Many women describe pregnancy as a beautiful and transformative experience. For many women, this is true. There’s another pregnancy side, one that isn’t as glamorous. It’s not all ultrasound photos, nursery ideas, and baby movements. One of the less-discussed challenges is PUPPP skin rash, a condition that’s incredibly common and extremely itchy.
You’re not the only one who has never heard of this name. PUPPP is Pruritic Papules & Plaques of Pregnancy. This medical term may sound complicated (and it is), but it’s not just a medical abbreviation. It’s also a frustrating and sleepless part of late pregnancy for 1 in 150 women.
What is rash PUPPP? Why does it occur? How can you survive it without itching your skin to death? Let’s discuss it, women to women.
What is PUPPP Rash exactly?
PUPPP is a skin disorder that usually appears during the 3rd trimester. The rash starts off innocently. Maybe you notice a small red patch near your stretch marks. After a few days, the patch is bigger. It’s now spreading to your legs. Next, your arms. You’ll soon find yourself scratching frantically at night, wondering if it’s going to be a good night.
The rash begins on the stretchmarks of a pregnant woman’s stomach–those silvery areas with stretched skin that develop as a baby bump grows. The rash may spread from there to the buttocks and thighs. It can also affect the arms, legs and back. It can sometimes reach the feet and hands, but usually the face is spared.
It starts as small red or pink bumps that look like insect bites or hives. These bumps may eventually merge to form larger areas of red or plaques. Some women develop small bumps on the skin around the rash.
The rash is not harmful to you or your child, but it can be incredibly itchy at night. Let’s face it, by the third trimester, most women already have enough anxiety, sleepless nights, backaches and heartburn. A full-body rash is not helpful.
What causes PUPPP Rash?
This is where things start to get murky.
Doctors do not know what causes PUPPP. There are several theories, all of which relate to how the body reacts to the physical changes that occur during pregnancy.
Theories about PUPPP causes:
- Skin Stretching. One of the more common theories is that rapid abdominal growth during pregnancy, particularly in the first trimester, can cause damage to the connective tissues of the skin. This stretching can trigger an inflammatory reaction, which results in a rash.
- Hormonal changes: Some experts believe the hormonal shifts during pregnancy–particularly in the third trimester–may play a role in triggering the immune system to react with a rash.
- FetalDNA A fascinating theory (and a little bit sci-fi), suggests that fetal skin cells can migrate into the mother’s skin, triggering an immune response. It’s almost as if the body believes it is being invaded. This may explain why PUPPP is more common among women who are carrying boys.
- Genetics. There is also speculation that PUPPP may have a hereditary component. It could be passed on through the father’s side family.
There is no sure-fire way to stop it, and there is no conclusive cause.
Who is at Risk?
PUPPP is technically possible for anyone. However, some women are at a higher risk than others. PUPPP is more common in women who:
- First time you’re pregnant
- You are Caucasian
- You are carrying a baby boy
- You are expecting twins or multiples
- If you have a rapid or significant weight increase
- You have a history of PUPPP
- You have the blood type Rh positive
- You have high blood pressure during pregnancy
It’s important to note that women with or without all of the risk factors can still get PUPPP. Like so many other things during pregnancy, it’s unpredictable.
What are the symptoms of PUPPP?
PUPPP’s hallmark symptom is intense itch. This occurs most often on the buttocks, belly, and thighs. Itching can be mild to severe, especially at night, when you are trying to sleep and your mind is quiet.
Other symptoms include:
- The bumps are small, reddish or pink and resemble insect bites.
- Plaques
- In some cases, bumps and fluid-filled blisters may occur.
- Spreading pattern that usually starts at the abdomen, and then moves out.
- Sleep disruption caused by discomfort and itching
Always consult your doctor if you experience a rash during pregnancy. PUPPP, while benign, can be more serious than other pregnancy-related rashes.
How is it diagnosed?
PUPPP can be diagnosed by a physical exam and a discussion of symptoms. Your GP or dermatologist may ask about:
- What caused the rash?
- Its location
- You may have experienced other symptoms such as fever or infection
- It’s your first or multiple pregnancy
Your doctor may perform a Skin biopsy or blood tests to rule out any other condition, especially if your rash is unusual or does not respond to standard treatments.
Is PUPPP Dangerous?
It is the good news that is not harmful to you or your baby.
The rash may cause discomfort, but it does not indicate a more serious problem. PUPPP is not associated with preterm labour, growth restrictions, or complications in delivery. The majority of babies born to PUPPP mothers are healthy.
PUPPP is also emotionally draining. The itching, sleep loss, and lack of control can be incredibly frustrating–especially when you’re already coping with third-trimester exhaustion. It’s fine to admit that and seek both physical and emotional relief.
What is PUPPP treated?
There is no cure for PUPPP. Only symptom management. PUPPP can only be “cured” by delivering a baby. The rash usually fades in just a few days up to six weeks following delivery. In rare cases, it may last longer.
How to treat the symptoms
Topical Treatments
- Steroid Creams: They reduce inflammation and itch. Your doctor might prescribe mild to moderate corticosteroids.
- Moisturisers: Keep skin hydrated to prevent irritation.
- Baking soda or oatmeal baths are soothing to the skin and help with itching.
Medications:
- Antihistamines can help reduce itching, particularly at night.
- Oral Corticosteroids In severe cases, a short course of oral corticosteroids may be prescribed.
Tips for a comfortable and stylish lifestyle
- Avoid baths or showers as they can irritate and dry the skin.
- Use cool compresses to soothe itchy skin.
- Avoid synthetic fabrics and choose cotton clothing that breathes.
- Keep cool environments. Heat tends to aggravate the itching.
- Avoid friction by wearing loose clothing.
Rest is the most important thing to do. When you are uncomfortable, sleep can be difficult to come by. Small things such as sleeping with a fan, using icepacks, or elevating your leg may help.
Does it happen again in future pregnancies?
You’re more likely to experience PUPPP again if you have had it before, but not to the same extent. Many women have reported that the rash was less severe, or even not present, during subsequent pregnancies.
If your PUPPP appeared during pregnancy or was severe at first, it’s possible that the condition could return. Inform your team of future pregnancies to ensure they monitor your skin and can begin treatment early if necessary.
Last Thoughts: You are not alone
You may be scratching your stomach at 2 am.
You are not the only one who is worried about this mysterious rash.
PUPPP rash can be frustrating and is a common occurrence. You’re not imagining it. You don’t “shouldn’t” complain about it. It’s okay to get fed up.
The good news PUPPP is a temporary and relief is near. After your baby’s birth, the rash should fade and your skin return to normal. Give yourself permission to rest and seek help. You can also soothe your skin in any way you like.
The pregnancy is not always perfect. You’re doing a great job, despite the discomfort and itching.
Do you want this article formatted as a podcast, health newsletter, or parenting blog? I can help you to break it down in social media posts or into a printable guide for expectant mothers.
