What Is PUPPP Rash? Symptoms, Causes, and Treatment

An intensely itchy rash is the last thing you want to deal with near the end of pregnancy. If red, raised bumps have appeared in the stretch marks on your abdomen and begun spreading, you may be wondering whether you have PUPPP rash.

PUPPP stands for pruritic urticarial papules and plaques of pregnancy. It is an uncomfortable but generally harmless pregnancy rash that most often develops late in the third trimester. It usually begins on the abdomen and may spread to the thighs, buttocks, breasts, arms, or legs.^1,5

Here is what PUPPP rash looks and feels like, what may cause it, how it is treated, and when you should contact your healthcare provider.

PUPPP is a very itchy, raised rash that usually begins in the stretch marks on the abdomen during the third trimester. It is not considered dangerous to you or your baby and usually clears after delivery.^1,5

PUPPP is an intensely itchy rash that usually begins in the abdominal stretch marks late in pregnancy.
The rash may spread to the thighs, buttocks, breasts, arms, or legs.
PUPPP is generally harmless to both the pregnant parent and baby.
Treatment focuses on relieving itching and inflammation with provider-approved topical steroids, antihistamines, and soothing skin care.
Contact your healthcare provider about any new or severe pregnancy rash so they can rule out other pregnancy-related skin conditions.

What Is PUPPP Rash?

PUPPP stands for pruritic urticarial papules and plaques of pregnancy. It is also called polymorphic eruption of pregnancy (PEP) and is sometimes abbreviated as PUPPS.¹ PUPPP affects approximately 1 in 160 pregnancies.⁵

PUPPP most often develops during the third trimester, particularly during the final weeks of pregnancy, although it can occasionally appear shortly after delivery.^1,5 It usually begins as small, intensely itchy red or pink bumps within the stretch marks on the abdomen. The bumps may join together into larger raised patches and spread to the thighs, buttocks, breasts, arms, or legs.^1,5

A typical feature of PUPPP is that the rash often surrounds but spares the belly button itself.¹ Because other pregnancy-related conditions can also cause itching or skin changes, contact your healthcare provider about any new rash during pregnancy.

Related: Ways to Cope With Pregnancy Discomforts

What Does PUPPP Rash Look Like?

PUPPP usually develops during the third trimester and often begins within the stretch marks on the abdomen. As the rash progresses, it may spread to other areas of the body and become intensely itchy. Common signs include:^1,5

Small pink or red bumps that begin within abdominal stretch marks
Raised, hive-like patches or plaques
Severe itching that may interfere with sleep
A rash that spreads to the thighs, buttocks, breasts, arms, or legs
Inflamed, irritated, or eczema-like skin

PUPPP usually spares the belly button. If you develop blisters, a rash directly involving the belly button, or a rash that worsens quickly, contact your healthcare provider promptly. These symptoms may point to a different pregnancy-related skin condition that requires further evaluation.¹

What Causes PUPPP?

The exact cause of PUPPP is unknown. Researchers have proposed that rapid stretching of the abdominal skin may contribute, which may help explain why the rash is more common during first pregnancies, multiple pregnancies, or pregnancies with greater abdominal stretching.⁷

Hormonal, immune, and connective tissue changes have also been studied, but no single cause has been confirmed. PUPPP is not considered the result of toxins, poor diet, or an overworked liver or kidneys.⁷

Related: 10 Skin Changes During Pregnancy

How Is PUPPP Diagnosed?

A healthcare provider usually diagnoses PUPPP by examining the appearance and location of the rash and asking when the symptoms began. There is no single blood test that confirms PUPPP.¹

Your provider may order tests or refer you to a dermatologist if the diagnosis is unclear. This helps rule out other causes of itching or rash during pregnancy, including pemphigoid gestationis, intrahepatic cholestasis of pregnancy, eczema, allergic reactions, or infection.¹

Is PUPPP Harmful?

PUPPP is generally not harmful to you or your baby. It can, however, cause intense itching, discomfort, sleep disruption, and considerable stress.^1,6

Because other pregnancy-related conditions can also cause itching or a rash, avoid self-diagnosing and contact your healthcare provider for an evaluation. Seek prompt guidance if the rash blisters, involves the belly button, spreads rapidly, or is accompanied by fever, pain, yellowing of the skin, dark urine, or feeling unwell.

Related: Cholestasis of Pregnancy: What Is It?

How Is PUPPP Treated?

Treatment for this pregnancy rash focuses on relieving itching and inflammation until the rash resolves. Your healthcare provider can recommend options based on the severity of your symptoms and where the rash is located.^2,8

Moisturizers and Cool Compresses

Apply a fragrance-free moisturizer or emollient regularly to help soothe dry, irritated skin. Cool compresses may also provide temporary relief from itching. Avoid heavily fragranced products that may further irritate the rash.

Topical Corticosteroids

Your healthcare provider may recommend or prescribe a topical corticosteroid to reduce itching, redness, and inflammation.^2,8 Follow their instructions about which product to use, how often to apply it, and how long to continue treatment.

Antihistamines

An oral antihistamine may help reduce itching and make it easier to sleep. Ask your healthcare provider which antihistamines are appropriate during pregnancy before taking one.^2,8

Oral Corticosteroids for Severe Symptoms

If the rash is severe or widespread and does not improve with topical treatment, your provider may prescribe a short course of an oral corticosteroid.^2,8

Oatmeal Baths

A cool or lukewarm oatmeal bath may temporarily soothe itching and irritated skin.⁵ Avoid hot water, which can make itching feel worse.

Loose, Breathable Clothing

Wear loose, lightweight cotton clothing that does not rub against the rash. A fragrance-free detergent formulated for sensitive skin may also help reduce additional irritation.

Related: Third Trimester Checklist: What to Do in Weeks 28 to 40+

When to Contact Your Healthcare Provider

Contact your healthcare provider if you develop a new rash or severe itching during pregnancy. Although PUPPP is usually harmless, other conditions can cause similar symptoms and may require testing or closer monitoring.

Seek prompt medical guidance if:

You develop blisters or sores
The rash involves your belly button, face, palms, or soles
You have intense itching without a visible rash
You notice yellowing of your skin or eyes, dark urine, fever, or severe pain
The rash spreads rapidly, or your symptoms become difficult to manage
You notice decreased fetal movement or have any concern about your baby

How Long Does PUPPP Last?

PUPPP most often develops during the third trimester and usually improves after delivery. For many people, the rash fades within several days to a few weeks, although the timing can vary.⁵

PUPPP rarely begins after birth, but postpartum cases can occur. Contact your provider if the rash persists, worsens, or begins after delivery so they can confirm the diagnosis and recommend treatment.

PUPPP can be intensely uncomfortable, especially when it appears during the final weeks of pregnancy. The reassuring news is that PUPPP is usually harmless and typically goes away after your baby is born.

Still, every new pregnancy rash deserves a call to your healthcare provider. Once they confirm the cause, they can recommend safe ways to calm the itching and help you feel more comfortable while the rash runs its course.