PUPPP Rash: Causes, Symptoms, and Treatment

By Dr. Kenosha Gleaton, OBGYN

Pregnancy can lead to many unexpected symptoms and bodily changes. I’m not just referring to morning sickness or weird food cravings- you may also experience changes to your skin and hair during and after pregnancy. Today we’re going to discuss the causes, symptoms, and treatment options for one of the most common pregnancy skin conditions, PUPPP rash. 

What Is PUPPP? 

Pruritic urticarial papules and plaques in pregnancy (PUPPP) is an itchy skin rash that sometimes appears during pregnancy. [1] PUPPP rashes are thought to impact about one in every 160 pregnancies. [2] A PUPPP rash will appear as a patch of itchy bumps that form in stretch marks on the belly and can spread to other parts of the body. It’s most common to see PUPPP later in pregnancy, typically around week 35 of the third trimester. [1-2] While it can be uncomfortable and inconvenient, PUPPP won’t cause you or your baby any harm. [1-2] 

Common Symptoms of PUPPP Rash

PUPPP rashes tend to resemble hives and are often scattered, itchy bumps on the belly and surrounding areas. Some symptoms you may notice include [1-2]:

• Itchy bumps on or near stretch marks
• Raised patches of skin around the belly 
• A rash spreading from the belly to the thighs, butt, breasts, and arms
• Pink or red bumps and patches in those with a lighter skin tone, or dark/skin-colored bumps and patches on those with a darker skin tone. 
• No rash around the belly button area
• Itching that interferes with daily activities or sleep

Experiencing dry skin during pregnancy? Learn more here. 

What Causes PUPPP?

Researchers are still trying to figure out what causes PUPPP. One popular theory is that the skin cells have a difficult time keeping up with a fast-growing belly. [2] As the connective tissue in the skin is stretched, the skin can become damaged and inflamed, leading to bumps or a rash. Connective tissue damage may also lead to the exposure of antigens within collagen, eliciting an allergic-type reaction. [1] Other researchers believe that PUPPP rash could be caused by hormonal changes, placental factors, and the role of fetal DNA in skin lesions. [1] 

Risk Factors

While we still aren’t sure what exactly causes PUPPP rash, researchers have identified some risk factors that can increase someone’s chances of getting PUPPP [2]:

• First pregnancy
• Multiple pregnancy (twins or triplets)
• Caucasian race
• Pregnant with a boy

Diagnosing PUPPP

When a provider is trying to diagnose PUPPP or another skin condition, they will likely conduct a few different tests. First, they will do a physical exam and ask you about any other health conditions, previous skin conditions, and family history. [2] Other tests that may be used include a blood count, liver function test, metabolic panel, serum hormone tests, and more. [2] Your provider may also take a biopsy to test your skin sample. 

PG vs. PUPPP

Pregnancy PUPPP rash may be mistaken for another skin condition known as pemphigoid gestationis (PG). [2] PG also causes itchy hives and often appears in the third trimester. PG can lead to some health complications in rare instances, so it’s important to have your provider take a look at any rashes, bumps, or other abnormalities during pregnancy. [2] 

Treating PUPPP Rash

Fortunately, PUPPP is a temporary condition that often lasts from four to six weeks. [1-2] PUPPP typically goes away on its own within a few days to a few weeks after childbirth. If the rash is causing you a lot of discomfort or irritation, you can speak with your provider about other treatment and management options. Some options for treatment include home remedies and rash medications.  Learn more about treating itchy stretch marks → 

Home Remedies

PUPPP can’t harm you or your child, but it can be uncomfortable to live with. While you wait for the rash to disappear on its own, you may find some relief at home using the following methods [1-2]:

• Taking oatmeal baths
• Using cold compresses on your rash
• Wearing comfortable, light-weight clothing
• Taking cool baths or showers
• Using lotion that is fragrance-free and good for sensitive skin
• Using hydrating belly oils that are safe for pregnancy

Rash Medication

In addition to home remedies, your provider may instruct you to try out some sort of rash medication. It’s important to get a provider’s approval before using any new products during pregnancy. Various antihistamines and corticosteroids may ease the itchiness, bringing you some more comfort. [1-2] These may include creams, gels, or oral pills. 

How to Prevent PUPPP

So, can you do anything to prevent a PUPPP rash? Unfortunately, there aren’t any surefire ways to stop PUPPP from occurring. The rash appears in about one in every 160 pregnancies, making it fairly common. [2] You can soothe your symptoms if PUPPP does arise, and the rash often goes away on its own after childbirth. If you have any concerns or questions about your pregnancy or symptoms, speak with a provider. 

Pamper Your Pregnant Belly With Natalist

Pregnancy and postpartum are periods of rapid transformation in the body and come with both pleasant and unpleasant changes. At Natalist, we believe every reproductive moment is worthy. That’s why we offer information and products that support your needs from preconception to postpartum. If you’re experiencing itchy or dry stretch marks, know that you aren’t alone. Belly Oil and Cooling Cream may be helpful for swelling, itching, or dryness. Always check in with your healthcare provider about any products you’re hoping to use and any symptoms you’re experiencing. You got this! 

References:

1. Chouk C, Litaiem N. Pruritic Urticarial Papules and Plaques of Pregnancy. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-
2. PUPPP Rash. Cleveland Clinic. February 2022. https://my.clevelandclinic.org/health/diseases/22374-puppp-rash

Dr. Kenosha Gleaton is board-certified in gynecology and obstetrics and is the Medical Advisor of Natalist. She received her MD from MUSC and completed her residency at Carolinas Medical Center in Charlotte, NC.

Dr. Gleaton is passionate about women, health equity, and mentoring. She is the CEO of The EpiCentre, an OBGYN spa-like practice, and is a Clinical faculty member of Charleston Southern University. She is also a member of the American College of Obstetrics & Gynecology, the American Association of Gynecologic Laparoscopists, and the American Association of Professional Women