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How to Identify and Treat PUPPP Rash

puppps rash

Pruritic urticarial papules and plaques of pregnancy (PUPPP) rash is an itchy rash that appears in stretch marks of the stomach during late pregnancy.

While the exact cause of PUPPP rash isn’t known, the stretching of the skin seems to be a trigger for the rash to occur. PUPPP rash occurs in about 1 in every 150 pregnancies.

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Other names for the condition are:

  • nurse’s late-onset prurigo
  • Bourne’s toxemic rash of pregnancy
  • toxic erythema of pregnancy
  • polymorphic eruption of pregnancy

What Are the Symptoms of PUPPP Rash?

Typically, the PUPPP rash will appear during the third trimester of pregnancy. Your baby’s growth rate is very rapid during this time, especially during the last five weeks of pregnancy.

It’s most likely to occur during a first pregnancy and during a multiples pregnancy, where the skin stretches even more.

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During your pregnancy, sometimes your skin stretches faster than your skin cells can keep up with. This can cause stretch marks to appear. Adding further insult to injury is the PUPPP rash, which can occur in the stretch marks around the bellybutton.

PUPPP usually begins on the abdomen and spreads to other extremities within a few days.

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The rash appears as small, pink pimple-like spots that appear in the stretch marks. They closely resemble hives. Eventually, the rash may start to come together and form large, red, plaque-like areas.

Blisters can sometimes form around the rash. These plaques can then spread from the stomach to the:

  • buttocks
  • thighs
  • arms
  • legs

Usually, the rash won’t spread higher than your breasts.

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A PUPPP rash tends to be very itchy, especially at night. Along with your growing belly, it may affect your ability to get a good night’s rest.

How Is a PUPPP Rash Diagnosed?

Your doctor will typically diagnose a PUPPP rash by examining your skin. Usually no further testing is required. But your doctor may need to rule out another infection, like a fungal infection or scabies.

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Your doctor may order some blood tests to rule out other infections, including:

  • complete blood count
  • liver function test
  • serum cortisol
  • serum human choriogonadotropin (HCG)

What Are the Risk Factors for PUPPP Rash?

Some women are more likely than others to experience a PUPPP rash. Risk factors include:

  • being Caucasian
  • being pregnant with a boy
  • a first pregnancy
  • maternal hypertension (high blood pressure)
  • multiples pregnancy
  • rapid or higher-than-usual weight gain in pregnancy

Some women will experience this rash regardless of risk factors.

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How Is a PUPPP Rash Treated?

The ultimate “cure” for a PUPPP rash is delivering your baby. Usually after you give birth, the PUPPP rash will go away within one to two weeks. But some women may find that the rash persists for a few weeks after giving birth.

In the meantime, you can control your symptoms by trying the following:

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Moisturizers

You can apply itch-relieving moisturizers to your skin as much as relieves your discomfort. Avoid moisturizers that have ingredients that aren’t baby-friendly. Examples include salicylic acids, retinol, vitamin A, retinyl-palmitate, and tropic acid.

Topical Steroids

A steroid-containing cream, such as a 1 percent hydrocortisone cream, applied to any patchy areas can help to reduce itching. While these creams are largely considered harmless during pregnancy, always check with your doctor before using them. Your doctor may also prescribe topical steroids that are stronger.

Antihistamines

These medicines can relieve itch, but always check with your doctor before taking them. Examples of medications that are generally thought to be safe during pregnancy include diphenhydramine (Benadryl) and cetirizine (Zyrtec). These medications have been studied in greater detail than other antihistamines.

Itch-Relieving Baths

Taking an oatmeal or baking soda bath can help to reduce the itching associated with the rash.

A cool, wet compress might also help. Although it can be difficult, avoid scratching the rash when possible. Doing this will likely only make the rash symptoms worse.

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In some cases, a doctor might prescribe an oral steroid to relieve pain and itching associated with the condition. But these are usually prescribed for women who are experiencing severe symptoms associated with the condition, including intense itching and discomfort.

The Takeaway

It’s possible that your baby could be born with a milder form of PUPPP rash. But the rash itself shouldn’t cause any complications for you or your baby.

While a PUPPP rash may have been present during this pregnancy, chances are that the rash will not recur with a future pregnancy. But, there’s a slight chance that you could have a milder PUPPP rash if you become pregnant again. 

Article Resources
  • Polymorphic eruption of pregnancy. (2015, December 30). Retrieved from http://www.dermnetnz.org/reactions/puppp.html
  • Pruritic urticarial papules and plaques of pregnancy. (n.d.). Retrieved from http://www.aocd.org/?page=PUPPP
  • Pruritic urticarial papules and plaques of pregnancy. (2014, June 1). Retrieved from http://www.sw.org/HealthLibrary?page=Pruritic%20Urticarial%20Papules%20and%20Plaques%20of%20Pregnancy
  • Third trimester. (2006, March 3). Retrieved from http://www.netwellness.org/healthtopics/pregnancy/faq9.cfm
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