What is PUPPS (or "Pregnancy Rash")? - Baby Chick

What is PUPPS (or “Pregnancy Rash”)?

pregnancyUpdated January 13, 2022

by Kristen v.H. Middleton

Former Teacher and Administrator


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You’re nearing the end of your pregnancy and you’re feeling good. You survived the morning sickness, swelling, aches, and pains. The light at the end of the tunnel is starting to show! Suddenly, you start to get itchy. You notice a large, painful rash across your abdomen, arms, or back. And it won’t go away! What in the world is happening? It turns out you have a pregnancy-induced rash called PUPPS. What is it and how do you treat it? Here’s what you need to know.

What is PUPPS or PUPPP?

Pruritic urticarial papules and plaques of pregnancy (aka PUPPS or PUPPP) is a pregnancy-induced rash. It’s known as polymorphic eruption of pregnancy in the United Kingdom, or PEP for short. PUPPS occurs in one out of 130 to 300 pregnancies.

Not to be confused with other skin ailments such as acne, stretch marks, linea nigra, or pigmentation, PUPPS is associated with pregnancy and can begin as tiny red bumps around the navel and progress to large painful, itchy patches across a mother’s entire body. Pregnant mamas have reported the rash appearing on their chest, abdomen, arms, legs, back—even on the palms of their hands! A distinguishing characteristic is that it typically surrounds but doesn’t affect the navel itself. In most cases, PUPPS appears around week 35 of pregnancy.

What Are The Symptoms?

  • Rash first happens when pregnant
  • Typically shows up during the third trimester
  • Initially appears on the abdomen
  • Spreads across body
  • Tiny red bumps
  • Itchy, red patches
  • Looks like eczema
  • Blistering
  • Severe itchiness

What Causes PUPPS?

The etiology of PUPPS is still unknown. It’s usually diagnosed by the process of elimination once your healthcare provider rules out other skin conditions. Placental products, hormonal alterations, and damage to connective tissue have been proposed as possible causes by the traditional medical community. The naturopathic community has also suggested additional probable causes of PUPPS to be the following:

Overly stressed organs

For example, symptoms exhibit as skin rashes and discolorations when your liver or kidney is overworked. Your liver is your body’s primary detox organ and the kidneys filter your blood. When you combine the added weight of supporting another life inside you with toxins already present in food, beauty products, household products, and the environment, your body’s organs can get overwhelmed.

Abdominal Stretching

Carrying multiple babies, large babies, or simply putting on excess weight can stress your skin and damage connective tissue leading to inflammation and eventually PUPPS.

Fetal Cells

Your baby’s cells migrate to different parts of your body during your pregnancy, including your heart and skin. This can offer protective benefits from certain diseases and trigger your skin to see these cells as foreign invaders. If this happens, a rash may result.

What Are the Treatments for PUPPS?


Gentle, consistent exercise helps keep your blood clean and your organs healthy.

Clean Foods

Eating clean, organic, and plant-based foods supports healthy liver and kidney function, which can eliminate rashes. Stay away from processed foods and artificial ingredients. Drink lots of water and green juices. Try adding natural detoxifiers like arugula in your next salad or making fresh juice drinks.

Avoid Toxins

While it sounds obvious, it’s easy to forget that many beauty and household products contain harmful chemicals. While it may be in small doses, it adds up. Toxins from makeup and cleaning products can be absorbed into your body through the skin or inhalation. Opt for beauty, hair, cleaning, gardening, and laundry products with minimal or no toxins.

Herbal Remedies

Under the direction of a professional such as an herbalist, naturopath, or midwife, blood purifying herbs such as nettle, dandelion root, and beet juice can help flush toxins out of your body. But remember, it’s important to have the direction of your healthcare provider in knowing how much to consume when you’re pregnant.

Topical Creams

Treatment consists of topical or oral corticosteroids. Antihistamines and topical steroids may be used to treat PUPPS, and systemic corticosteroids may be used for extreme cases. Consult your healthcare provider for specific recommendations.

Soothing Baths

Soaking in an oatmeal bath or Grandpa’s Old Pine Tar Soap has been reported to help relieve itchiness associated with PUPPS. This soak will help to calm irritated skin and moisturize. In small doses, other ingredients to add to your bath include calendula, Chinese skullcap, apple cider vinegar, and chamomile.

Light, Cotton Clothing

Consider wearing lightweight, cotton clothing that will not irritate or inflame your skin. Look into switching to a non-toxic, hypoallergenic laundry detergent designed specifically for sensitive skin, as well.

Is PUPPS Harmful?

No, PUPPS is not life-threatening to you or your baby. It can, however, add stress, anxiety, and discomfort to your pregnancy experience. It’s a symptom of a bigger issue, but luckily there are ways to support your organs to function better. There are also many remedies for soothing itchy skin from PUPPS (see Treatments for PUPPS).

When Will It Go Away?

The PUPPS skin condition typically appears in the third trimester, and some mamas even develop it shortly after their delivery. However, PUPPS will disappear a few weeks after delivery in most cases.

“Polymorphic Eruption of Pregnancy Treatment & Management.” Medscape. (https://emedicine.medscape.com/article/1123725-treatment)
“A Liver Cleanse May Help Reduce These Symptoms.” (https://globalhealing.com/natural-health/liver-cleanse-may-help-reduce-symptoms/)
“Arugula Helps Prevent Fatty Liver Disease.” Arugula contains cleansing properties that may counteract toxic heavy metals, pesticides and herbicides (https://www.prohealth.com/library/arugula-helps-prevent-fatty-liver-disease-89442)
“Three cases of pruritic urticarial papules and plaques of pregnancy (PUPPP) treated with intramuscular injection of autologous whole blood.” (https://pubmed.ncbi.nlm.nih.gov/24593765/)
“Pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy.” Taylor & Francis Online. (https://www.tandfonline.com/doi/full/10.1080/14767050600590573)
“Pruritic urticarial papules and plaques of pregnancy: polymorphic eruption of pregnancy.” Science Direct. (https://www.sciencedirect.com/science/article/abs/pii/S0738081X05001288?via%3Dihub)


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