What Is a PUPPP Rash?

Medically Reviewed by Poonam Sachdev on April 27, 2022
4 min read

PUPPP stands for pruritic urticarial papules and plaques of pregnancy. It’s one of the most common skin conditions of pregnancy and is often also called polymorphic eruption of pregnancy or toxemic rash of pregnancy.

It’s a harmless but itchy rash with hive-like bumps that usually appear on your belly and stretch marks during your third trimester. It can spread to other parts of your body, like your back, breasts, arms, and buttocks. 

A PUPPP rash sometimes manifests during pregnancy. It usually goes away on its own and doesn’t cause any scarring or lasting color changes to your skin. 

Experts don’t know what causes a PUPPP rash, but it might be linked to stretch marks. One theory is that if your skin stretches too quickly around your belly, your cells can’t keep up. The underlying tissue becomes damaged, which exposes proteins that cause a quasi-allergic reaction. The result is a rash near your stretch marks. 

A PUPPP rash is more common in twin or triplet pregnancies because you often quickly gain a lot of weight when you carry more than one baby, and your skin expands quickly. A rash is also common in first-time pregnancies when your skin hasn’t stretched the same way before.

Another theory is that the rash is a reaction to your baby’s DNA. Doctors have found the baby’s DNA in the skin of some people with a PUPPP rash, suggesting a type of immune response.

Normally, your body suppresses your immune system during pregnancy to protect your baby, but with a lower immune system, your baby’s cells can move into your blood and tissues like your skin, which temporarily gives you two different sets of DNA. Your body sometimes reacts to this, which could cause a PUPPP rash. 

The rash usually goes away on its own after your baby is born. You rarely get it again during another pregnancy, which suggests you might build immunity to it. It might also be linked to high levels of progesterone hormone during pregnancy, but there are no definitive causes.

PUPPP rashes that occur during pregnancy often feel like hives. The rash starts with itching on your belly, especially in your stretch marks. A few bumps appear and then become a large rash as the sores spread. The rash looks like a mix of hives, raised lumps, small blisters, and a large, red, inflamed area across your belly, but typically not your belly button. On darker skin, the lumps and bumps might be the color of your skin or a darker shade.

Other PUPPP rash symptoms include:

  • A yellow discharge that leaks from blisters when you scratch
  • A crust over the skin 
  • Severe itching that interferes with daily activities
  • Widespread markings across your arms, breasts, thighs, butt

A PUPPP rash rarely affects your face, feet, or hands. 

There is no test for a PUPPP rash. Your doctor will simply look at your skin and record a history of your symptoms. They’ll make a diagnosis based on the appearance of the rash and its location. 

If the rash looks unusual, your doctor might order tests to rule out other conditions. Tests may include:

Sometimes, a PUPPP rash looks like another skin condition called pemphigoid gestationis, or PG. Both conditions cause a rash in your last trimester, though PG can show up earlier. PG is rare, but it can cause serious side effects for your baby. Your doctor might take a sample of your skin to do a test called immunofluorescence and rule out PG. 

In most cases, your doctor can tell you have a PUPPP rash by looking at it, though. 

A PUPPP rash goes away within 3 to 4 weeks of delivery. The condition doesn’t harm you or your baby, so you usually don’t need medical treatment. Most people need relief from the intense itching, though. You can treat such symptoms at home with personal care, over-the-counter medications, and home remedies

Personal care. Take cool baths or showers to soothe your skin and use fragrance-free body wash. A soothing oatmeal cleanser is a good option. You can also add colloidal oatmeal to a bath and soak for 10 to 15 minutes, which helps with itching.

After your shower, moisturize your skin with a fragrance-free lotion or ointment for itchy skin. Petroleum jelly can also help relieve very itchy skin and might work better than a cream. Then, wear loose-fitting, cotton clothes. 

Home remedies. You can ease swelling and itching with a cool compress. Soak a clean cloth in cool water and apply to the area. Once it gets warm, soak it again and re-apply as needed. You can apply a cooling or soothing moisturizer afterward, too. 

Over-the-counter medications. If personal care and home remedies don’t help, you can use over-the-counter medications from the pharmacy. You should always read the label and check with your doctor to make sure they’re pregnancy-safe. 

If your rash only affects a small area, you can apply a hydrocortisone anti-itch cream to the area and take newer antihistamine allergy medication, like cetirizine or cyproheptadine. Not all antihistamine medication is safe for pregnancy, though, so make sure you have the correct type.

Prescription medication. Sometimes a PUPPP rash causes intense itching that interferes with your daily life. If you have trouble sleeping or the rash causes intense discomfort that leads to exhaustion or other problems, your doctor can prescribe medications. These can include prescription steroid creams to relieve inflammation and itching. If the rash is widespread, your doctor might suggest a short course of steroid pills. 

A PUPPP rash is a harmless yet itchy and annoying rash that occurs during pregnancy. You can often treat it at home with personal care and home remedies, and it will eventually get better on its own. If the symptoms are intense or interfere with your sleep or life, talk to your doctor about other treatments.