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5 Ways to Deal With PUPPs, That Annoying Pregnancy Rash

Pregnancy famously comes with a whole host of aches, pains, and surprising symptoms, including itchy, annoying rashes like PUPPs.

This hive-like rash, known as pruritic urticarial papules and plaques of pregnancy (or PUPP, PUPPs, or PUPPP), usually appears in the third trimester. Although PUPP will abate with time and care, there are other, much more serious skin conditions that arise in pregnancy that can be mistaken for PUPP. These issues require further treatment and medical attention, which is why any rash that crops up while you’re pregnant should be examined and diagnosed properly.

Here, we’ll take a closer look at PUPP, how to treat it, and, most importantly, how you can be totally sure that’s what you have.

What are the symptoms of PUPP?

Usually pinkish and reddish in hue, PUPP can be either raised or smooth, but it’s always itchy, sometimes to an extremely uncomfortable degree. Karen Duncan, M.D., assistant professor in the Department of Obstetrics and Gynecology at NYU Langone Health, tells SELF that, in some patients, PUPP may begin as smaller papules that eventually coalesce into larger plaques.

PUPP lesions are always concentrated on the stomach, but they may spread beyond to the upper torso and upper thighs, Dr. Duncan says. But, she adds, they’re “usually limited to the trunk.” It’s unlikely that they’ll spread as far out as, say, the hands and feet.

But a PUPP rash can actually take many forms, Jenny Murase, M.D., assistant clinical professor at the University of California, San Francisco, and director of medical consultative dermatology, Palo Alto Medical Foundation, tells SELF. So the term PUPP is no longer considered a completely accurate description of the rash’s actual appearance, because this term implies that the rash presents exclusively as hives in every case.

In addition to the classic hives-like rash, a PUPP rash can also “present as vesicles in the skin, which are little blisters,” Dr. Murase explains. It can present as eczema or as targetoid lesions, meaning the rashes look like little targets, she says. Your doctor may refer to PUPP a PEP (polymorphic eruption of pregnancy) as a nod to the variety of shapes it may take.

What causes a PUPP rash?

Although the exact cause of PUPP remains unknown, Dr. Murase says the current medical understanding is that a reaction occurs in the skin when it stretches rapidly to accommodate the growth of the baby in the third trimester. Dr. Duncan notes that this reaction is thought to be due to a combination of inflammation and changes in hormone levels, which can become more dramatic toward the end of a pregnancy.

With that in mind, someone who’s having twins or triplets will have an increased chance of acquiring PUPP than someone who’s only pregnant with one baby. However, Dr. Murase is quick to clarify, anyone whose skin stretches suddenly in order to keep up with the baby’s development can end up with PUPP.

Despite how uncomfortable it can be (Dr. Murase says its accompanying itchiness and dryness can keep sufferers up at night), PUPP is a benign rash that won’t threaten the pregnancy. It goes away on its own, usually about two weeks after delivery, Dr. Duncan says.

PUPP can look like other serious conditions, so you should always get it checked.

If you notice that you’re developing any type of rash at any point in your pregnancy, your first step should be to see your obstetrician, Dr. Duncan says. “With a very typical PUPP-appearing rash that is limited to the abdomen in the third trimester—the classic presentation—probably a lot of ob-gyns feel comfortable making that diagnosis. It’s the cases when things are not textbook that it’s more common for women to have a biopsy done.”