PUPPP and Other Pregnancy Skin Conditions

Approximately one percent of women will develop an itchy, raised rash in the last part of their pregnancy called PUPPP (pruritic uticarial pupules and placques of pregnancy), also known as polymorphic eruption of pregnancy. According to the American Academy of Dermatology it is the most common skin condition of pregnancy, usually appearing during the third trimester, and, although the discomfort and itching may keep you up at night, PUPPP is harmless to both you and your baby.

The cause of PUPPP is unknown and it is not associated with any other pregnancy condition, such as preeclampsia, or any abnormality of the fetus. It appears to run in families and, oddly, 70 percent of women with PUPPP give birth to boys. This correlation has given rise to the hypothesis that male fetal DNA acts as a skin irritant, but conclusive evidence is still needed.

PUPPP usually develops during a first pregnancy and appears first on the abdomen near the belly button (often in stretch marks) and then spreads to the thighs and extremities as the small, red wheals of the rash gradually merge to create larger wheals.

There is no cure for PUPPP, but the irritation usually can be relieved with cortisone creams, high strength steroid creams, or oral steroids if the itching is severe. The rash and the itching usually resolve a couple of days to a week after delivery.

Prurigo gestationis

Another harmless but potentially annoying pregnancy rash is called prurigo of pregnancy, or prurigo gestationis, which appears as many tiny bumps that look like bug bites, usually on the hands, feet, arms and legs, although they can develop anywhere on the body. Prurigo of pregnancy can occur any time during your pregnancy, but it is more common during the second half and affects about 1 in 300 pregnant women. Although there is no cure for the condition, the itching can be relieved with topical cortisone or antihistamines and the rash usually resolves soon after delivery.

Pemphigoid gestationis

Rarely, pregnant women develop itchy patches that initially look like hives, but then turn into large, blistering lesions. This is called pemphigoid gestationis or herpes gestationis (however, it is has nothing to do with the herpes virus) and occurs in 1 pregnancy out of 7,000 to 50,000. The rash usually begins on the abdomen, around the belly button, and may spread to the arms and legs. This condition may be associated with a greater risk of preterm delivery and fetal growth problems, and 5 percent of newborns born to women with this condition have a noticeable rash. While this condition usually starts in the third trimester, it can appear at any time, even shortly after delivery. Pemphigoid gestationis usually develops again in subsequent pregnancies and tends to be more severe.

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy is a potentially harmful pregnancy skin irritation that appears in the second or third trimester, usually on the palms of the hands and soles of the feet. No rash develops, but the intense itching may cause you to scratch and result in red, irritated skin.

This condition affects up to 2 percent of pregnant women and occurs when bile secretion in the liver is impaired. As the bile backs up, bile acids increase in the bloodstream and are eventually deposited in the skin which causes the itching. Other symptoms include darkened urine and fatigue. If you suspect you have this condition, your doctor will perform blood tests to check your liver function and an ultrasound to monitor your baby's health, as the condition is associated with an increased risk of stillbirth, premature labor, fetal distress, and maternal and fetal hemorrhaging. Depending on your and your baby's health, you may be induced earlier than your due date. The condition resolves on its own after delivery; however, it may recur with later pregnancies.

To keep you and your baby safe, alert your caregiver immediately if you develop any sort of rash during your pregnancy.