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Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a distinct pruritic eruption of pregnancy that usually begins in the third trimester, most often in primigravidae. There is no increased risk of fetal morbidity or mortality.


Not understood. There is little evidence to suggest that PUPPP is an autoimmune disease. This reaction may represent a maternal response to paternal antigens expressed in the fetal placenta. No HLA subtypes appear to be predisposed when patients are compared with North American controls.


The rash of PUPPP almost always begins in the stretch marks (striae) of the abdomen. It does not involve the belly button distinguishing it from other common rashes of pregnancy.

The rash is very itchy, or pruritic, hence the name. This condition is harmless to mother and baby, but can be very annoying. Sometimes the rash can include small vesicles.

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