PUPPS Rash During Pregnancy – What You Need To Know

PUPPS Rash During Pregnancy – What You Need To Know

Pregnancy brings with it many experiences – some amazing and some less welcome. For around 1% of pregnant women, a very unwelcome side effect is an itchy rash known as PUPPS (pruritic urticarial papules and plaques of pregnancy).

PUPPS rash can be unsightly, but fortunately it doesn’t cause any harm to your baby – just a lot of discomfort for you.

If you have an itchy rash appearing on your baby belly, it’s possible you have this condition.

Find out more about what it is, what causes it, and how to treat it.

What Is The PUPPS Rash?

The rash appears as small bumps some time in the third trimester, usually around 35 weeks, but sometimes women can experience it earlier. It begins on the abdomen, around the belly button (but not inside it), or in stretch marks.

The rash is quite distinctive, appearing as very itchy bumps which may look like stretch marks. Over time, it spreads over a larger area, and becomes bumpy and red and welt-like.

From the abdomen, the rash will start to spread to other parts of the body, including the thighs, buttocks, breasts, neck and face.

PUPPS usually lasts around 6 weeks. In some cases women experience PUPPS after the birth of their baby, and find it worsens immediately after the birth and then clears up after 2 weeks.

What Causes PUPPS?

Research hasn’t discovered what causes PUPPS but it only occurs to women during their first pregnancy, and generally when they are carrying multiples. The link to multiples pregnancy has led researchers to believe it could be an inflammatory response to rapid abdominal wall stretching.

Around 70% of PUPPS occurs in women having boys, and some research is looking at the possibility that male DNA acts as a skin irritant. However, because 30% of cases are in women who give birth to girls, this cannot be the only cause.

Other studies are looking at the possible link between PUPPS and obesity in pregnancy, Rh-positive blood types and genetic factors.

PUPPS is not linked with any other pregnancy complication, such as gestational diabetes, hormone imbalances, fetal abnormalities, hypertension or preeclampsia.

Can PUPPS Be Prevented?

Unfortunately there is no way to predict who will get PUPPS and who will avoid it. There are several different conditions that can cause pregnancy skin rashes, so it’s important to see your care provider for an accurate diagnosis and a management plan. The itchiness of PUPPS is intense and can cause fatigue due to disturbed sleep, and infection due to severe scratching; it can also severely affect your mood.

Treatment Options For PUPPS

If your care provider diagnoses PUPPS you have a number of options for relieving the itchiness:

  • Topical corticosteroids: these creams are applied directly to the rash, and aim to relieve itching and the appearance of the rash.
  • Oral corticosteroids: these are given in more severe cases.
  • Oral anti histamines: these tend to be less effective but might help control itching. Different types work for different women.

You might prefer to avoid medications, or use more natural treatments as well as those above:

  • Moisturisers keep your skin hydrated. Organic virgin coconut oil and olive oil are good natural choices.
  • Flaxseed oil and dandelion root are said to be very effective in relieving symptoms. You can buy them in capsule form, but check with your care provider before taking any herbs.
  • Oatmeal can be used in a warm bath or shower, or as a moisturiser. There are some commercial products available or you can use oatmeal in a stocking.
  • Pine tar or coal tar soap.
  • Cool, wet compresses directly on the rash.
  • Avoid tight clothes made from synthetic fibres. Loose and light cotton clothing will be less likely to irritate your skin.
  • Avoid hot and humid conditions.
  • Keep your nails short and filed, so if you do scratch you are less likely to break the skin, which can lead to secondary infections.

PUPPS And Induction

Women who are experiencing the intense itch from PUPPS would give anything for relief. The only cure for PUPPS is birth, but there is no guarantee it will disappear immediately after birth.

If you are considering requesting an induction because of the extreme discomfort of PUPPS, bear in mind there are risks associated with early labour and birth, and your care provider should discuss them with you. Induction also carries risks for both you and your baby.

PUPPS is a relatively uncommon complication of pregnancy and might last a few weeks after the birth of your baby. There’s a number of reasons why science thinks women experience this intensely itchy rash, but so far there are no definite answers. If you have any kind of rash during pregnancy, it’s important you seek the advice of your care provider to rule out any other kind of condition.

Recommended Reading: How To Bring On Labour Naturally – 11 Natural Methods.



Sam McCulloch enjoys talking so much about birth that she decided to become a birth educator and doula, supporting parents in making informed choices about their birth experience. In her spare time she watches Downton Abbey and has numerous creative projects on the go. She is mother to three beautiful little humans.

One comment

  1. Hi there, I got PUPPS in the last month of my pregnancy and yes I did give birth to a boy. However the rash started at my ankles and spread up my legs, with only a few spots appearing on my belly, although it was very itchy there too. It began where I had become swollen around my ankles from standing at work. When I left work and spent less time on my feet, the rash slowly faded and stopped itching before I went into labor. I read online that PUPPS is related to stretching skin so this made sense in my case. I did have gestational diabetes but I am pretty fit and slim so not sure about the potential link to obesity.

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