What is PUPPs During Pregnancy?

Pregnant and Wondering About That Skin Rash? Learn More About PUPPP

PUPPP often starts in the stretch marks.
PUPPP often starts in the stretch marks.. Science Photo Library - IAN HOOTON/Getty Images

Are you pregnant and experiencing a rash on you body? Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy, is the most common rash in pregnant women. It normally occurs in a woman's first pregnancy, during the third trimester, with an average onset of 35 weeks, or to mothers carrying multiples. Thankfully, PUPPP does not usually affect subsequent pregnancies.

Appearance of PUPPP

The rash of PUPPP almost always begins in the stretch marks (striae) of the abdomen. It does not involve the belly button, which is the way doctors are able to distinguish the symptoms from other common rashes of pregnancy.

The rash itself consists of small, red, itchy bumps in the stretch marks that grow together to form larger wheals on the abdomen. Sometimes the rash can include small vesicles. Over the next several days, the rash can spread over the thighs, buttocks, breasts, and arms.

The rash is pruritic (an unpleasant sensation of the skin that gives you the urge to scratch it) hence the name. This condition is harmless to mother and baby, but can be very annoying. It lasts an average of 6 weeks and resolves by itself 1 to 2 weeks after delivery. The most severe itching normally lasts for no more than 1 week.

What Causes the Rash?

The cause of PUPPs during pregnancy is unknown.

It is not associated with preeclampsia, autoimmune disorders, hormonal abnormalities, or fetal abnormalities. Though higher levels of the male fetal DNA can be found in skin biopsies of the rash. Since approximately 70% of women with PUPPP give birth to boys, it has been hypothesized that male fetal DNA may act as a skin irritant.

Pregnancies with increased maternal weight are also associated with PUPPP, causing some researchers to suggest that the rapid abdominal wall growth and stretching damages connective tissue, causing an inflammatory response.

Diagnosis of PUPPs of Pregnancy

There are no laboratory tests that detect PUPPP, so the diagnosis of PUPPP is clinical, meaning it is based solely on the appearance of the rash.Skin biopsies are not generally performed unless there is a question about the diagnosis.


The treatment of PUPPP is symptomatic. This means that medication is given to relieve the rash and reduce itching, including:

  • High strength steroid creams or ointments, such as clobetasol (Temovate) or betamethasone (Diplrolene), used up to 5 to 6 times a day usually relieve the itching and prevent the spread of the rash.
  • Once the rash is under control, changing to a lower strength steroid used less frequently is advisable.
  • Oral antihistamines such as atarax, benadryl, and zyrtec, are generally less effective for itching than steroids, but may be useful at night to help with sleep.
  • Oral steroids are generally avoided during pregnancy, but they may be necessary to control itching for extremely severe cases. Your doctor may consider inducing labor (if you are close to your delivery date and the itching is extreme) instead of starting you on a dose of oral steroids.

Fortunately PUPPs during pregnancy does clear up within a couple of weeks after delivery. It also poses no long-term harm to you or your baby.


Cohen LM, Capeless EL, Krusinski PA, Maloney ME. Pruritic Urticarial Papules and Plaques of Pregnancy and Its Relationship to Maternal-Fetal Weight Gain and Twin Pregnancy.Arch Dermatol.1989;125(11):1534-1536.

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