Pruritic urticarial papules and plaques of pregnancy (PUPPP) rash is an itchy rash that appears in stretch marks of the stomach during late pregnancy.

While the exact cause of PUPPP rash isn’t known, the stretching of the skin seems to be a trigger for the rash to occur. PUPPP rash occurs in about 1 in every 150 pregnancies.

Other names for the condition are:

nurse’s late-onset prurigo

Bourne’s toxemic rash of pregnancy

toxic erythema of pregnancy

Typically, the PUPPP rash will appear during the third trimester of pregnancy. Your baby’s growth rate is very rapid during this time, especially during the last five weeks of pregnancy.

It’s most likely to occur during a first pregnancy and during a multiples pregnancy, where the skin stretches even more.

During your pregnancy, sometimes your skin stretches faster than your skin cells can keep up with. This can cause stretch marks to appear. Adding further insult to injury is the PUPPP rash, which can occur in the stretch marks around the bellybutton.

PUPPP usually begins on the abdomen and spreads to other extremities within a few days.

The rash appears as small, pink pimple-like spots that appear in the stretch marks. They closely resemble hives. Eventually, the rash may start to come together and form large, red, plaque-like areas.

Blisters can sometimes form around the rash. These plaques can then spread from the stomach to the:

buttocks

thighs

arms

legs

Usually, the rash won’t spread higher than your breasts.

A PUPPP rash tends to be very itchy, especially at night. Along with your growing belly, it may affect your ability to get a good night’s rest.