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Overview of PUPPP in Pregnancy

Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy (PEP), is a common skin condition that occurs during pregnancy. It is characterized by an itchy rash that typically appears in the third trimester and is most common in first pregnancies. The rash often begins in the stretch marks on the abdomen and can spread to other areas like the thighs, buttocks, and arms. Although uncomfortable, PUPPP is not harmful to the mother or baby and usually resolves after delivery.

Causes and Risk Factors

The exact cause of PUPPP is unknown, but it is thought to be related to the stretching of the skin, especially in first pregnancies or multiple gestations. This stretching may damage connective tissue, leading to an inflammatory response. Other theories suggest hormonal changes or the presence of fetal DNA in the mother's skin as potential causes.

Symptoms

Itchy Rash: The rash is intensely itchy and appears as small, red, hive-like bumps.
Location: It typically starts on the abdomen and may spread to the thighs, buttocks, and arms.
Timing: Most commonly appears in the third trimester and resolves after delivery.
Pruritic Urticarial Papules and Plaques of Pregnancy - StatPearls - NCBI Bookshelf
Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy (PEP) is the most common gestational dermatosis. It is a benign, pruritic, inflammatory skin disorder that is characterized by a polymorphous clinical presentation in the setting of ...
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Source: ncbi.nlm.nih.gov
Pruritic Urticarial Papules and Plaques of Pregnancy - an overview | ScienceDirect Topics
No immunologic or human leukocyte ... that PUPPP may be a hypersensitivity reaction. Its association with rapid weight gain and multiple births suggests that abdominal wall stretching may also be a pathogenic factor. A role for pregnancy-associated hormones has also been suggested. Treatment is geared ...
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Source: sciencedirect.com
Polymorphic Eruption of Pregnancy - Sussex Community Dermatology Service
It is characterised by an itchy rash that commonly begins on the abdomen, particularly within stretch marks (striae). It most usually develops during late pregnancy (third trimester) but can also start immediately after the baby is born. It was previously known as PUPPP (pruritic and urticarial ...
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Source: sussexcds.co.uk
Pruritic Urticarial Papules and Plaques of Pregnancy | UMass Memorial Health
PUPPP (pruritic urticarial papules and plaques of pregnancy) is a very common skin rash that can occur later in pregnancy. It usually happens in the third trimester, mainly in the last month. Rarely, it may occur in the postpartum period. It’s sometimes called PEP (polymorphic eruption of ...
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Source: UMM Health
Pruritic Urticarial Papules and Plaques of Pregnancy Occurring Postpartum Treated with Intramuscular Injection of Autologous Whole Blood - PMC
Pruritic urticarial papules and plaques of pregnancy (PUPPP) is one of the most common diseases associated with pregnancy. In most cases, the skin lesions develop in the third trimester of primigravidas. There are no systemic alterations seen in PUPPP; however, most patients report severe pruritus.
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Source: PubMed Central - National Institutes of Health's National Library of Medicine
Polymorphic Eruption of Pregnancy: Background, Epidemiology, Etiology
Polymorphic eruption of pregnancy (PEP), first described as pruritic urticarial papules and plaques of pregnancy (PUPPP), refers to a benign dermatosis that usually arises late in the third trimester of a first pregnancy. [1, 2] It can also manifest immediately postpartum.
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Source: Medscape
Pruritic Urticarial Papules and Plaques of Pregnancy | Saint Luke's Health System
PUPPP (pruritic urticarial papules and plaques of pregnancy) is a very common skin rash that can occur later in pregnancy. It’s sometimes called PEP (polymorphic eruption of pregnancy). People with PUPPP have patches of small, itchy red bumps over their belly (abdomen).
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Source: Saint Luke's Health System Kansas City
PUPPP Rash: Symptoms, Causes, Treatment & Prevention
PUPPP shows up late in pregnancy, usually around week 35 in your third trimester. Less commonly, PUPPP rashes appear shortly after delivery.
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Source: Cleveland Clinic
Prurigo Of Pregnancy: Causes, Treatment & What It Looks Like
Prurigo of pregnancy (also called ... complications for you or the developing fetus. It can begin any time during your pregnancy but usually develops in the second or third trimester....
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Source: Cleveland Clinic
Polymorphic Eruption of Pregnancy - Gynecology and Obstetrics - Merck Manual Professional Edition
Polymorphic Eruption of Pregnancy - Etiology, pathophysiology, symptoms, signs, diagnosis & prognosis from the Merck Manuals - Medical Professional Version.
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Source: Merck Manuals
Polymorphic eruption of pregnancy (syn. pruritic urticarial papules and plaques of pregnancy)
Polymorphous eruption of pregnancy is also known as PUPPP, which is short for Pruritic Urticarial Papules and Plaques of Pregnancy. It is an itchy rash that starts in the stretch marks of the abdomen in the last three months of pregnancy and then clears with delivery. The newborn is unaffected.
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Source: pcds.org.uk
Skin Conditions During Pregnancy | ACOG
In PUPPP, small, red bumps and hives appear on the skin later in pregnancy. The bumps can form large patches that can be very itchy.
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Source: American College of Obstetricians and Gynecologists
Polymorphic Eruption of Pregnancy Treatment & Management: Approach Considerations
Treatment is directed at relieving the pruritus associated with polymorphic eruption of pregnancy (PEP). Topical corticosteroids are the mainstay of treatment. [33] High-potency topical (class I or II), or even systemic, steroids may be required to alleviate symptoms.
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Source: Medscape
PUPPP Rash: Causes, Symptoms, Diagnosis & Treatments
Also known as polymorphic eruption ... during pregnancy. Though harmless, it does cause an itchy rash with hive-like bumps on your belly and stretch marks during your third trimester. It can spread to other parts of your body, including your back, breasts, arms, and buttocks.
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Source: WebMD
PUPPP Pregnancy Rash: Pregnancy Rashes Explained | Dr. Thais
Pruritic Urticarial Papules and Plaques of Pregnancy. Quite nicely alliterative, but also quite tricky to pronounce. No problem: this skin condition has several aliases from which to choose, including: ... But for the sake of simplicity, let’s just go with PUPPP or PUPPPs rash.
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Source: Dr. Aliabadi, Best Los Angeles OBGYN, Surgeon
PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy): Care Instructions | Kaiser Permanente
PUPPP usually goes away on its own within a week after birth. It is treated with medicine to stop the itching. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems.
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Source: Kaiser Permanente
Skin problems during pregnancy: symptoms, causes and treatments - HSE.ie
Skin itching is common during pregnancy. This is because of the increased blood supply and stretching of the skin. ... the itch is severe or only affecting your hands and feet - it may be a sign of a specific health condition · PUPPP rash stands for pruritic urticarial papules and plaques ...
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Source: HSE.ie
Polymorphic eruption of pregnancy. PUPPP
Rashes in pregnancy include those that affect non-pregnant women. An itchy rash early in pregnancy is usually caused by prurigo of pregnancy or atopic eczema. When the rash starts in the umbilicus itself or blisters are present, a diagnosis of pemphigoid gestationis may be considered.
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Source: DermNet®
7 types of pregnancy rash: Symptoms and what they look like
A PUPPP rash develops when the skin stretches, damaging the layer of tissue underneath. This causes inflammation, which appears as a rash. A PUPPP rash sometimes begins in the second trimester but usually develops in the final 3 months of pregnancy.
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Source: medicalnewstoday.com
PUPPP Rash: What to Know About This Pregnancy Rash
So what’s the deal with PUPPP rash, which—with its bumpy, veiny streaks—looks as terrible as it feels? We asked a series of experts to weigh in on what may cause the skin rash, when you can expect it to dissipate and how pregnant people experiencing even the worst cases of PUPPP in pregnancy ...
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Source: The Bump

Treatment and Management

Treatment focuses on relieving symptoms, as the condition itself is benign:

Topical Treatments: Low-potency corticosteroid creams and emollients can help reduce itching.
Oral Antihistamines: These can provide additional relief from itching.
Natural Remedies: Some women prefer natural treatments due to concerns about medication use during pregnancy.

In severe cases, systemic corticosteroids may be considered, but this is rare and should be discussed with a healthcare provider.

Prognosis

PUPPP is a self-limiting condition that typically resolves within a few weeks postpartum. It rarely recurs in subsequent pregnancies, and if it does, it is usually milder.

If you experience a rash during pregnancy, it's important to consult with your healthcare provider to confirm the diagnosis and discuss appropriate management options.

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Peer-Reviewed Research

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Medical & Academic Institutions

Information from hospitals, research institutions, or academic medical centers known for clinical expertise and research contributions.

General Health & Web Sources

Publicly available health-related articles from non-peer-reviewed sources. These may reference research or clinical guidelines, but are not primary sources.