Pregnancy Dermatoses

Mamas on Bedrest: PUPPS and Pregnancy

September 14th, 2012

PUPPS: A Case Study

Mrs. U, a 36 year old first time mom presents for a routine prenatal visit at 32 weeks gestation. She complains, however, of a new “itchy rash all over my chest.” Mrs. U first noticed the rash upon awakening. It is just on her trunk and does not involve the hands.

Mrs. U’s vital signs:

BP 124/64mm Hg, Pulse 88bpm.

On physical exam, small reddish papules were present on the chest, and she describes them as itchy. No fever, enlarged lymph nodes or any other symptoms. Mrs. U reports consistent, good fetal movement.

Fundal height: 32cm
FHT:  140 sets

The likely diagnosis for Mrs. U’s rash is PUPPS (pruritic urticarial papules and plaques of pregnancy). PUPPS is a chronic hive-like rash that generally begins appearing on the abdomen and can often spread to the chest, legs, and underarms. This condition more frequently occurs in first pregnancies during the third trimester. Mrs. U is reassured that PUPP has no long-term effects to the health and safety of both mother or fetus. She is prescribed Benadryl to alleviate the rash. A mild topical corticosteroid (e.g., clobetasol or betamethasone) is reocmmended to help with the itching.

I get case studies in my e-mailbox as part of my continuing PA education. This case study comes from the Monthly Prescribing Reference. I liked this particular case study because PUPPS was one of the first dermatology challenges I saw as a new physician assistant. A woman came into the office and had this cherry red bumpy rash all over her pregnant torso. It kind of freaked me out and I called in my supervising physician because I didn’t know what to make of it. My supervising physician chuckled a bit because both the mama and I were wide-eyed, expecting that she had some sort of seriously contagious condition. And much like the case study above, we prescribed the mama some atarax (a mild antihistamine, but a bit less sedating than benadryl) and a very mild hydrocortisone cream to help with the itching. Mama went home and later had a healthy baby and the PUPPS spontaneously resolved post partum as they always do.

Pregnancy is such an interesting state. While it is “natural” it often causes some pretty “unnatural” things to occur to a woman’s body. In the case of PUPPS, it  has no known origin and no known reason to occur. There is no way to predict which mamas will develop it and which ones won’t. And once mama delivers, it spontaneously resolves. The good news is that it has no known major side effects and does no harm to mama or the baby.

I share this case with you all as kind of a reminder that all that occurs during pregnancy isn’t negative or serious. For those who have experienced (or are experiencing) bed rest, anything out of the ordinary sends up “red flags” (yes, pun intended!!). But this is a reminder to relax, it’s all going to be okay!

If you’d like to see some images of PUPPS, click on the links below.

The American Academy of Family Physicians


Have you had a “weird” occurrence during pregnancy that you’d like more info about or would like discussed, send your inquiries or ideas to us at We’re more than happy to provide information and resources!