PUPPP Rash in Pregnancy
The short answer
PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy) is the most common pregnancy-specific skin rash, affecting about 1 in 160 pregnancies. It appears as itchy red bumps and hive-like patches that typically start in the stretch marks on the belly and may spread to the thighs, arms, and buttocks. It is not harmful to you or your baby.
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By Age
What to expect by age
PUPPP most commonly develops in the third trimester, particularly in first pregnancies or pregnancies with multiples. The rash typically starts within the stretch marks on the belly and does not affect the area around the belly button (periumbilical sparing). It can be intensely itchy. Cool compresses, oatmeal baths, calamine lotion, and fragrance-free moisturizers can help. Your provider may prescribe topical corticosteroids or oral antihistamines for relief.
PUPPP may persist up to delivery. The rash does not affect your ability to have a vaginal delivery. Let your care team know about the rash and any treatments you are using.
PUPPP typically resolves within days to weeks after delivery. In some cases, it may flare briefly in the early postpartum period before fading. It rarely recurs in subsequent pregnancies. No special treatment for the baby is needed.
What Should You Do?
When to take action
- Itchy red bumps and patches starting in stretch marks on the belly
- Rash spares the area immediately around the belly button
- Developed in the third trimester, especially in a first pregnancy
- Intense itching is the main symptom with no blisters or other lesions
- The rash is spreading to other parts of your body beyond the belly
- Over-the-counter remedies are not controlling the itching
- You are losing sleep due to the severity of the itching
- The rash includes blisters, which could indicate pemphigoid gestationis, a rarer but more serious pregnancy skin condition
- You develop intense itching of the palms and soles without a rash, which could be cholestasis of pregnancy
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Trust your instincts. If something feels wrong, reach out to your pediatrician.
Worrying about your baby means you care. That is a good thing.
Related Maternal Concerns
Itchy Skin During Pregnancy (Non-Cholestasis)
Mild itching during pregnancy is very common and usually caused by the skin stretching, dry skin, or hormonal changes. It typically affects the belly, breasts, and thighs. While usually harmless, severe or widespread itching, especially on the palms and soles, should be evaluated to rule out cholestasis of pregnancy.
Stretch Marks During Pregnancy
Stretch marks (striae gravidarum) affect up to 90% of pregnant people and occur when the skin stretches rapidly as the belly, breasts, and hips grow. They appear as pink, red, or purple streaks and gradually fade to silver or white after pregnancy. Genetics plays the biggest role in whether you develop them.
Cholestasis of Pregnancy
Intrahepatic cholestasis of pregnancy (ICP) is a liver condition that causes intense itching, usually in the third trimester, due to a buildup of bile acids in the blood. It affects about 1-2% of pregnancies. While the itching is very uncomfortable, ICP is treatable with medication, and with close monitoring and planned early delivery (usually around 36-37 weeks), outcomes for both mother and baby are generally very good.
Dealing with Abnormal Prenatal Screening Results
An abnormal prenatal screening result can be terrifying, but it is important to understand that screening tests are designed to cast a wide net and have significant false-positive rates. Most people with abnormal screening results go on to have healthy babies after further testing confirms the baby is fine. An abnormal screening is a reason for more information, not a diagnosis.
Pregnancy Over 35 (Advanced Maternal Age)
While pregnancy after 35 carries some increased risks (including chromosomal abnormalities, gestational diabetes, and hypertension), the vast majority of people over 35 have healthy pregnancies and healthy babies. The term "geriatric pregnancy" is outdated and does not reflect reality. With appropriate prenatal care and monitoring, outcomes are excellent.
Amniocentesis Questions and Fears
Amniocentesis is a diagnostic test performed between 15-20 weeks that analyzes amniotic fluid to detect chromosomal conditions and genetic disorders with over 99% accuracy. The risk of pregnancy loss from the procedure is approximately 1 in 500-1,000 when performed by an experienced provider. Understanding the actual risks can help you make an informed decision.