How To Deal With PUPPPs Rash In Pregnancy

When you think about pregnancy skin, one of the first things that often comes to mind is the pregnancy glow. But a healthy glow is not the only thing pregnancy can do to your skin., It can also bring acne, stretch marks, and, for some women, a painful and itchy rash known as PUPPPs.

Let’s talk about what causes PUPPP rashes, what you can do about them, and when you can expect relief.

What Is PUPPP?

PUPPP, short for pruritic urticarial papules and plaques of pregnancy, is an itchy but benign rash that occurs during pregnancy. It’s fairly normal, occurring in about 1 in every 150 pregnancies, and is more common in first-time moms and moms carrying multiples (source).

The PUPPP rash normally begins in the stretch marks on your belly, and looks like small pimple-esque hives in the beginning (source). The rash is often red and patchy, closely resembling eczema. It is also extremely itchy.

Within a few days, it will then move onto other parts of your body like your back, legs, buttocks, and arms. The good news? It never goes to your face for some reason. No one seems to know why, but we are grateful either way.

It’s Also Known As

PUPPP is a rash of many names.

Your doctor might use any one of the names below to describe the same condition:

  • Bourne’s toxemic rash of pregnancy.
  • Toxic erythema of pregnancy.
  • Nurse’s late-onset prurigo.
  • Polymorphic eruption of pregnancy (PEP).

While some of these sound scarier than others, they are all the same condition.

Who Gets It?

PUPPPs develops at a higher rate in women who are Caucasian, experiencing their first pregnancy, or are pregnant with multiples. It also seems to occur more often in women pregnant with a boy or those who are experiencing high blood pressure during their pregnancy.

While these scenarios might make you more likely to experience PUPPPs, remember that women can still have PUPPPs without these risk factors. PUPPPs does not discriminate and can affect women of all nationalities and skin types.

What Causes It?

No one knows exactly what causes PUPPPs, but some studies show the following reasons may cause a woman to experience PUPPPs while her friends do not.

1. Skin Stretching

When stress is put on the skin, causing it to stretch quickly, it can damage the connective tissue (source). This is what causes stretch marks, but in some pregnancies, it can also cause a PUPPP rash.

This is why it’s more common for PUPPPs to occur in women who are pregnant for the first time or are carrying multiples. The faster your skin stretches, and the more it stretches, the more damage occurs and the higher the risk for PUPPPs.

Learn More
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2. Fetal Cells

Fetal cells can migrate to different parts of the mom’s body, and that includes your skin. While sometimes this benefits the mom because it protects against certain diseases, your body can also look at these fetal cells as a foreign body it needs to fight against.

Some studies show that PUPPPs rash is a reaction to the fetal cells that migrate to your skin. Fetal cells seem to migrate to the skin more often in women who are pregnant with boys, which would explain why 60 to 70 percent of PUPPP cases occur in moms who are carrying a boy.

3. An Overworked Organ System

The liver is our body’s main detox organ, while the kidneys are in charge of filtering out our blood. If your liver is over compromised and unable to detox your body’s toxins properly, this can sometimes reveal itself in a skin rash or discoloration. The same can happen if the kidneys are having a hard time keeping up.

Some believe a liver detox can help treat PUPPPs rash. There are also studies that show blood cleansing can help get the kidneys to function properly and relieve the PUPPP symptoms (source).

How Is It Diagnosed?

It’s important to see your doctor for an official diagnosis instead of assuming your rash is PUPPPs. That’s because while PUPPPs is generally harmless, other similar conditions can develop during a pregnancy which are a lot more serious.

Conditions such as pemphigoid gestationis, which can be passed on to your baby, need to be ruled out (source). Cholestasis, which can also cause a rash, is a liver disease that can occur in pregnancy and carries risk factors such as preterm birth, fetal distress, and even stillbirth (source).

Will It Require a Test

Most doctors can diagnose PUPPP with a simple clinical exam, but they will sometimes order a skin biopsy to rule out other issues. Other tests they might order to rule out other infections conditions are blood tests including a liver function test, a complete blood test, serum cortisol, and a serum human choriogonadotropin.

Can I Prevent It?

Unfortunately, no, there is no way you can fully prevent PUPPPs from happening. That’s because we aren’t always sure what causes it, and some things, like migrating fetal cells, can’t be prevented.

What you can do is make sure to eat a healthy diet, gain weight slowly and steadily, and try not to scratch as your skin stretches to prevent irritation. These things can help lower your risk factors for PUPPPs.

Will It Hurt My Baby?

Getting sick while pregnant can be a scary situation. You don’t only have yourself to worry about, you have your healthy baby too. Thankfully, PUPPPs is not a condition you have to stress over.

PUPPPs will cause itching, and, in worse cases, can lead to permanent scarring on the areas in which it occurs. But other than that, it is a relatively harmless condition that does not have any long-term effects on either you or your baby.

12 Tips for Managing PUPPP

The bad news is there is no definitive cure for PUPPPs — all that is known is it will usually go away within several weeks after your baby is born (source). But the lack of a cure does not mean you have to sit idly by while your body feels like it’s slowly being taken over by a colony of ants.

Below is a list of tried-and-true methods that can help gain some relief from the itching, and help you maintain your sanity while dealing with PUPPPs.

  1. Do Not Scratch: When you have an itchy area of skin it’s normal for you to want to give it a good scratch. Don’t! Scratching only leads to further damaging already stretched-out skin and will eventually just make your rash worse.
  2. Antihistamines: Oral antihistamines can do a great deal to relieve the itching that comes with a rash like PUPPPs. But while they are usually safe to take while pregnant, you should still talk to your doctor before choosing one that is right for you.
  3. Oatmeal Baths: Oatmeal baths can help to relieve itching and also soothe and moisturize your skin. Take one cup of oats and process it with a blender or food processor until it reaches the consistency of a fine powder. Then place it into a bathtub filled with warm water. If you do not want to deal with the mess the ground oatmeal can leave, you can also place the ground oats into a cheesecloth or muslin bag and allow the water to run over it into the bath.
  4. Moisturize: Aloe vera, Vitamin E, cocoa butter, coconut oil, and shea butter are all topical moisturizers that can help to soothe your skin and stop the discomfort that comes with PUPPPs rash. You should avoid moisturizers that contain fragrances since they can be drying to the skin. You should also avoid moisturizers that contain retinol, Vitamin A, and salicylic acid since they have been known to cause birth defects (source).
  5. Steroids: Steroids can be an effective way to treat PUPPPs rash, but make sure you do so only with your doctor’s guidance. When you go to your doctor, they might first suggest a topical steroid cream with hydrocortisone to help with the areas of itching.If your rash continues to get worse, they might even prescribe a round of oral steroids to treat the condition more aggressively.
  6. Grandpa’s Pine Tar Soap: Why this soap works isn’t clear, but some moms swear by it. The best part is it doesn’t only seem to help with the itching, but for some women, it helps with making the rash go away. For this treatment, wash the affected area, as well as the skin around it, three times a day. After bringing up a good lather with the soap, rinse it off with cool or lukewarm water. Moms who have used this method say they have seen the rash start to disappear in as little as three days.
  7. Cold Compresses: Cold temperatures can slow down the transmission of nerve signals to your rash, temporarily helping with the itching the rash can bring on (source). Simply soak a cloth in cool water and then lay it on the affected area. You can also soak it in cold milk for a compress that will help nourish the skin while it cools it.
  8. Soft Clothing: Nothing is more annoying than an itchy sweater against the already aggravated skin. While dealing with PUPPPs, choose soft and loose clothing. These will be more comfortable and won’t irritate your skin more than it already is.
  9. Flaxseed Oil: Flaxseed oil is often used to help heal rashes and calm the itching and burning that comes with them. This oil is not used topically though. For best results you should instead drink it daily by mixing two tablespoons of the oil with a cup of milk.
  10. Vegetable Juice: Although it is not proven as a way to help PUPPPs, vegetable juice is a well-known way to detox. Drinking fresh vegetable juice daily can help your liver keep up with detoxing for your body. This, in theory, can help relieve PUPPP symptoms if liver toxicity is the cause. Beets, broccoli, kale, and parsley are all good vegetables for juicing and are known for their detox properties (source).
  11. Natural Anti-Inflammatories: Calendula and chamomile are natural anti-inflammatories, and when applied topically can give some relief to itchy and irritated areas. Combine the herbs with either aloe vera, witch hazel, or unscented lotion and apply to your rash three times a day.
  12. Dandelion and Nettle Leaf: Dandelion root and nettle leaf are known to help purify the liver and blood. Dandelion root helps with liver function and nettle leaf is used as an antihistamine and anti-inflammatory. You can use these herbs as a tea or in capsules taken daily.
In my experience, the two things that contribute most to urticarial rashes like PUPPPs are heat and itching. Heat and sweating will make this type of rash worse and itching releases more histamine in the skin, which makes urticaria much worse.
Headshot of Christine, Traxler, MD, BS

Editor's Note:

Christine Traxler, MD, BS

The Bottom Line

PUPPPs can be painful, itchy, and irritating. If it’s happening to you, we understand how annoying it can be. We’ve been there, done that, and with a lot of patience and self-control, we reached the light at the end of the PUPPPs tunnel.

If you’re currently experiencing the discomfort that PUPPPs can bring, remember that this is not forever. The rash will go away within weeks of your baby being born, and soon it will all be just a distant, albeit annoying, memory.

Did you experience PUPPPs during your pregnancy? What did you do to help you get through it?

Do you have a mama friend currently dealing with the discomfort of PUPPPs? Please share this article with her.

We hope she can find some relief through the tips we’ve shared. That way she can get back to the excitement of waiting for her little one’s arrival!

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