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 commonly 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.
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I got an extreme case of PUPPPS at 25 weeks: all over my belly, breasts, and neck. Absolute agony. I couldn’t sleep a wink. I tried every home remedy abs over the counter fix and nothing worked. Prescription 2.5% hydrocortisone didn’t work either. Finally, it got so bad I was subscribed a short stint of oral steroid: predisone. It helped immediately. If I didn’t take it I would have lost my mind.
Hi, I started getting PUPPP rash on my lower belly area around 32 weeks. It was only directly on my stretch marks which wasn’t much. And they did not itch as bad. Here I am at 35 weeks and it got worse this past weekend. The rash has spread upwards on my belly, my hips, my thighs, below my butt, my legs, all around my arms, sides of my breasts, wrists. I was not itching intensely until the rash started to spread and have scratched around here and there. The more I scratch the more it spreads and the more pain I feel. I use a tea tree oil bar soap, cold to work showers. Warm bath with Aveeno Oatmeal. Pat dry. Then I apply Cortizone cream. Then I spray Calamine cooling spray. An oatmeal spray. I use Aloe Vera gel if I the itch really intensifies to cool me down. The heat makes it worse as well so does wearing clothes. I try and stick to as minimal clothes as possible. I’ve also stopped putting my cocoa butter on my body. It does not do justice for my body. I’ve read and read on how to treat and help my body, but only home remedies I see from other moms have helped it for a few minutes to hours. No such thing as a cure besides giving birth. Even at that I see that it takes 2-6 weeks after giving birth for it to go away. Also some moms said it returned around the time they started to breastfeed and was much worse too. I really hope that’s not my case since I want to breast feed. I am having a boy and this will be my first pregnancy. No one I know he’s ever even heard of PUPPP rash. My doctor also only took a slight look at my stomach and said there wasn’t anything he could do. I just had to stick it out. But with it progressing day by day it’s causing me to be nauseous, chills, and slight fevers here and there. I’m hoping this all calms down and I make it to my due date before I scream in pain to be in induced.
Hi there , I am currently pregnant with girl and I have pupps the amount of itchy that I have is crazy till now I don’t have streach Marks I don’t screach my self and if I do is with cloth on not to the skin
It is painful and basic you can’t do nothing about it just cold water on your Bally that make me little better but not 100% good I am 27 weeks so I think I have long journey still to go wish me good luck and good luck to all of you suffering from pupps ☹️
My pupps rash started at 17 weeks. I am carrying a boy. My first pregnancy was a girl, didn’t have it. It became more aggressive my 24th week and spread from my abdomen to lower back, breast arms, and neck. My doctor ordered me prescription strength hydrocortisone. So I bath twice a day, apply ice packs, rub down with organic tea tree oil, then apply the hydrocortisone, coconut oil, then Eucerin lotion, pepcid, benedryl at night. All this twice a day. I seemed to get it under control. Im 33 weeks and it’s flaring up again, but I haven’t stuck to my routine lately. Also I have to wear softer smoother fabrics, cotton and tight clothing makes it worse. Hope this helps.
I started having mild itching around 35 weeks under my abdomen , increasing more around 36 weeks. Basically spreading from my belly to my arms and lastly from my thigh to my feet. I’m in miserable pain ! I have tried everything , bynadril , oatmeal bath , calamine lotion and bio oil. NOTHING helps and the rashes don’t go away but get itched by the hour, unfortunately a miserable ending to my pregnancy.
I feel it’s more stress related. I actually didn’t get it with my first pregnancy which the most easy going. My second pregnancy I was very stressed out all the time and not sleeping well and I got it really bad. That’s actually what caused my stretch marks because I scratched insanely. This time I am having a girl so the boy thing isn’t true. I am again very stressed out and not getting good rest. I heard that it is related to your liver being overloaded trying to fight toxins or whatever it is and that would make sense too because the more stressed and have bad diet or not sleeping well, the harder your liver has to work. It makes perfect sense. With my last pregnancy my midwife got me some anti fungal cream which really helped. I don’t remember what it was though and I have a different Midwife this time so we will see how this thing works out! Been drinking nettle leaf tea which is supposed to help and it seems to help a little but you have to drink like 4-5 cups a day just to feel any slight difference. Not worth it. I’m gonna try the coconut oil. Aloe Vera helps for like 20 minutes lol. This is a journey that I don’t wanna take and I still have two more months of pregnancy to go so hopefully it doesn’t last that long.
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.