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Polymorphic eruption of pregnancy
Other Resources UpToDate PubMed

Polymorphic eruption of pregnancy

Contributors: Jordana Gilman MD, Vivian Wong MD, PhD, Susan Burgin MD, Mitchell Linder MD
Other Resources UpToDate PubMed


Polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy (PUPPP), is the most common specific eruption of pregnancy. The etiology is unknown, but it may be related to skin distension. It is a benign condition that almost always begins in the third trimester of a first pregnancy or in the immediate postpartum period. This pruritic eruption develops in and around the abdominal striae and it may then spread to the extremities, chest, and back. It presents as erythematous or urticarial papules and plaques. Polymorphic clinical features are seen in around half of patients, including the development of eczematous papules and plaques, vesicles, and target lesions. Pruritus can be severe, leading to sleep disturbance.

PEP occurs in about 0.5% of pregnancies and is associated with a higher frequency of multiple gestation and significant intrapartum weight gain (with a higher degree of stretching of abdominal skin). Other risk factors include primiparity and Northern European descent. It is important to note that there is no association with adverse fetal or maternal outcomes. PEP is self-limiting and typically resolves within 4 weeks of rash onset, usually 2 weeks postpartum. Recurrence with subsequent pregnancies is uncommon.


O26.86 – Pruritic urticarial papules and plaques of pregnancy (PUPPP)

88697005 – Pruritic urticarial papules and plaques of pregnancy

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Last Reviewed:02/21/2021
Last Updated:02/28/2021
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Patient Information for Polymorphic eruption of pregnancy
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Contributors: Medical staff writer


Pruritic urticarial papules and plaques of pregnancy (PUPPP) is the most common skin condition of pregnancy. Typically, women affected by PUPPP develop red, itchy bumps on the belly near stretch marks (striae) during their third trimester. PUPPP usually gets better within a few weeks after delivery, does not affect the health of your baby, and has no long-term consequences for you.

Who’s At Risk

PUPPP is common in pregnant women, occurring in approximately 1 in every 200 pregnant women. The cause is unknown but has been thought to be due to increasing hormones, skin stretching (distention), and various reactions of the immune system. PUPPP usually appears in the third trimester, most often during a woman's first pregnancy and in women expecting multiple babies. PUPPP typically does not occur in woman in second or later pregnancies.

Signs & Symptoms

The earliest signs of PUPPP are red, itchy bumps near areas of stretch marks. These bumps may spread to other parts of the body, usually to the chest, arms, and legs. It is uncommon for the rash to appear on the face, palms, or soles of the feet. The individual bumps may get larger and form raised, red areas that look like hives. Blisters filled with liquid may also be seen. Although the appearance of the rash can vary and change over time, most women's main concern is the intense itching that is a key component of this condition. PUPPP usually goes away about 1 week after delivery (postpartum) but can disappear anywhere from a week before delivery to up to 6 weeks postpartum.

Self-Care Guidelines

Thick moisturizers can be applied to the rash throughout the day to prevent dryness and relieve itching. An over-the-counter topical steroid such as hydrocortisone (0.5 or 1%) may be applied to affect areas. An over-the-counter antihistamine such as diphenhydramine is safe to take during pregnancy and can decrease the itching, but it may make you sleepy. Loratadine and cetirizine are other antihistamines that are less sedating and may help during the day.

When to Seek Medical Care

The most common treatment your doctor will give you is a steroid cream - either prescription-strength or something available over the counter - to be applied directly to the affected areas. Only in severe cases are oral steroids required to control the itching. Rarely, if your doctor is unsure of the diagnosis of PUPPP, he or she may recommend a skin biopsy to confirm the diagnosis.


Your doctor may give you a prescription for a topical corticosteroid. In rare cases, you may need oral corticosteroids.


Broza Z, Kasperska-Zajac A, Oles E, Rogala B. Pruritic urticarial papules and plaques of pregnancy. J Midwifery Womens Health. 2007;52(1):44-48. PMID: 17207750.

Thurston A, Grau RH. An update on the dermatoses of pregnancy. J Okla State Med Assoc. 2008;101(1):7-11. PMID: 18390233.

Tunzi M, Gray GR. Common skin conditions during pregnancy. Am Fam Physician. 2007;75(2):211-218. PMID: 17263216.
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Polymorphic eruption of pregnancy
A medical illustration showing key findings of Polymorphic eruption of pregnancy : Abdomen, Pruritus, Striae, Maculopapular erythema
Clinical image of Polymorphic eruption of pregnancy - imageId=24163. Click to open in gallery.  caption: 'A close-up of urticarial plaques arising within striae.'
A close-up of urticarial plaques arising within striae.
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