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PUPP: 3 Things to Know About This Pregnancy-Related Rash

Your body undergoes a lot of changes during pregnancy. Your hips spread, your breasts enlarge and your belly swells with your developing baby (or babies). You may also notice changes to your skin.

One of the first things that comes to mind is that pregnancy glow that everyone talks about. But a healthy glow isn’t the only thing pregnancy can do to your skin. “Normal skin changes during pregnancy include darker skin around your nipples, on your cheeks (melasma) as well as a dark line running up your abdominal wall,” said Dawn Martin-Herring, MD, an OBGYN at Banner – University Medicine North in Tucson, AZ.

You may also experience stretch marks, acne, varicose veins, spider veins and an itchy, bothersome rash known as pruritic urticarial papules and plaques of pregnancy, also known as PUPP, PUPPP and PEP (polymorphic eruption in pregnancy).

PUPP poses no harm to you or your baby during pregnancy, but there are other, more serious skin conditions that can be mistaken for PUPP.

Read on to learn more about PUPP, its causes, how to treat it and how to make sure your symptoms aren’t something more serious.

What is PUPP?

“PUPP is essentially itchy bumps and patches in pregnancy,” Dr. Martin-Herring said. “While this seems to be of little consequence, for 1 in every 150 to 300 people who get this rash it can be very difficult to manage.”

This rash usually first appears during the last month or so of pregnancy on the stomach, or abdomen, specifically on stretch marks and can progress into patches of red bumps. It usually spreads to the upper thighs and buttocks “but typically doesn’t affect the belly button, face, hands or feet,” Dr. Martin-Herring said.

For people with lighter skin, there is sometimes a white halo around the patches while those with darker skin color may have less obvious changes. If you have a darker skin color, you might notice a slight purple hue or even just darkening of the affected skin.

For most people, the rash will resolve by the second week after your baby is born and doesn’t usually return for other pregnancies.

What causes PUPP?

The cause of PUPP is unknown but Dr. Martin-Herring said it may be related to excessive stretching of the skin that damages underlying tissue leading to inflammation of the skin.

“This theory is supported by the fact that we see this condition more often in first pregnancies, those who’ve had rapid weight gain, diabetes or who are pregnant with multiples such as twins or triplets,” she said. “There may be other immune causes and a slight increase for those pregnant with male babies.”

Is it PUPP or something else?

If you develop itching or a rash at any point during your pregnancy, seek medical attention with your health care provider as soon as possible.

“While PUPP doesn’t affect the long-term health of you or your baby, there are medical conditions in pregnancy that cause itching and/or rash that can be harmful to you both,” Dr. Martin-Herring said. “Skin problems like eczema and psoriasis often improve in pregnancy, so if you have a new skin condition or are worsening, make sure this isn’t another condition related to pregnancy.”

Other conditions such as drug allergies and even COVID-19 can cause changes similar to PUPP. Never assume that changes in pregnancy are normal and certainly don’t take medications without first checking with your provider.

[Also read “If You’re Expecting and Your Hands and Feet Itch, It Could Be Cholestasis.”]

How is PUPP treated?

The most effective cure is simply to deliver your baby. If your little one has more “baking” to do, however, you don’t have to sit idly by resisting the urge to scratch your belly.

Below is a list of tried-and-true methods that can help provide some relief from the itching:

  • Steroid creams and antihistamines: Depending on the severity of your symptoms, your provider may recommend an over-the-counter hydrocortisone-based ointment for your skin, and oral antihistamines, such as Benadryl, Claritin and Zyrtec. When itching is severe, they may prescribe a short course of systemic corticosteroids, like prednisone.
  • Moisturizers: To help prevent your skin from drying and getting itchier, try a fragrance-free and hypoallergenic moisturizer, such as aloe vera and cocoa butter.
  • Itch-relieving baths: Take an oatmeal or baking soda bath to help reduce the itching associated with the rash.
  • Cold compresses: A cold ice pack or cool soak in the tub can also help calm itching.

Can I prevent PUPP?

There’s no way you can entirely prevent PUPP from happening. What you can do is make sure to eat a healthy diet, slowly gain weight during your pregnancy and avoid scratching to prevent irritation.

[Check out “How Much Weight Should I Gain During My Pregnancy.”]

Bottom Line

PUPP, PUPPP or PEP goes by many names, but this bothersome rash isn’t harmful during pregnancy. With time, and a little support, your PUPP rash will go away.

Before you self-diagnose, however, reach out to your provider so they can rule out any other possible conditions or causes that could be dangerous.

Also read:

Pregnancy Women's Health