PUPPP Rash in Pregnancy
Medically reviewed by Dr. Lisa Okafor, MD, FACOG · Board-Certified OB-GYN
Content reviewed against published ACOG, NIH, AAP guidelines
Last reviewed:
Your health matters just as much as your baby's. If you are dealing with puppp rash in pregnancy, here is what you need to know.
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.
Key takeaways
- 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.
- Usually normal when: Itchy red bumps and patches starting in stretch marks on the belly
- Call your doctor if: The rash includes blisters, which could indicate pemphigoid gestationis, a rarer but more serious pregnancy skin condition
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to ACOG, NIH, AAP guidelines, 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. At Third trimester, 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. It is generally considered normal when itchy red bumps and patches starting in stretch marks on the belly. However, you should contact your pediatrician promptly if the rash includes blisters, which could indicate pemphigoid gestationis, a rarer but more serious pregnancy skin condition.
Normal vs. Concerning
By Age
What to expect by age
Third trimester
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.
Labor & delivery
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.
Postpartum
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 to Tell Your Pediatrician
- Describe when you first noticed puppp rash in pregnancy and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if the rash is spreading to other parts of your body beyond the belly.
- Mention if over-the-counter remedies are not controlling the itching.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
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
What You Can Do at Home
- Keep track of when you notice puppp rash in pregnancy — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that itchy red bumps and patches starting in stretch marks on the belly — this is generally within the range of normal.
- At Third trimester, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Prioritize your own rest and nutrition. Accept help when offered, and do not hesitate to reach out to your healthcare provider.
- While monitoring at home, seek immediate care if the rash includes blisters, which could indicate pemphigoid gestationis, a rarer but more serious pregnancy skin condition.
Related Conditions
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.
Related Resources
Rash Decision Tree
Identify common rashes and determine when to seek care.
Postpartum Recovery Guide
Week-by-week postpartum recovery timeline and warning signs.
Month-by-Month Development
Detailed monthly development guides from birth through 24 months.
When to Call the Doctor
General guide on when to call the pediatrician, visit urgent care, or go to the ER.
Frequently asked questions
Is puppp rash in pregnancy normal?
When should I call the doctor about puppp rash in pregnancy?
When is puppp rash in pregnancy normal?
What causes puppp rash in pregnancy?
What should I mention to my pediatrician about puppp rash in pregnancy?
Is puppp rash in pregnancy normal at Third trimester?
Is puppp rash in pregnancy normal at Labor & delivery?
Should I go to the ER for puppp rash in pregnancy?
Does puppp rash in pregnancy go away on its own?
References
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss PUPPP Rash in Pregnancy.
Things to mention
- Describe when you first noticed puppp rash in pregnancy and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if the rash is spreading to other parts of your body beyond the belly.
- Mention if over-the-counter remedies are not controlling the itching.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- 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
Urgent signs to report immediately
- 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
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members
Related Resources
Bottom line
Most cases of puppp rash in pregnancy are normal. Talk to your pediatrician if the rash includes blisters, which could indicate pemphigoid gestationis, a rarer but more serious pregnancy skin condition.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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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.