PUPPP or pruritic urticarial papules and plaques

You thought when you got that pregnancy acne under control that you were good to go. And the overall itchiness of your stretching skin has been managed mostly by slathering on moisturizer every chance you get. So now what’s up with these reddish raised patches – poison ivy?!  It might be PUPPP.

No, that’s not a cute little puppy dog, which probably would be ever so much nicer.  PUPPP stands for pruritic urticarial papules and plaques of pregnancy (sounds and is rather nasty) which are series of small, very itchy bumps that can show up on your skin during the third trimester. They usually appear on the belly, especially if you have stretch marks, but some women have them on their thighs, rear end, breasts and upper arms – again wherever there are stretch marks.  The good news is they go away after delivery and just because you got them in one pregnancy does not mean you’ll have them in another. Actually, PUPPP appears to be most common in first pregnancies.

Also good to know is that, while we don’t know what causes it, PUPPP is not associated with serious issues like preeclampsia, autoimmune disorders or problems with the developing baby. It’s just a nasty rash that’s likely to irritate the daylights out of you.

Any rash should be shown to your health care provider.  She will treat the symptoms. High strength steroidal creams used 5 or 6 times a day usually are good to start with because they bring it under control and prevent spreading. Once under control, a lower strength cream is commonly prescribed. Oral antihistamines like Benadryl or Zyrtec may be helpful with relieving itching at night and helping you sleep, but don’t take these without first checking with your doc. For severe cases, your provider may recommend oral steroids. If you’re not keen on these options, try oatmeal baths or pine tar soap.

If you had PUPPP, what worked to control the itch for you?


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    Susanne Cash May 30, 2012

    Strangely enough I had this after giving birth. My doctor said I was the first patient he’d ever seen to develop it after delivery. It drove me nuts for a little over a week. Tried all kinds of stuff, A&D ointment helped. It is definitely a pain but don’t be fooled to think it only happens during pregnancy or that it goes away after. 😉

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    Kristina May 30, 2012

    Had a PUPPP immediately after the birth of my son. It is unusual that it happens post-pregnancy, but it does happen. I am allergic to benadryl but ice cold washclothes and cool baths really helped me out

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    Susanne and Kristina, you bring up a good point – it’s rare but it can happen after delivery. Sadly, you two are the proof! It’s good to remember that pregnancy-related conditions like PUPPP and preeclampsia can occasionally occur after delivery and we should continue to be alert for symptoms for a few weeks after the baby arrives. Thanks.

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    This is my second case of PUPPP’s and honestly… All I use is A&D Diaper Rash Cream… Worked wonders on my and my older sister!!! Only took 3 days for me 2 days for my sister!!!

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    Wow Gema! I wish the A&D Diaper Rash cream did anything for me! It just made my skin feel sticky with itchy underneath! I had this (and it got progressively worse the 4 days before I finally started googling it). Started on my stomach on my stretch marks, moved over to the sides of my belly and up toward my boobs, onto my butt and covered the entirety of my upper thighs, then my ankles and tops of my feet, and finally behind my knees and on my kneecaps. Then it attacked my top half – on my wrists, forearms, armpits, elbows, and biceps….ugh! At this point, I realized I needed to research this before I ripped my skin off itching! It’s like poison ivy and athlete’s foot, combined. And if you itch it, the welts/hives get WORSE! So, I don’t like medicine – and I read somewhere that hives happen when your liver is working too hard, so figured, the first thing I need to do is a liver cleanse – hubs went out and got me a bunch of lemons (squeeze half a fresh lemon into a cup of hot water and drink 30 minutes before eating any food each morning) and V8 (drink 2 cups/day). This really helps you internally. I usually had a cup of V8 in the afternoon when my itching started back up, and it helped to subside it. Now topically – I used that Grandpa’s Pine Tar Soap for a couple days (order online, check GNC/Whole Foods) – shower (wash your hair/face) in luke warm water, and then cut the water to cold (shut off all the hot) and scrub this soap all over your body – now grab your loofa and go to town. Oh. My. Gosh. Feels so good! This was the only time I was allowed to scratch all day – in the shower! You actually may want to just cut the water off for this part, because it could be 30 minutes before you bother to rinse off. But when you do, you want the water as cold as you can get it! In the morning I used that Sarna Sensitive Skin lotion (it has 1% hydrocortisone cream) and my subsequent showers throughout the day I used Burt’s Bees After Sun Soother Lotion. It has a lot of similar ingredients to the pine tar soap and is a little cheaper than the Sarna, and to be honest, they work about that same. So July 5 my husband brought home the grandpa’s pine tar soap (I was like one giant walking hive), and on July 7 we bought the lotions and the V8. It’s now July 12, and I was able to shower only once yesterday – still using the special soap and lotion, but one shower is a whole lot easier than 3! Was a little itchy around 3am, showered around 8am with the whole routine, and it’s now 5:15pm and I still feel totally fine, and you can barely see the rash. By the way, I got a mani/pedi two hours ago, and with all that hot water and stuff they use, thought I’d be a hot mess again, but my skin barely reacted at all. The first couple days of using the soap will kind of “draw out” the rash, but the lotion stops it from itching and within 3-4 days you should be good to go! I go to the obgyn twice a week for preeclampsia, and even my doctor asked what I had done between Mon and Thurs to make it disappear! Good luck! This thing seriously sucks.

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    I had this with my first son and it was right after i deliver. My doctor had no clue to what could cause it beside saying that it was the stretch marks. I needed to moisturize it. I tried alot of cream and medication for itchy skin and nothing worked until I bought some generic Benedryl from Walmart and took them and found that it helped really control the rash. It lasted for 6 months and it never came back. As of now, I just had my third son and I have developed the itch again and it has been 8 years since my first and I have been searching and found out that I have PUPPP. I am totally itching everywhere and i cannot stop. I am going to talk to my doctor about this and maybe have her agree that I may have PUPPP even after I had deliver my son. Also I read somewhere on the internet that it is mostly common to mothers who bare son so are all of you ladies that have PUPPP have boys? Just curious.

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    Hi All!
    I am 14 weeks into the pregnancy and have shocked my friends and family with an early onset of PUPPPs.

    Medications and ointments have reduced the redness and tenderness of the rash, however it seems to be moving down my legs and arms. Has anyone had the rash on their hands? This new development is concerning me that Cholostasis might be part of the problem. Since I’ve only just entered my second trimester I’m starting to grow in my concern.

    Anyway, I have appreciated all the moms out there who have helped provide some camaraderie and help to get through this first challenge as a mom-to-be!

    God Bless!

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    Hi! PUPPP is seriously the worst thing in the history of ever. I had it during my third trimester with my son, and I legitimately thought I was going to lose my mind. Thanks for this post!

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    I seriously can say that pupps was probably the worst thing I have ever experienced and for some reason, I still have night mares about it even though I have been clear for about a week. I just wanted to let everyone know that I tried everything….LITERALLY EVERYTHING and nothing worked. Someone mentioned the pupps cleanse and I have been thanking her for the past week….no lie…everyday for the past week. Please try the pupps cleanse. It can be found at http://www.pupppcleanse.com. It will save you tons of agony, pain, and money.

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    Thank you all so much for your comments and ideas. We’re glad people are sharing their remedies, but keep in mind that the March of Dimes does not endorse any products or services. Make sure you discuss any treatment option that you may be considering with your health care provider.

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    I started developing PUPPP in my 34th week and it all but covered my belly in four days. Of course the doctor wasn’t available until midway through the next week and my hands had started itching and showing a rash by then. So yeah she gave me a very low dosage steroid cream to use only twice a day and benadryl for before bed. The day after I started the cream it suddenly spread to my feet and up my arms, another day and it was all but covering my legs. And now at 36 weeks it’s almost everywhere except my face. I had to stop using the cream because it irritated my skin so badly that unmarred skin would burn. I still take the benadryl, which honestly, doesn’t help much either, and bought pine tar soap. It helps the itch for a few good hours before I have to use it again.