What is PUPPP?

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  • Written By: J.M. Densing
  • Edited By: Jacob Harkins
  • Last Modified Date: 29 February 2020
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PUPPP is an acronym that stands for pruritic urticarial papules and plaques of pregnancy, also known as pregnancy skin rash, or polymorphic eruption of pregnancy. PUPPP is a rash that occurs in a small percentage of pregnant women. It is usually very itchy, and causes multiple raised red bumps, similar to hives. It usually starts on the abdomen, and then may spread to other body parts, and most often begins in the third trimester of pregnancy.

The rash that develops with PUPPP is extremely itchy, in fact the word pruritic in the name refers to the itchiness. It consists of many small, slightly swollen, red lumps, and is usually first noticed on stretch marks, if there are any. From there the rash quickly spreads to the rest of the abdomen, but does not develop on the belly button. As it spreads, larger red raised patches can develop that look like hives. After a few days, it frequently spreads to other areas of the body, like the chest, arms, buttocks and thighs. It does not affect the face, however.


Having PUPPP does not pose any threat to the mother or to the baby, but it can make the mother very uncomfortable. When it occurs, the first symptoms are commonly noticed during the third trimester, on average during the 35th week, and last for the rest of the pregnancy. The itching is usually quite intense, especially during the first week. The rash and itching usually disappear by the second week after giving birth, but in rare cases it can last longer, or even begin after the birth.

There is no clear answer to what causes PUPPP, although there are several theories. It does seem to affect women during their first pregnancy, and those carrying twins, more often than the rest of pregnant women. One theory of cause is that it is genetic on the father's side. Another theory is that fetal cells invade the mother's skin and cause the rash. If a woman suffers from PUPPP during one of her pregnancies, it does not make her more likely to experience it again.

Caution needs to be used when treating the symptoms of PUPPP, a doctor should be consulted. Oral steroids should not be used because of potential harm to the baby. Topical steroid creams or ointments can be used in small, carefully monitored doses, and can provide relief. Antihistamines are generally considered safe and can be used if recommended by a doctor. Some home remedies that can bring some comfort include baking soda or oatmeal baths, aloe vera gel, or cool compresses.


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