PUPPP Rash: What is it?

Along with the baby glow and, of course, the bump, you might also see other less welcome changes to your skin during pregnancy and postpartum. With your belly stretching and hormones going haywire, your skin may develop some rashes, stretch marks, acne, and whatnot¹.

Pruritic urticarial papules and plaques of pregnancy (PUPPP) can cause itchy skin rashes during pregnancy and a few weeks after childbirth. This skin condition is often characterized by small purple, pink, or red hive-like bumps which can coalesce to form large patches.

What exactly is PUPPP rash? What causes the rashes and what can you do to alleviate them? Read on for the lowdown on PUPPP — prevention, management, and treatment options, including home remedies to incorporate into your postpartum care.

What are PUPPP rashes and what causes them?

If your belly skin has broken out in itchy red bumps or hive-like patches, you might be suffering from pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy (PEP). This is a rare skin condition, only affecting less than one percent of pregnant mothers in the US.

PUPPP, or PEP, is a cluster of itchy, raised skin rashes that normally appear on the skin of your belly in stretch marks. These annoying yet benign skin rashes can also show up on the arms, butt cheeks, thighs, and other extremities. Although rare, the rash can become extremely itchy and spread to the entire body; except for the face.

PUPPP rash usually emerges during the 3rd trimester, though it can start in the course of the first 2 weeks after childbirth. It appears on average at around the 35th week of pregnancy².

Interestingly, PUPPP often affects moms during their first pregnancy. It’s also more commonly seen in moms carrying multiples or postpartum in those who gave birth to twins or triplets. The reason behind this prevalence is still a puzzle to the scientific and clinical communities.

Whereas they may appear unsightly or feel uncomfortable, PUPPP rashes are generally harmless to you or your little one (thank goodness for that!)

PUPPP Appearance

(image from momlovesbest.com)

The PUPPP rash usually begins as an itchy bump on the skin of the abdomen in the striae (aka stretch marks). Thankfully, the rash doesn’t affect the belly button, which is how physicians and dermatologists tell PUPPP apart from other skin conditions of pregnancy and postpartum, such as eczema, acne, hives, and dark spots.

The rash almost always itches like no one's business and comprises small, itchy red bumps that may bleed into each other to form larger patches on the abdomen. In some cases, the rash may include small clear bumps filled with fluids (also known as vesicles). It can spread for several days to your back, buttocks, thighs, and, often seldom, your legs and arms.

The rash usually appears red or pink in fair skin women; it takes a darker hue or skin-color in women of color or those with more pigmented skin. In either case, these rashes often appear as bumpy skin lesions. Luckily, they won’t appear on your feet, hands, neck, and most importantly, your face.

PUPPP rash is said to be pruritic, which refers to that “scratch me” sensation on your skin. This is how the rash got its name. The average lifespan of the rash is six weeks and it should go away on its own within 1-2 weeks after childbirth. The itchiest phase of the rash usually lasts for less than a week.

What causes PUPPP rash?

What causes it is not yet fully known, but several theories are floating around. What's known for sure is that hormonal imbalance doesn't have a thing to do with it, unlike with most pregnancy and postpartum symptoms.

The first theory postulates that rapid abdominal wall stretching and growth may damage surrounding tissue, leading to an inflammatory reaction. In some corners, experts suggest that cells of the fetus may be invading the mom’s skin, which causes abdominal itching. It’s also thought that the father’s genetics may be responsible.

Prevention, Management, and Treatment of PUPPP

The actual cause of PUPPP is unknown, so there are no viable prevention strategies. If you’re predisposed to PUPPP, you will likely get it. There’s not much you can do to prevent it. Don’t forget that the rash will disappear on its own, plus it’s harmless to both you and your adorable baby.

Be that as it may, PUPPP rash can be extremely itchy and annoying. Good thing, there are a handful of home remedies and other treatment options for managing the rash.

Medications: Your physician, OB/GYN, or dermatologist may prescribe some medications to relieve the pain and discomfort:

• Steroid topicals – If the rash is severe, you’ll start with a high-strength steroid cream to soothe itching and stop it from spreading. Once the rash has been controlled, you can move to a lower-strength cream.

• Oral antihistamine – Think Zyrtec, Benadryl, or Atarax. Though less effective than steroid-based creams, they are great for relief at night

Oral steroids are a big no-no during pregnancy and breastfeeding. So, once the itching is under control, you can turn to home remedies.

Home remedies: there are several effective home remedies for the condition.

• Cold compress – apply it gently on the affected area to calm the itching

• Oatmeal baths – take a soothing oatmeal bath. Use a cup of uncooked or finely ground oatmeal. Baking soda can suffice, too.

• Aloe Vera lotion – The vitamin E in aloe vera will help soothe the itching skin. You can try shea butter gel or lotion, as well.

Try as many remedies as possible. What’s eventually ideal is what soothes the itching. As a general rule of thumb, always wear loose-fitting clothes made from soft, non-itchy material like cotton. 

When do we need to see a doctor?

Seek professional help if the rash becomes too severe or the itching is too unbearable.

Sources:

1. www.acog.org

2. pubmed.ncbi.nlm.nih.gov

Meet Our KeaMommy Contributor: Sara Gale Sara loves traveling and exploring new places with her family. She is mom to 2 lovely children and loves bringing them out on adventures.