Your Red, Itchy, Bumpy Pregnant Skin: PUPPP


Of all the common skin conditions caused by pregnancy, pruritic urticarial papules and plaques of pregnancy, or PUPPP, is probably the one that women find the most frustrating. Similar to linea nigra and striae (stretch marks), PUPPP is benign and harmless to the mother and unborn child. However, this fact doesn't lessen the discomfort and often annoying effects on the skin caused by PUPPP.

The Appearance of PUPPP
Affecting 1 of every 200-300 pregnant women, the development of PUPPP is due to increased hormones, stretching of the skin, and the various reactions of the immune system. It begins as small, red, itchy bumps that are approximately 1-2 millimeters in size. These bumps may be surrounded by a thin pale area known as a halo. Occasionally the bumps are filled with fluid. Quite often, these initial signs of PUPPP are mistaken for hives. However, PUPPP lesions are usually associated with striae (stretch marks), as both are due to the stretching of the skin. The small, red, itchy bumps – the telltale sign of PUPPP – develop near the stretch marks and commonly appear within the stretch marks themselves. Eventually the multiple small bumps merge together into one continuous itchy area defined by raised, red, uneven, bumpy skin. PUPPP usually makes its appearance during the third trimester.

Given that PUPPP is associated with striae and skin stretching, it makes sense that the condition develops most frequently on the belly, which experiences the greatest swelling during a pregnancy. PUPPP can also spread to the thighs, buttocks, and breasts – the same body parts that are sensitive to striae. An angry-looking red rash, PUPPP is visually bothersome, but fortunately the face is usually spared.

Fearsome Itching
Women who have experienced PUPPP describe it as an extraordinarily itchy, annoying, and frustrating rash. Affected women may have trouble sleeping at night because of the itch. Some women believe that the rash feels more intense at night compared to day because the distraction of daily activities keeps their mind off of the itching. Fortunately, PUPPP is not permanent. It usually begins to resolve spontaneously within a few days after delivery and goes away entirely within several weeks postpartum.

If You Have PUPPP
If you are a woman affected with PUPPP, do your best to avoid scratching your skin. PUPPP is due, in part, to the various reactions of the immune system, so try and get plenty of rest. You can apply a thick moisturizer twice a day to help. Cool soaks may also help. Antihistamines can be used for itchiness, but they may make you drowsy. Consult your obstetrician for guidance.

For more guidelines on self care for PUPPP, go to, where you will find suggestions on over-the-counter medications in the Self-Care Guidelines for PUPPP.

Additional links: The Dark Line of Pregnancy • Stretch Marks and Pregnancy

Published on 03/20/2012 | Last updated on 10/18/2018