Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)

What is PUPPP?

There are many skin changes that can occur during pregnancy and around 5% of pregnancies will result in a skin condition. One of the more common skin conditions during pregnancy is called pruritic urticarial papules and plaques of pregnancy (PUPPP), which occurs in 1 in 130-350 pregnancies. It typically develops in the third trimester, but on rare occasions, it develops postpartum.

Also known as polymorphic eruption of pregnancy (PEP) in Europe, it is characterized by small, itchy, raised areas of skin. PUPPP can be uncomfortable to experience, but is harmless and easily treated.

What are the risk factors for PUPPP?

The following factors increase the risk for PUPPP:

  • First-time pregnancy
  • Pregnancy with multiples
  • Caucasian race

What are the symptoms of Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)?
  • Pruritus (itchy skin)
  • Small, red, raised bumps on the skin, typically located within stretch marks

What is the treatment for Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)?

As this typically develops during late pregnancy or early postpartum, an OB/GYN or midwife should be familiar with PUPPP. However, you may be referred to a dermatologist. A skin biopsy may be recommended to diagnose the condition and rule out alternatives.

Typically, recommended treatments include oral antihistamines (like Benedryl), skin emollients, and topical corticosteroids to relieve the itching. These generally are considered safe for pregnancy and for breastfeeding, and your provider should be able to address any concerns.

In rare cases of severe itchiness, systemic corticosteroids are prescribed. These may have potential negative effects during pregnancy and breastfeeding, so talk to your healthcare provider about the benefits and risks.

When PUPPP occurs during pregnancy, it typically resolves within days following delivery. However, in 15-20% of women, it lasts 2-4 weeks postpartum. It usually leaves no scarring.

Who can help diagnose/treat Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)?
  • OB/Gyn
  • Primary Care Physician (PCP)