• The rash caused by PUPPP starts on the stomach and spreads outward.pregnant belly button image by davidcrehner from Fotolia.com
  
  According to the American Congress of Obstetricians and Gynecologists, Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) affects 1 of 200 pregnant women. This condition generally develops during a woman's first pregnancy, or if she's pregnant with multiple babies. The cause of PUPPP is unknown but may be related to increased hormones and skin stretching. Also, this condition may be caused by various reactions of the immune system, possibly to male fetal DNA, since 70 percent of women with this condition give birth to boys. Symptoms of PUPPP usually resolve spontaneously after the baby is delivered but can disappear a week before delivery or up to six weeks after the baby is born.
  
  

Papules

• The first symptom of PUPPP is the appearance of papules on or near stretch marks. Papules are raised, solid skin lesions that have a noticeable border. These red skin lesions measure less than 1cm in diameter. Papules appear first on the stomach but can spread to the chest, arms and legs. It isn't common for the papules to develop on the face, palms or soles of the feet. Papules usually appear in the third trimester.
  
  

Plaques

• Papules can grow together, forming plaques that are similar in appearance to hives. Plaques are a raised area of skin that measures greater than 1cm in diameter. Small, elevated, fluid-filled blisters called vesicles can also form in the affected area. A characteristic of PUPPP is that the rash doesn't spread to the bellybutton. To prevent dryness, you can apply a moisturizing lotion to the papules and plaques throughout the day.
  
  

Itching

• Itching over the affected area is described as mild, annoying, intense and unbearable. The itching can interfere with your sleep by keeping you awake at night. Your doctor may recommend medications to help control the itching, such as over-the-counter or prescription steroid creams, as well as over-the-counter antihistamines including diphenhydramine (Benadryl), loratadine (Claritin) or cetirizine (Zyrtec). Diphenhydramine can make you sleepy, so it may be more helpful with the itching at night.