Puppp Rash

What is puppp rash?

PUPPP refers to Pruritic Urticarial Papules and Plaques of Pregnancy. Pregnant women often experienced this unique skin rash. The onset of the PUPPP is more common at last trimester, but there is a possibility of the occurrence at any stage.

The different countries denoted this with various names which include Polymorphic Eruption of Pregnancy (PEP), specifically used this term in the United Kingdom. PUPPP is also named as toxemic rash of pregnancy, toxic erythema of pregnancy and late-onset prurigo of pregnancy.

Puppp rash in pregnancy

Image 1: Puppp rash in pregnancy

The prevalence of the development of PUPPP is more common in first time pregnancy and different surveys are reported that the probability of incidence rate is 0.5%.

Though the symptoms are not fatal for both the mother and her baby, but it provides too much uneasiness and depending upon the patient discomfort, gynaecologists even suggest initiating the labor before one week of the usual duration (at 39 weeks).

Usually after delivery within a week, the symptoms disappear, rarely sustained for a longer period and may be due to retention of the placental product. There is a negligence chance of recurrence with subsequent pregnancy or by using of oral contraceptives.

Puppp rash condition before and after pregnancy

Image 2: Puppp rash condition before and after pregnancy


The discomfort due to PUPPP rash is mainly due to itching sensation. The first appearance of the rashes is usually in the region of the umbilicus, where the stretching is most. Then it extends on the buttocks and proximal thighs and can extend over the trunk and lower limbs. The specific characteristics of the PUPPP rash are:

  • Papules (small red or pink coloured) arises within majorly with the part where maximum skin distension occurs
  • Rashes are elevated
  • Small vesicles shaped
  • PUPPP rash does not appear on the palms, soles and face.
  • PUPPP rash is intensely pruritic, rarely excoriations.
  • Night sleep disturbance
  • Pale colour is developed at the surrounded part of the papules.
  • These papules unite to form urticarial plaques (large red, raised patches)
  • Rarely extended to the breast.


The exact reason of development of PUPPP rash is not known, different researchers provide the possible reasons of PUPPP rash occurrences, which are as follows:

  • Multiple gestation pregnancies, the risk are higher for triplet over twin due to stretching of the abdominal skin is much more.
  • Increased maternal weight gain due to maximum skin expansion.
  • Maternal hypertension
  • With Male foetus has greater chances than female foetus (ratio 2:1)
  • Chimerism due to presence of foetal deoxyribonucleic acid (DNA) in the skin of mothers

Other possible causes are

  • At the last trimester, the skin extension is too much
  • Abdominal skin is tight in the first pregnancy
  • Wight of the baby is more than the normal.


It is advisable do not treat this symptom by own, as the medication side effects may produce adverse effects to foetus. It is also recommended to follow natural treatments, as they have no side effects which can initiate adverse events. Following are some natural treatment options and advices are given:

  • Use of cool, soothing baths;
  • Topical application of emollients, preferably Aloe Vera and oat preparation, which provide cooling sensation. Other than these local application of moisturizing lotion and aqueous based ointments are also beneficial.
  • Cool soaks and ice pack
  • Avoid exposure of sun or hot climate which worsen the itch
  • Wear loose cotton clothes, synthetic tight wearing increase the discomfort

Other than these, in worsening situation, doctor may recommend:

  • Topical application of corticosteroid ointments or creams which contain less quantity of prednisone or hydrocortisone.
  • Anti-allergic tablets which restrict the release of histamine by stabilizing the mast cells. These tablets include cetrizine and many more and have fewer side effects in the foetus in the last trimester.
  • Very rarely doctor prescribed oral corticosteroid for very severe cases which cannot be controlled by other medications, as systemic absorption of corticosteroid has several side effects which may hamper child growth. Though the chances of adverse events are less as in last trimester child’s bone development almost completed.


puppp rash image

puppp rash photo

puppp rash

puppp rash images


  1. http://www.dermnetnz.org/reactions/puppp.html
  2. http://www.pregnancycorner.com/being-pregnant/complications/pupps.html
  3. http://emedicine.medscape.com/article/1123725-overview
  4. http://www.babycenter.com/400_puppp-remedies_1790484_958.bc
  5. http://www.whattoexpect.com/pregnancy/whose-body/skin-rashy.aspx

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