PUPPS rash

Pruritic urticarial papules and plaques of pregnancy (PUPP) is a skin condition that is developed during pregnancy and it causes itching. It is one of  the most common and apparent skin rash evident in pregnant ladies. PUPPS is known by other terms like PEP (Polymorphic eruption of pregnancy) in UK, toxemic rash of pregnancy, toxic erythema of pregnancy and late onset prurigo of pregnancy.

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Itching is a very common problem among pregnant women. Because of the fact that during pregnancy there are many changes in the body from increased hormone production to stretching of skin, it is most likely to develop skin irritations during gestation. PUPPS rash is most likely to happen to a woman if it is her first pregnancy or she is going to give birth to a boy.

The rashes are mostly developed during the 35th week of pregnancy and occurs on an average in 1 of every two-hundred first time cases of pregnancy. This skin condition has very noticeable signs and symptoms.


Till date, the causes of PUPPS rash are not known but there are definitely some hypotheses about this skin condition.

The first reason considered for outburst of PUPPS rash is that during pregnancy abdominal wall suddenly swells up. The temporary impairment of connective tissues around it causes inflammatory reaction and so rashes are developed.

The second proposal is that male DNA in woman’s body causes irritation. There is also a supporting study for this hypothesis. It is noticed that around 3/4th of the ladies with these rashes give birth to baby boy.

However this is for sure that PUPPS has nothing to do with preeclampsia, hormones, autoimmune disorders or abnormalities related to fetus. It is also said that PUPPS rash occur when the woman is expecting multiples i.e. twins, triplets etc. Hypertension is also one reason.

There is a potential risk associated with this skin disorder which is the bacterial infection caused due to scratching. But it can be minimized or prevented by keeping the affected area clean and keep scratching to minimum.


The  presence of PUPPS rash is mostly known as bumpy, itchy papules which after few days become red, scaled skin with swelling. In the beginning they are stretch marks which turn into bumpy, red, big rash.

Mostly, the PUPPS rashes are developed around the time stretch marks are formed on the belly. These look like small red nodules in the beginning but few days later they grow and appear as large red patches which are prominent not only on the abdomen but other parts of the body as well.

Generally the condition does not affect the skin but they spread to body parts like breasts, arms, thighs and buttocks. However if the rash comes severe, it can reach up to legs and neck of the woman.

PUPPS is also associated with itching that is most in the very first week and gradually reduces but never goes away. This skin disorder makes woman very uncomfortable and gives a feeling of discomfort especially during hot season. For most women itching is the most difficult thing about this skin problem.

The fortunate part is that doctors and experts have not yet reported any potential threat to the mother and baby. To summarize the signs and symptoms of PUPPS, here is a comprehensive list:

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  • Redness
  • Colour of the rash changes with time
  • Causes itching
  • Appears on abdomen first and later begin to spread on other parts
  • Small blisters
  • Lesions which appear like eczema
  • No rash present on belly button
  • Stretching of the skin and so stretch marks is the sign of onset of PUPPS rash


In most of the cases, PUPPS rash occur between 33 and 36 months of pregnancy. But in few women it can arise as early as second trimester. PUPPS is clinically diagnosed which means to diagnose this condition it is important to study the symptoms. There are no tests to diagnose this skin disorder but biopsies are sometimes done to arrive at the conclusion by eliminating other associated reasons of the development of rash.


The only cure for this skin problem is to give birth to the baby but its growth can be reduced and discomfort associated with it can be greatly reduced. Wear loose clothes, keep cool and do not go near hot places, apply cold compresses or cold mist at the affected area.

Further, oatmeal and tar pine soap baths are used to provide soothing affect but these are not the permanent solution. Do not bath in hot water and use only cold or warm water because hot water will aggravate the skin problem.

Certain medications are also prescribed for relieving PUPPS. These include steroidal creams like cortisone and oral histamines. But before taking any preventive measure it is always advised to consult a doctor or midwife.

Pupps rash pictures

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