Your Body Treating a PUPPP Rash During Pregnancy By Heather L. Brannon, MD Heather L. Brannon, MD Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years. Learn about our editorial process Updated on November 03, 2022 Medically reviewed Verywell Family articles are reviewed by board-certified physicians and family healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Andrea Chisholm, MD Medically reviewed by Andrea Chisholm, MD Facebook LinkedIn Twitter Andrea Chisolm, MD, is a board-certified OB/GYN who has taught at both Tufts University School of Medicine and Harvard Medical School. She has over 20 years of clinical experience and is currently is in practice at Cody Regional Health in Cody, Wyoming. Learn about our Medical Review Board Print PUPPP often starts in the stretch marks. Science Photo Library - IAN HOOTON / Getty Images Table of Contents View All Table of Contents Appearance Causes Diagnosis Treatment If you're pregnant and experiencing a rash on your body, it could be pruritic urticarial papules and plaques of pregnancy (PUPPP). PUPPP, which is also known as polymorphic eruption of pregnancy, is the most common rash in pregnant people. The skin condition can also be called PUPPS or PEP. It normally occurs in a pregnant person's first pregnancy during the third trimester (with an average onset of 35 weeks). PUPPS also common in parents-to-be who are carrying multiples. Thankfully, PUPPP does not usually affect subsequent pregnancies. Learn more about treating a PUPPP or PUPPS rash during pregnancy. Appearance of PUPPP The rash of PUPPP almost always begins in the stretch marks (striae) of the abdomen. It does not involve the belly button, which is how doctors are able to distinguish the symptoms from other common rashes of pregnancy. The rash consists of small, red, itchy bumps in the stretch marks that grow together to form larger wheals on the abdomen. Sometimes the rash can include small vesicles (clear, fluid-filled bumps). Over a period of several days, the rash can spread over the thighs, buttocks, breasts, and arms. This condition is harmless to the mother-to-be and the baby, but it can be very annoying. The rash is pruritic (an unpleasant sensation of the skin that gives you the urge to scratch it), hence its name. It lasts an average of 6 weeks and resolves by itself 1 to 2 weeks after delivery. The most severe itching normally lasts for no more than 1 week. Causes The cause of PUPPP is unknown. It is not associated with preeclampsia, autoimmune disorders, hormonal abnormalities, or fetal abnormalities. Although higher levels of the male fetal DNA can be found in skin biopsies of the rash. Pregnancies with increased maternal weight are also associated with PUPPP, causing some researchers to suggest that the rapid abdominal wall growth and stretching damages connective tissue, causing an inflammatory response. Diagnosis There are no laboratory tests that detect PUPPP, so the diagnosis of PUPPP is clinical, meaning it is based solely on the appearance of the rash. Skin biopsies are not generally performed unless there is a question about the diagnosis. Treatment for PUPPP The treatment of PUPPP is symptomatic. This means that medication is given to relieve the rash and reduce itching, including the following. High-strength steroid creams: Ointments may be prescribed to relieve itching and prevent the spread of the rash.Lower-strength steroid creams: Once the rash is under control, changing to a lower-strength steroid that's used less frequently is advisable.Oral antihistamines: Atarax, Benadryl, and Zyrtec are generally less effective for itching than steroids but may be useful at night to help with sleep.Oral steroids: Generally avoided during pregnancy, oral steroids may be necessary to control itching for extremely severe cases. Your doctor may also consider inducing labor (if you are close to your delivery date and the itching is extreme) instead of starting you on a dose of oral steroids. A Word From Verywell Keep this in mind: While it's frustrating and uncomfortable, PUPPP does clear up within a couple of weeks after delivery. It also poses no long-term harm to you or your baby. Loading shell for quizzesApp1 vue props component in Globe. 3 Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American College of Obstetrics and Gynecologists. Skin conditions during pregnancy. June 2014. Kim EH. Pruritic urticarial papules and plaques of pregnancy occurring postpartum treated with intramuscular injection of autologous whole blood. Case Rep Dermatol. 2017;9(1):151–156. doi:10.1159/000473874 Ambros-Rudolph CM. Dermatoses of pregnancy - clues to diagnosis, fetal risk and therapy. Ann Dermatol. 2011;23(3):265–275. doi:10.5021/ad.2011.23.3.265 Additional Reading Brzoa, Z., Kasperska-Zajac, A., Oleś, E., Rogala, B. (2007). Pruritic urticarial papules and plaques of pregnancy. J Midwifery Womens Health, Jan-Feb, 52(1), 44-8. Tunzi, M., Gray, G.R. (2007). Common Skin Conditions During Pregnancy. Am Fam Physician, Jan, 75, 2, 211-18. By Heather L. Brannon, MD Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit