PUPPP Rash: 7 Little known Ways to Sooth Your Pregnancy Rash without Using Steroids

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Did you get a rash during your pregnancy? Are you worried about this rash and want to know more about why it is happening and how to deal with it? Were you told that you have pruritic urticarial papules and plaques of pregnancy (PUPPP)? In this article, we will answer the most common questions to give you everything you need to know about this kind of pregnancy rash and how to manage it.

During your pregnancy, your body goes through different changes inside and out. Your hormone levels are very different from before pregnancy, and your body is getting bigger and heavier. If it is your first time getting pregnant, there is a chance that your body does not adapt well to these changes.

puppp pregnancy rash acupuncture

What causes PUPPP Rash?

1. Hormonal changes: This includes a significant increase in progesterone in your body. Elevated progesterone has been identified in women presenting with PUPPP.

2. Stretched skin: Excessive and sudden increase in the abdomen size is usually the triggering cause of PUPPP. The stretching of the skin on the abdomen often results in an inflammatory response, which leads to itch, scratching, and more inflammation.
The resulting rash on the belly is made up of little bumps that are itchy but not painful. Scratching may aggravate the intensity and extent of the rash.

Who is at higher risk of getting PUPPP?

Some pregnant women are more likely to get this kind of rash. If you present with any of the following, you might be at higher risk of getting PUPPP:

  • You are having your first baby (first-time moms are more likely to experience this)
  • You are expecting a baby boy (this is related to fetal DNA)
  • You are carrying twins (this increases the extent of a stretch of the skin on the abdomen)

What are the symptoms of PUPPP?

PUPPP is known by the characteristics of the rash, which include:

  • Painless
  • Itchy red bumps
  • Hive-like rash on the belly
  • Scattered near your stretch marks
  • Spreads to the butt, breasts, thighs, and arms
  • It does not affect the neck, face, hands, or feet

Diagnosis of PUPPP

A medical practitioner will diagnose PUPPP clinically, meaning they will base their decision on how the rash looks. A skin biopsy will only be done if there are doubts about the diagnosis, although your doctor might order blood tests to rule out alternative explanations.

PUPPP can occasionally be mistaken for the more severe pemphigoid gestationis (PG) disorder. A rare autoimmune rash known as PG develops during pregnancy’s second and third trimesters. One in 50,000 pregnancies is affected by it.

In contrast to PUPPP, PG lesions typically begin earlier in pregnancy and tend to collect around the belly button. Atopic dermatitis, contact dermatitis, and irritating dermatitis are a few other disorders that may be mistaken for PUPPP.

Cholestasis of pregnancy, in which the passage of bile from the gallbladder is slowed or interrupted, may cause itching during pregnancy. Complications such as stillbirth or premature birth may result from this.

Risk Elements

PUPPP rash is more frequent in first-time mothers and in those carrying multiples. Except for individuals who are carrying multiples (in which case it typically subsides), it typically does not recur in later pregnancies.

Certain assisted reproductive technologies may also raise the likelihood of having PUPPP rash in first trimester, however this has not been confirmed.

PUPPP can be painful and, in some situations, is severe enough to impair one’s ability to sleep and enjoy life. This can be extremely challenging and may cause or exacerbate depression. You might employ coping mechanisms in addition to PUPPP treatment to lessen symptoms.

The following are some tips for dealing with PUPPP:

  • Showers or baths that are cool and relaxing.
  • Avoid scratching the rash as much as possible, even though this can be challenging. This may only exacerbate the symptoms of the rash.
  • Emollients should be used frequently since they keep moisture in the skin and stop it from evaporating.
  • Wearing light cotton garments.

7 alternative ways to treat PUPPP Rash?

There are some home remedies and some other tools that help with this kind of rash, which includes:

  1. Taking cool baths or showers. Stop taking warm showers because they aggravate the skin.
  2. Wear only breathable fabrics like cotton. Avoid polyester, nylon, or other nonbreathable fabrics. Avoid linen because, although breathable, it may irritate the skin.
  3. Use fragrance-free and non-caustic soaps.
  4. Apply cold compresses on your rash.
  5. Apply soothing moisturizer on the affected areas. This is a hit-and-miss, but sometimes it does reap positive results. Calendula, rosehip, and even emu oil can be very helpful, but so are many conventional creams.
  6. Acupuncture is a little-known TCM pregnancy treatment that can immediately reduce skin inflammation. The good thing about acupuncture is that you are not using steroids to treat PUPPP. Receiving acupuncture during pregnancy is not common; it is, therefore, important to see someone experienced in administering acupuncture to pregnant patients.
  7. Avoid eating red meat, barbeque meat, durians, dairy, and other pro-inflammatory foods that aggravate skin inflammation. Eat more vegetables instead.

When to visit a Doctor if you have PUPPP rash symptoms

If you develop a rash or any other new symptoms while pregnant, let your doctor know right once. In many cases, symptoms may improve with at-home care, and the condition will go away altogether once your baby is born.

However, other symptoms, such as high fever, severe itching, or skin that has become yellow, should be taken seriously and treated by a doctor. Anytime you have worries about your health or the health of your child, it’s a good idea to call your doctor.

How your Doctor will identify your rash

At your appointment, your doctor will probably look at your rash and inquire about its origin, spread, and length of time you’ve been having symptoms. Any additional symptoms you may be having may also be questioned in order to ascertain the underlying cause.

Depending on the rash, you may need to undergo additional tests. Blood tests, for instance, can check for infections or bile levels. Identification of rashes brought on by triggers, such as hives, may be aided by allergy tests, either skin or blood. In order for your doctor to examine the rash under a microscope, you can even have a skin biopsy.


Will scratching spread my rash?

While some may say that scratching will not spread your rash, what we see in the clinic differs. As your skin gets aggravated, the rash is likely to spread.

When does PUPPP usually start, and when does it stop?

In most cases, this rash occurs during the third trimester, but it may start earlier in some women. You can expect it to stay for the rest of the pregnancy, with some women seeing it resolve only after the baby’s birth.

Will PUPPP harm my baby?

Not to worry, this condition does not affect your unborn baby. While it affects your quality of life, your little one will not be affected by this skin condition.

What medications can help with PUPPP?

Antihistamines and steroids are the usual was to intervene. These are the medications that are known to relieve the itch and reduce inflammation. Some women see significant improvement after using these drugs; some women do not improve significantly.

Can PUPPP recur in subsequent pregnancies?

PUPPP is most common in first pregnancies, and can recur in subsequent pregnancies. As an estimate, about 30% of women who develop PUPPP in one pregnancy will develop it again in a subsequent pregnancy.

The reason why PUPPP recurs in subsequent pregnancies is not fully understood. That said, we know that the same factors that contribute to the development of PUPPP in the first pregnancy may also contribute the recurrence of the rash. This includes factors like stretching of the skin, hormonal changes and predisposing genetic factors.

What is Invisible PUPPP?

In some cases, you may experience pregnancy itch without a visible rash. This is called invisible PUPPP. The rash is called invisible because it is too small or because it is located in an area that is not easily seen, such as the inner thigh. Notwithstanding, invisible PUPPP has the same causative factors as PUPPP with a visible rash.

Symptoms: The main symptom of invisible PUPPP is itching. The itching can be severe and can make it difficult to sleep and to get around. There is no visible rash, but the skin may feel warm and tender.

Diagnosis: There is no specific test to specifically diagnose invisible PUPPP. The diagnosis of invisible PUPPP is based on the symptoms and the patient’s medical history. During the intake, other possible causes of itching, such as allergies or infection, are also ruled out.

Treatment: The treatment for invisible PUPPP is the same as the treatment for PUPPP rash. You can find out more about the treatment here.

What happens to the baby if the mother has PUPPP?

PUPPP cannot be passed on to the baby. The rash is caused by a combination of hormonal changes and stretching of the skin, and it is not contagious.

PUPPP may be present even after the birth of your little one. But it is important to know that it is not contagious.

If your baby is born with a neonatal skin rash, it is caused by hyperactive oil gland after birth and the colonization of a natural yeast called Malassezia Pityrosporum. This is separate from the PUPPP condition that you have. For neonatal rash, consider seborrheic dermatitis, nappy rash and cradle cap as possible diagnoses.

What are the foods to avoid when you have a PUPPP Rash?

  1. Avoid food you could be intolerant to: If you notice that certain foods trigger or worsen your symptoms, it may be helpful to avoid them. Common food allergens include nuts, shellfish, eggs, soy, dairy, and gluten. If you don’t really know the extent of your food intolerances, it maybe advisable to work with naturopath to figure out what your trigger foods are.
  2. Avoid irritant foods: Spicy foods, caffeine, and alcohol can potentially worsen itching and irritation for some individuals. If you notice a correlation between consuming these substances and your symptoms, consider reducing or avoiding them.
  3. Limit processed foods: Processed foods, such as fast food, sugary snacks, and sodas, are often low in nutrients and can contribute to inflammation in the body. Choose instead to eat fresh, whole foods instead — this includes fruits, vegetables, lean proteins, and whole grains.

In addition to avoiding certain foods, consume more of these:

  1. Water: Drinking an adequate amount of water helps maintain skin hydration and supports overall skin health. Aim for at least 8 glasses of water per day, or more if you are physically active or in a hot climate.
  2. Skin-friendly nutrients: Certain nutrients can promote healthy skin. Include these foods in your diet:
    1. Foods rich in Antioxidants: berries, leafy greens, tomatoes
    2. Foods rich in Vitamin C: citrus fruits, bell peppers)
    3. Foods rich in Vitamin E: nuts, seeds, avocados
    4. Foods rich in Omega-3 fatty acids: fatty fish, walnuts, flaxseed

When you have a PUPPP Rash, what are the foods to avoid according to TCM?

  1. Dampness-producing foods: In TCM, conditions like rashes are often associated with an accumulation of dampness in the body. It is advised to avoid or minimize the intake of foods that are considered dampness-producing:
    1. Dairy products
    2. Greasy or fried foods
    3. Excessive sugar
    4. Processed foods
    5. Alcohol.
  2. Spicy and pungent foods: These types of foods are believed to promote heat in the body and can potentially exacerbate skin conditions. Limit or avoid the following:
    1. chili peppers
    2. strong spices
    3. pungent herbs

Instead, consume more of foods that help to reduce inflammation in the body. They include:

  1. Cooling foods: Including cooling foods in your diet can help reduce heat and inflammation in the body. Because you are pregnant, you don’t want too much of these, but using them sparingly can be helpful if you suffer from PUPPP. Some examples of cooling foods in TCM include:
    1. cucumber
    2. watermelon
    3. mung beans
    4. green leafy vegetables
    5. herbal teas like chrysanthemum or mint tea
  2. Nourishing foods: Focus on consuming nourishing foods that support healthy skin. TCM suggests including foods like:
    1. sweet potatoes
    2. carrots
    3. pumpkin
    4. apples
    5. pears
    6. goji berries
    7. fish
    8. walnuts

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