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PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy)

PUPPP (pruritic urticarial papules and plaques of pregnancy) is a very common skin rash that can occur later in pregnancy. It’s sometimes called PEP (polymorphic eruption of pregnancy). People with PUPPP have patches of small, itchy red bumps over their belly (abdomen). These patches may also spread to the buttocks, breasts, and thighs. The PUPPP rash doesn’t affect the pregnancy. It doesn’t harm the baby. In most cases, the rash goes away shortly after the baby is born.

What causes PUPPP?

Experts don’t know exactly what causes PUPPP. But it may be due to excessive skin stretching on the belly during pregnancy, especially if someone is pregnant with more than 1 baby (multiple birth). It’s possible that this stretching may damage connective tissue. This may cause an inflammatory reaction that results in the rash.

People are more at risk for PUPPP if they:

  • Are pregnant for the first time

  • Gain a lot of weight very quickly during pregnancy

  • Are pregnant with twins or triplets (multiples)

Once you’ve had PUPPP, the rash isn’t likely to come back in another pregnancy.

Symptoms of PUPPP

The PUPPP rash often starts in the last 2 to 3 weeks of pregnancy. But it can appear any time after the 24th week. It usually goes away about 7 to 10 days after the baby is born. In some cases, it may last longer.

The rash is often first seen in the stretch marks that appear on the belly during pregnancy. It may spread from the stomach over the breasts, buttocks, thighs, and sometimes the arms.

The rash is made up of small, raised, pimple-like bumps that look like hives. These red spots often cluster together to form larger patches. The patches may have small blisters in the center. The skin around the patches is often very pale.

The PUPPP rash is often very itchy. In some cases, the itching can be severe enough to keep you awake at night.

In most cases, the rash doesn’t come back in future pregnancies.

Diagnosing PUPPP

PUPPP usually clears up after delivery. Treatment is focused on easing the itchiness and reducing the rash. Symptoms can often be controlled with a combination of:

  • Corticosteroids. A mild rash can be treated with topical creams.

  • Nondrowsy oral antihistamines. These medicines can help ease itching.

Sometimes the itching is so severe that it can disrupt your sleep. If this is the case, talk with your healthcare provider. They may prescribe short-term corticosteroids that you can take by mouth.

Online Medical Reviewer: Heather M Trevino BSN RNC
Online Medical Reviewer: Irina Burd MD PhD
Date Last Reviewed: 5/1/2022
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