What Is PUPPP Pregnancy Rash: How Do You Get Relief?

PUPPP is not a stutterer trying to say puppy, it is an acronym for the most common itchy rash that pregnant women get. PUPPP stands for pruritic (itchy) urticarial (hives) papules (pimples) and plaques (wide, elevated skin growths) of pregnancy. PUPPP is a mouthful, but it describes the skin rash very well. PUPPP is a new name that was given to the rash in 1979. Before that, it went by many names including toxemic erythema of pregnancy and late onset prurigo of pregnancy. In the United Kingdom it is usually called polymorphic eruption of pregnancy. Let’s stick with PUPPP.

What Happens if You Get PUPPP?

If you get PUPPP, it will probably be in the last three months of pregnancy, most likely in the last 5 weeks. You will be sharing the rash experience with about 1 out 200 pregnant women. You might first notice papules in the stretch marks around your belly button. They will look like solid little pimples (papules) with a pale halo around them.

The papules will start to group together over a few days into very itchy red welts (hives and plaques). A PUPPP rash usually spreads to other areas where there are stretch marks, such your buttocks, thighs, back, breasts, and legs. The rash rarely spreads above the breasts.

Who Is at Risk for PUPPP?

PUPPP almost always occurs with a first pregnancy. It tends to be a one and done. Once you have it, it is very rare to have it again. It is more common in women with white skin and less common with dark skin. It is more common if your baby is a boy. It is more common in women with stretch marks due to weight gain or the stretching from carrying more than one baby. The risk for women with triplets shoots up to 14%.

The cause of PUPPP remains a mystery. The main theory is that it is a reaction of your body’s defense system (immune system) to the stretching of your skin. This may be why it is more common during a first pregnancy and with bigger baby bellies. Another theory is that it is an immune system reaction to your baby’s cells getting into your blood stream.

What Do You Do?

If you get PUPPP, the good news is that the rash is not harmful to you, your pregnancy, or your baby. The only treatment is delivery. Once your baby is born, the rash will start to fade away. It may take a week or a month. That is all good, but what to do when you have it? The rash is very itchy and it can keep you up at night.

Let your pregnancy care provider know about the rash. Your provider will probably be able to diagnose PUPPP by your symptoms and the appearance of the rash. There are no special tests. If your rash is bothersome, and it usually is very itchy, these treatments are available for relief:

  • A good first choice is using a moisturizer frequently to soothe the rash three to four times a day. Possible lotions include calamine, colloidal oatmeal, and pramoxine. Ask your health care provider for a recommendation.
  • If itching continues, you may add diphenhydramine or hydroxyzine. These are antihistamines that can relieve itching. Antihistamines are usually considered safe later in pregnancy, although they can make you drowsy. Ask your health care provider first.
  • If the rash is not responding, you may be able to add a steroid cream. These can range from low to high-potency. They are usually considered safe if you limit use to 2 weeks, but follow your health care provider instructions.
  • Finally, for a very resistant rash and itching, you may be prescribed a tapered dose of oral steroid. There are some risks associated with oral steroids and pregnancy, but they are small and the relief may outweigh the risk if you are struggling to get enough sleep. Oral steroids are often used to treat other conditions during pregnancy, like asthma. This option would be only by prescription from your pregnancy care doctor.

PUPPP is the most common cause of itchy rash during pregnancy. If you get an itchy rash that starts near your belly button towards the end of pregnancy, PUPPP will probably be the culprit. Let your doctor know right away and get started on treatment. PUPPP is still unlikely, but if you do have to deal with it, at least it’s usually a one and done.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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