Mom, are you experiencing cracked and itchy skin on your abdomen during pregnancy? If so, there’s no need to worry, as this isn’t a serious condition. This condition is known as PUPPP (pruritic urticarial papules and plaques of pregnancy).
PUPPP is a common condition experienced by women who are heavily pregnant. The itching and rashes that appear on the skin’s surface are quite bothersome and can even cause irritation if not treated properly.
What is PUPPP in Pregnant Women?

PUPPP is an itchy bump that usually appears on the abdomen, along with stretch marks on the skin, and sometimes on the thighs, buttocks, or arms. This condition is most common in women with their first pregnancy and in mothers carrying twins.
While not dangerous, PUPPP can be quite bothersome. The itching can be severe and spread throughout the body. Fortunately, the condition doesn’t spread to the face.
Symptoms of PUPPP
PUPPP rash usually appears in the third trimester of pregnancy. This is when the baby’s growth in the womb increases rapidly, especially during the last five weeks of pregnancy.
This condition is very likely to occur for mothers experiencing their first pregnancy. Furthermore, mothers carrying twins are also at greater risk of experiencing it. This is because the skin stretches more.
During pregnancy, your skin stretches faster than your skin cells can keep up. This can cause stretch marks to appear. Worse yet, a PUPPP rash can develop on stretch marks around the belly button.
PUPPP often resembles bumpy skin, or is a pink or dark lump on the skin. PUPPP may appear pink or red on fair skin, but may be a lighter or darker skin tone on women with richer pigmented skin.
The rash usually first appears on the surface of the abdomen and then spreads to other areas within a few days. The rash typically appears as small, pink, pimple-like spots. It resembles a hive, as the small rashes begin to merge and form large, red, plaque-like areas.
Blisters usually form around the rash. From the abdomen, the plaques then spread to the following areas:
Typically, this rash won’t spread beyond your breasts. It tends to be very itchy, especially at night, which can disrupt your sleep. However, as your belly grows, it will also become easier to fall asleep at night.
Causes of PUPPP

The exact cause of skin rashes during pregnancy is unclear. Unlike most other symptoms, PUPPP is not caused by increased hormone levels. One theory suggests that fetal cells invade the mother’s skin during pregnancy. This is thought to be one cause of abdominal itching that then spreads.
Another theory suggests that PUPPP is a genetic condition and can be passed down through the father’s side. However, there’s no definitive cause for this skin rash. However, PUPPP usually appears in the third trimester and disappears after delivery.
Risk Factors for PUPPP Rash
Some pregnant women are at greater risk of developing PUPPP rash. Some of these risk factors include:
- Comes from the Caucasian or white race
- Pregnant with a boy
- First pregnancy
- Hypertension or having high blood pressure during pregnancy
- Pregnant with twins
- Rapid or higher than usual weight gain during pregnancy
Despite all the above conditions, some mothers are still at risk of experiencing this rash even though they do not have these risk factors.
How Is PUPPP Diagnosed?
How can you tell if you have a skin rash caused by PUPPP? The first thing to do is see your obstetrician immediately. The doctor will usually diagnose the rash by examining the skin for symptoms.
Usually, no further testing is necessary. However, your doctor may want to compare it to other skin infections, such as fungal infections or scabies. To further confirm the diagnosis, you will likely have several blood tests to check for the following conditions:
- Complete blood count
- Liver function tests
- Serum cortisol
- Serum human choriogonadotropin (HCG)
How to Treat PUPPP

PUPPP will disappear completely after delivery. It usually disappears on its own within one to two weeks after delivery. Some women may still experience the rash for several weeks after delivery.
However, there are several things that you can do to relieve the symptoms, namely as follows:
Using Moisturizer
You can apply an itch-relieving moisturizer to your skin to relieve itching and discomfort. Avoid moisturizers containing ingredients that are not suitable for babies, such as salicylic acid, retinol, vitamin A, retinyl palmitate, and tropic acid.
Applying Topical Steroids
Steroid creams, such as 1 percent hydrocortisone cream, applied to the rash can help reduce itching. Although these creams are generally considered safe to use during pregnancy, always consult your doctor before using them. Your doctor may prescribe a stronger topical steroid.
Antihistamine Consumption
These medications can relieve itching, but always consult your doctor before taking them. Examples of medications generally considered safe to take during pregnancy include diphenhydramine (Benadryl) and cetirizine (Zyrtec). These medications have been studied more thoroughly than other antihistamines.
Itch Relief Bath
Bathing with oatmeal or baking soda can help reduce the itching of a rash. Applying a cool compress to the affected area can also help. While it may be difficult, avoid scratching the rash, as this will only worsen the symptoms.
In some cases, doctors may prescribe oral steroids to relieve the pain and itching associated with the condition. However, these are usually prescribed for women experiencing severe symptoms associated with the condition, including intense itching and discomfort.
Using Aloe Vera Gel
You can relieve discomfort in the PUPPP area by applying aloe vera gel after bathing. Skin often feels dry after bathing, which can make the rash itchy. Applying aloe vera gel provides a cooling sensation and moisturizes the affected area.
Wear clothes made of soft cotton.
Certain clothing materials can trigger itching in areas affected by PUPPP. To prevent this, wear soft cotton clothing that is comfortable against the skin. If you still scratch the itchy area, you can prevent this by wearing gloves to prevent skin damage.
Can PUPPP Be Prevented?
Unfortunately, the answer is no, PUPPP cannot be prevented. If you’re going to experience PUPPP, you will. However, try to remember that it’s temporary and will disappear soon after your baby is born.
It’s possible that your baby may also experience a milder form of PUPPP rash. However, this rash is usually harmless and doesn’t cause any complications for you or your baby.
Even if you experience a PUPPP rash during this pregnancy, it’s unlikely to recur in your next pregnancy. However, there’s a small chance you could experience a milder PUPPP rash the next time you’re pregnant.
Those are the important things you need to know about the PUPPP rash, which commonly occurs in pregnant women. We hope this is helpful.
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Republished with permission from theAsianParent Indonesia