Overview

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.

What is the difference between a PUPPP rash and pemphigoid gestationis (PG)?

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.

Who does a PUPPP rash affect?

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:

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 common is PUPPP?

PUPPP rashes are the most common skin condition associated with pregnancy. They appear in about every 1 in 160 pregnancies.

Symptoms and Causes

What are the symptoms of a PUPPP rash?

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

Scattered, itchy bumps appear on or near the stretch marks on your belly, sometimes forming raised patches of skin, or a rash.
The rash spreads to your thighs, butt, breasts, and arms.
There’s no sign of the rash in the area circling your belly button.
On skin with less melanin, the bumps or patches may look pink or red.
On skin with more melanin, the bumps or patches may be the same color as your skin or a darker shade of your skin tone.
The itching from your rash makes it tough to focus on daily activities and interferes with your sleep.

What causes PUPPP Rash during pregnancy?

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.

Diagnosis and Tests

How is PUPPP rash diagnosed?

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 or PG, your provider may order a biopsy to test a skin sample. This test is called a direct immunofluorescence test.

Management and Treatment

How is PUPPP treated?

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.

PUPPP rash home remedies

Take care of your skin by:

Taking oatmeal baths.
Taking cool baths or showers.
Applying fragrance-free moisturizer.
Wearing light-weight, cotton clothes.
Use cold compresses on your bumps or rash.

PUPPP rash medication

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:

Anti-itch creams.
Antihistamine pills.
C orticosteroids.

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

Prevention

How can I prevent PUPPP Rash?

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.

Outlook / Prognosis

What can I expect if I have PUPPP Rash?

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.

Living With

What questions should I ask my doctor?

Get your doctor’s approval for any medications you take during pregnancy, even over-the-counter ones.

Are there topical creams you would recommend to relieve my itching?
Are there antihistamines you would recommend?
At what point should we try corticosteroids?
What kinds of corticosteroids would you recommend?
How can I relieve my itching so that I can sleep better?

Frequently Asked Questions

How do you get rid of a PUPPP rash?

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.

How long does PUPPP last?

PUPPP usually lasts from four to six weeks.

Does scratching PUPPP make it spread?

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.

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PUPPP Rash