condition called pemphigoid gestationis (PG). PG causes itchy hives that can feel like PUPPP. Both types of skin conditions show up in the third trimester, although PG can show up earlier, too. But PG is rarer and more concerning than PUPPP rash. While PUPPP doesn’t pose any risks, PG can cause pregnancy complications in rare instances. Your healthcare provider can determine whether you have PUPPP rash or a different skin condition.
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PUPPP shows up late in pregnancy, usually around week 35 in your third trimester. Less commonly, Puppp rashes appear shortly after delivery. Your chances for getting PUPPP increase if:
PUPPP doesn’t usually show up during the first and second trimesters. If you notice an itchy rash, see your provider to rule out other skin conditions, like contact dermatitis.
PUPPP rashes are the most common skin condition associated with pregnancy. They appear in about every 1 in 160 pregnancies.
PUPPP rashes look and feel a lot like hives. Here are some signs that you may have PUPPP:
No one knows for sure what causes PUPPP, but the cause may have something to do with stretch marks. The most popular theory is that your belly gets so big so fast that your skin cells can’t keep up. That’s when you see stretch marks. The stretching causes the connective tissue in your skin to get damaged and become inflamed, causing bumps to form and a rash to appear. Another theory suggests that hormone changes during pregnancy cause PUPPP.
Regardless of the cause, PUPPP rash is an unpleasant annoyance when you’re pregnant.
Your provider will do a physical exam to see if you have PUPPP. If there’s a question about whether you have PUPPP or a different skin condition, your provider may order tests to be sure. Your provider may order any of the following:
If it’s tough to tell for sure whether your rash is PUPPP or PG, your provider may order a biopsy to test a skin sample. This test is called a direct immunofluorescence test.
PUPPP usually lasts from four to six weeks. It usually goes away on its own within a few days up to a few weeks after your baby comes. While you wait for your rash to disappear, medication and home remedies can help ease your symptoms.
Take care of your skin by:
If home remedies don't help, your provider can recommend medications. Keep in mind that your provider should approve any medications you’re taking when you’re pregnant, even over-the-counter meds. Your provider may suggest you try:
Antihistamines and corticosteroids usually ease the itching within a day or two.
You can’t prevent PUPPP rash, but you can soothe your symptoms until it goes away on its own. Speak to your healthcare provider about safe ways you can manage the itching until your rash disappears.
PUPPP is irritating while it lasts, but there is a light at the end of the tunnel. PUPPP rashes go away after your pregnancy. PUPPP usually doesn’t leave scars. Also, having PUPPP rash during one pregnancy means that you’re less likely to have one if you have another pregnancy. While you do have PUPPP, work with your provider to ease the itching.
Get your doctor’s approval for any medications you take during pregnancy, even over-the-counter ones.
The best way to get rid of PUPPP is to have your baby. PUPPP only affects pregnant people and, in rare cases, people who’ve just had a baby. Once you’re no longer pregnant, the rash should go away within a few weeks.
PUPPP usually lasts from four to six weeks.
Scratching doesn’t spread PUPPP, but it can make the itching worse. So try not to scratch. Instead, talk to your provider about safe ways to relieve the itching, like home remedies, creams, and corticosteroids.
A note from Cleveland Clinic
Having an itchy PUPPP rash appear at the moment you’re feeling most impatient for your baby to arrive can feel agonizing. If you’re noticing signs of PUPPP, don’t wait to get relief for your symptoms. Your provider can help with your diagnosis and suggest ways to manage your itching so that it doesn’t keep you up at night. Your PUPPP is an annoyance, but it’s a temporary one.
Last reviewed by a Cleveland Clinic medical professional on 02/09/2022.
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