PUPPP (pruritic urticarial papules and plaques of pregnancy) is a very common skin rash that can occur later in pregnancy. It usually happens in the third trimester, mainly in the last month. Rarely, it may occur in the postpartum period. It’s sometimes called PEP (polymorphic eruption of pregnancy). PUPPP causes patches of small, itchy red bumps over the 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. It may be due to excessive skin stretching on the belly during pregnancy, especially if someone is pregnant with more than one baby. It’s possible that this stretching may damage connective tissue. This may cause an inflammatory reaction that results in the rash.
You're more at risk for PUPPP if you:
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Are pregnant for the first time.
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Gain a lot of weight very quickly during pregnancy.
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Are pregnant with twins or triplets (multiples).
After 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 although 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. Rash over the face, palms, and soles of the feet is quite rare.
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.
Diagnosing PUPPP
The condition is found mainly based on medical history and an exam. There are no specific tests available for PUPPP.
Treating PUPPP
PUPPP usually clears up after delivery. Treatment is focused on easing the itchiness and reducing the rash. Creams or moisturizers may help ease the itching. Symptoms can often be controlled with:
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Corticosteroids. A mild rash can be treated with topical creams.
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Non-drowsy oral antihistamines. These medicines can help ease itching.
If the itching is disrupting your sleep, talk with your doctor. They may prescribe short-term corticosteroids that you can take by mouth.
