Pregnancy can do a number on our skin… from acne to stretch marks to linea nigra and pigmentation issues. Some women are also hit with an itchy, sometimes painful rash known as PUPPS or PUPPP.
You may wonder where in the world this rash came from, or if you’re at risk of getting PUPPS rash, and most importantly, how to get rid of it!
What is PUPPS?
PUPPS is short for pruritic urticarial papules and plaques of pregnancy. It’s also known as PUPPP. In the UK, it’s known as polymorphic eruption of pregnancy, or PEP for short. It’s a rash that starts off unobtrusive enough and begin as tiny, itchy red bumps in the stretch marks on the abdomen. Its distinguishing characteristic is that it surrounds, but never affects, the navel. These little red bumps get bigger, forming large patches that spread down the legs, and up the chest. Eventually, most of the body can be covered in the itchy, eczema like rash.
Symptoms of PUPPS
- Itchy red bumps
- Starts on the abdomen, then spreads
- Red, eczema like patches
- Severe itching
How to diagnose PUPPS
Many women get skin discolorations or rashes of some sort during pregnancy. So how do you know if it’s actually PUPPS?
There aren’t any lab tests that will diagnose PUPPS, so it’s usually determined by a process of elimination. Your healthcare professional can conduct a biopsy to rule out more serious skin conditions. (source)
If the navel is unaffected, and other skin conditions and rashes have been ruled out, then it’s highly likely it’s PUPPS.
Why do pregnant women get PUPPS?
While there is speculation, and some good studies out there, we don’t have conclusive answers as to why pregnant women get a PUPPS rash. Here are the main theories:
1. An organ system is overtaxed
Since the liver is the body’s main detox organ, when it becomes overwhelmed with toxins, the symptoms are exhibited through the skin through rashes and discolorations. Many of us already have livers that are compromised from the toxins found in our food, beauty products and environments. Add to that supporting another life, and your body’s organs can really take a beating. (source)
The kidneys are in charge of filtering the body’s blood, and is also thought to play a potential role in PUPPS rash. One study injected 3 moms who had PUPPS with their own blood to try and treat the PUPPS rash. Some herbalists use blood purifying herbs to help treat it. The evidence seems to suggest that cleansing the blood is helpful for PUPPS. (source)
2. Abdominal stretching that causes skin inflammation
Carrying extra weight, having multiples, or large babies puts extra stress on the skin and damages the connective tissue. It starts out as stretch marks, but the damage can cause the skin to be inflamed and develop into a PUPPS rash. (source)
3. Fetal cells migrating to the mother’s skin
There’s an old saying that you’ll carry your children in your arms for a short while, but in your heart forever. Science is finding that that statement is more than just sentimental. During pregnancy, fetal cells migrate to different parts of the mother’s body, including her heart and skin. While this can offer protective benefits from certain diseases, research suggests that your skin may see these cells as foreign invaders, triggering a systemic response and causing a PUPPS rash.
This cell migration is more likely to occur if you’re having a boy. In 60-70% of women with PUPPS, who were carrying boys, male DNA was detected in their PUPPS rash. (source)
Is PUPPP very common?
Many rashes and skin conditions during pregnancy fall under a general umbrella and aren’t given a specific diagnosis. PUPPS however is the most common specific skin condition during pregnancy. About 1 in every 130 to 1 in 300 pregnancies develop this rash. It’s more likely to occur in a first pregnancy, but can sometimes occur in subsequent ones. (source)
Should I be worried if I have PUPPS?
Even though the rash is itchy, uncomfortable and looks unappealing, it isn’t anything to be overly worried about. PUPPS doesn’t cause life threatening harm to you or your baby. It’s a symptom of a bigger issue, though there isn’t any conclusive opinion as to what that main cause is.
A surprising side effect
Fitness expert Beth Learn of fit2B specializes in helping others strengthen and heal their core abdominal muscles, especially before, during and after birth, as carrying a baby puts stress on the abdominal muscles and skin. The resulting diastasis recti is a condition that 35-62% of women have (source). Even though the strength of your core won’t make you less likely to get a PUPPS rash, this rash may effect postpartum healing. She’s found that her clients who had PUPPS suffer from some painful and unsightly side effects.
“The discomfort of this awful condition has affected the ability of many of my clients to therapeutically splint a weak core, or do their restorative exercises. The pain and weakened tissue the rash leaves in its wake can have far-reaching consequences, and one client in particular who has successfully narrowed her diastasis and has a fully functional core, is still dealing with a lot of residual muscle and skin softness where her PUPPS was the worst, and the common theory among other fit pros and therapists I polled was that fat seems to gravitate to those weakened areas, perpetuating the look of pregnancy long after a core has healed and baby is walking. In my mind, a comfortable support garment that hugs the soft places without restricting range of motion is ideal while the tissues continue to heal and gentle exercises continue to be performed.”
Since no one is really sure what causes PUPPS exactly, there isn’t a guaranteed way to prevent it. You can however make some healthy choices that may decrease or prevent your chances of getting the condition.
Taking an internal collagen and gelatin supplement can strengthen skin and connective tissue around the abdomen. This can prevent the damage that is thought to lead to PUPPS.
Doing a liver cleanse before becoming pregnant will reduce the toxic load on your body that can be a contributor to PUPPS. You can also use gentle, liver and blood purifying herbs during the third trimester. This dandelion tea is a delicious and healthy way to keep your liver happy.
Using immunomodulating herbs, like astragalus and ashwaganda during the third trimester can potentially prevent your immune system from having a negative reaction to migrating fetal cells. These herbs are also adaptogens, and act as a tonic to balance the immune system. (source)
Massaging a stretch mark body butter over the abdomen not only helps to relieve tight, itchy skin and diminish the appearance of stretch marks, but it can further strengthen the skin. Apply your body butter throughout the whole pregnancy. Gotu Kola in particular helps prevent stretch marks and connective tissue damage, and is the perfect herb to infuse in a body butter. Some people have allergic reactions to Gotu Kola, so always do a patch test first. (source)
The problem with conventional treatment
Conventional medicine is mainly focused on managing symptoms, not actually fixing the problem, and PUPPS is no different. Topical and oral steroids are usually used to relieve the itching. Antihistamines like Benadryl are also sometimes prescribed, but these aren’t effective (source). Steroids can be dangerous, and haven’t been thoroughly studied for safety during pregnancy. Topical steroid use has even been linked to low birth weight. (source)
When will my PUPPS rash go away?
The PUPPS rash usually begins in the third trimester, around the 35th week. Some women develop a PUPPS rash shortly after the delivery of the baby. If left untreated, it disappears on its own within a few weeks to months after delivery. (source) Since it goes away after birth, some doctors recommend induction as a method of treatment. However, induction carries its own risks and complications and isn’t even considered effective at stopping PUPPS. (source)
Natural treatments for PUPPS
There are many ways to relieve the itching of PUPPS, and there are also natural treatments that can potentially prevent or make the rash go away altogether. (source) (source)
Vegetable juices are a gentle way to cleanse and detox the body. Although there’s no clinical evidence proving vegetable juice will cure your PUPPS, there’s plenty of anecdotal evidence. Some women swear by this method. (source)
To use: Drink pure vegetable juices throughout pregnancy, but especially during the third trimester. Follow this video post’s recommendations on the best veggies to juice (and which ones should never go through your juicer!) Fresh pressed is best. Don’t drink large amounts of beet juice though, as this is a very potent detoxer.
Gelatin is a super food for skin issues. Did you know that collagen molecules, found in gelatin, are too large to actually penetrate the skin when applied topically? Those expensive collagen creams don’t hold a candle to grass-fed collagen supplements. This helps strengthen and repair damaged connective tissue that can cause PUPPS.
To use: Add a few scoops of grass-fed collagen protein to your smoothie or juice. (where to buy)
Dandelion root & nettle
Dandelion root and nettle are both liver and blood purifiers that are traditionally used by midwives and herbalists for PUPPS. In fact, this is probably the most popular and effective remedy. Many women have resolved their PUPPS by drinking dandelion root tea and/or nettle leaf tea, as well as taking dandelion root capsules. Dandelion root supports the liver while nettles are a natural antihistamine and anti-inflammatory agent. Nettles are also commonly used during pregnancy to help with anemia because it builds iron levels.
To use: Make dandelion root and nettle leaf tea. Take one teabag of your dandelion root (where to buy) or 1 tsp. of loose tea (where to buy) and steep in 1 cup of boiling hot water for at least 10 minutes up to 1 hour. Do the same with nettle leaf tea, either tea bags (where to buy) or loose tea (where to buy). You can also take dandelion root capsules (where to buy) with your midwife or doctor’s approval.
Chamomile, calendula and Chinese skullcap can be used to reduce skin inflammation when applied topically. Since the PUPPS rash often feels hot and irritated, a salve can feel uncomfortable and irritating so isn’t the best option. Herbal extracts added to soothing aloe vera, witch hazel or lotion is the ideal way to apply these herbs to the skin.
To use: Rub a herbal infused lotion (where to buy) onto the abdomen, 3X a day.
Soaps and suds
Grandpa’s Old Pine Tar Soap is a classic remedy for PUPPS. Use up to 4 times a day on rash. Soaking in an oatmeal bath can relieve the itchiness associated with PUPPS. This helps to soothe and moisturize the skin, and can be done several times a day. You can also make a strong tea with soothing herbs like calendula, Chinese skullcap and chamomile to dump in the bath.
To use: Place 1 cup of rolled oats and 1 cup of organic chamomile loose tea (where to buy) into some cheesecloth or an old t-shirt and secure tightly with a rubber band. Drop this into a tub full of warm water and soak for at least 20 minutes. Occasionally squeeze the oats to release their milky liquid.
Pregnancy can be a stressful time, and this can have a heavy impact on your immune system. Adaptogens help support and modulate the immune system. The body’s response to fetal cells migrating to the mother’s skin, can be calmed with adaptogens. Unfortunately, there isn’t a lot of research around using these while pregnant so best to be cautious and just use maca, which is deemed safe by most herbalists.
To use: Add 1 TB of maca root to your morning smoothie.
Relaxing your nervous system
PUPPS can start to get on your nerves with the constant itching and unsightly rash. Many women report that the itching keeps them up at night and causes restlessness. Gentle nervines like lavender and chamomile can be used in moderation to relax expectant mothers and promote sleep.
To use: Drink a cup of two of this calming tea blend.
What worked for other mamas…
Dana says: “I read that the liver being overtaxed could be one of the contributors to PUPPS and that anything to support the liver would help. So I started taking dandelion/ milk thistle/nettle capsules and also took a homeopathic remedy, sulfur tablets, and I was amazed, only about a few days, and my horrific rash began to fade and the itching completely subsided.”
KB says: “I had PUPPPs twice. Second time I thought I’d try drinking BLACK CHERRY JUICE!!! Easy and if it didn’t work there would be no side effects. Can I tell you how amazed I was because I tried all the recommended natural remedies with minimal relief! Things like dandelion tea / extract / supplement or nettle leaf tea did little for me. After drinking black cherry juice my rash went away within 2 weeks.”
Beth says: “Dandelion Root tea and Nettle tea and dandelion root capsules! Those were the things that got rid of my rash.”
How about you?
Did you get any weird skin conditions during your pregnancy? What did you use to relieve the symptoms? Let us know about it in the comments below!