PUPPP Rash

PUPPP is an itchy rash that can happen during pregnancy. The letters PUPPP stand for “pruritic urticarial papules and plaques of pregnancy.” PUPPP rash is a patch of itchy, hive-like bumps that form in the stretch marks on your belly. It can spread to other parts of your body, like your thighs, breasts and arms.

PUPPP is harmless to both you and your baby. It usually shows up late in your pregnancy and lasts from four to six weeks. It goes away within a few weeks of your baby being born. PUPPP rashes are one of the most common skin conditions during pregnancy. They appear in about 1 in every 160 pregnancies.

Symptoms of PUPPP rash

PUPPP rashes look and feel a lot like hives. Here are some signs that you may have PUPPP:

• You have scattered, itchy bumps on your belly, sometimes forming raised patches of skin.
• The rash spreads to your thighs, butt, breasts and arms.
• There’s no sign of the rash in the area right around your belly button.
• On light skin, the bumps or patches may look pink or red.
• On dark skin, the bumps or patches may be the same color as your skin or slightly darker than your skin.
• The itching from your rash makes it tough to focus on daily activities and disrupts your sleep.

PUPPP rash causes

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. Stretching damages your skin’s connective tissue and causes inflammation. This leads to a bumpy rash to form on your skin.

Another theory suggests that hormone changes during pregnancy cause PUPPP.

Regardless of the cause, PUPPP rash is an unpleasant annoyance when you’re pregnant.

Risk factors

PUPPP shows up late in pregnancy, usually around week 35 in your third trimester. Less commonly, PUPPP rashes appear shortly after delivery. Your chances of getting PUPPP increase if:

• You’re white
• You’re carrying a male fetus
• This is your first pregnancy
• You’re carrying twins or triplets

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.

How doctors diagnose PUPPP rash

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:

• Complete blood count
• Liver function test
• Metabolic panel
• Serum cortisol test
• Serum hCG test

If it’s tough to tell for sure whether your rash is PUPPP, your provider may order a biopsy to test a skin sample.

How is it treated?

PUPPP usually lasts for about four to six weeks. It usually goes away on its own within a few days to a few weeks after your baby is born. Scratching doesn’t spread PUPPP, but it can make the itching worse.

While you wait for your rash to disappear, medication and home remedies can help ease your symptoms.

Home remedies

Take care of your skin by:

• Taking oatmeal baths
• Taking cool baths or showers
• Applying fragrance-free moisturizer
• Wearing lightweight cotton clothes
• Using cold compresses on your bumps or rash

Medication

If home remedies don’t help, your provider can recommend medications. Keep in mind that your pregnancy care provider should approve any medications you’re taking when you’re pregnant, even over-the-counter ones. Your provider may suggest you try:

• Anti-itch creams
• Antihistamine pills
• Corticosteroids

Antihistamines and corticosteroids usually ease the itching within a day or two.

When should I see my healthcare provider?

Contact your pregnancy care provider if you think you have PUPPP. They can suggest at-home treatments or medications that are safe for pregnancy. It’s best to get their approval for any medications you use during pregnancy, even over-the-counter ones.

What can I expect if I have PUPPP rash?

PUPPP can be irritating while it lasts, but there’s a light at the end of the tunnel. PUPPP rashes go away after your baby is born. It usually doesn’t leave scars. Also, having PUPPP rash during one pregnancy means that you’re less likely to have it in future pregnancies. While you do have PUPPP, work with your provider to ease the itching. Don’t take or use medications until you talk to your pregnancy care provider.