Rashes In Pregnancy: Causes, Symptoms, Treatment & Remedies

Pregnancy is associated with several skin changes, rashes being one of them. Around one in five women are likely to experience rashes in pregnancy, and it is a common complaint. Some rashes are specific to pregnancy (dermatoses of pregnancy), while some are due to an increase or decrease in existing conditions and other non-specific occurring anytime other than pregnancy (1) (2).

Pregnancy skin changes could be due to endocrine, metabolic, immunological, and vascular changes in the body. Most rashes usually resolve after pregnancy, and a few may require certain treatments as they may pose a risk to the fetus (3) (4).

Read on to learn about the types of rashes, their causes, complications, treatments, and home remedies.

Is A Rash An Early Pregnancy Symptom?

A rash may not be considered an early pregnancy symptom since not all pregnant women experience rashes. Moreover, the rashes experienced by some women are non-specific and can occur in non-pregnant women too.

In a study conducted in 2019, out of 4,280 pregnant women, 99 women complained of skin conditions. Moreover, out of these 99 women, only 22% had pregnancy-specific rashes, while the other 78% had non-specific rashes (5).

What Rashes Occur During Pregnancy?

The most common rashes that may occur during pregnancy may include heat rash and hives.

Heat rash

Heat rashes are small bumps that irritate the skin, making it red and itchy. It happens due to over-sweating.

Pregnant women are more likely to get a heat rash because the hormonal changes affect the sweat glands causing more sweat. The sweating and dampness could make the skin itchier.

These rashes do not cause any harm and may resolve in three to four days. However, it is advisable to see a doctor if the heat rashes are due to an infection or if the rashes become serious and make you feel dizzy and nauseous.

Heat rashes may be relieved by keeping the skin dry, wearing loose clothing, and bringing down the body temperature (6) (7) (8).

Hives

Hives cause itching and occur due to allergic reactions to several things. Since a pregnant woman’s skin is stretched, itchy, and sensitive, she is more likely to develop hives (1).

Causes of hives

Some common causes of hives during pregnancy are (1):

• Medicines
• Insect bites
• Pollens
• Chemicals
• Foods such as nuts, shellfish, and dairy products

Minor hives do not cause any problems and resolve themselves; however, serious rashes may need to be treated by a healthcare provider. Oral medications and anti-itch creams would help treat the condition.

If you are more susceptible to hives, these preventive measures may help you stay away from them (1).

• Avoiding excessive hot showers
• Wearing loose clothing
• Not scratching the affected skin
• Practicing relaxation techniques

PUPPP rash

PUPPP rash (Pruritic Urticarial Papules and Plaques of Pregnancy) causes intense itching and begins in the stretch marks on the abdomen during the third trimester. It later spreads to the buttocks, thighs, arms, and legs.

The rash appears as pink papules (elevated skin lesions less than 1cm in diameter) with a pale halo around each of them. These papules join together to form large, red hive-like plaques (elevated skin lesions more than 1cm in diameter) (9).

PUPPP rash occurs in around one in 160 pregnant women and is most common in (9):

• First pregnancy
• Women with excess weight
• Women carrying multiples (twins, triplets, etc.)
• Women carrying a male fetus

The exact cause of PUPPP rash is unknown, but it may be related to stretching of the abdomen’s skin and genetic factors (1).

The rash does not cause any major fetal risk. However, some babies might be born with a mild form of PUPPP rash, which clears out by itself.

There is no specific treatment for this rash; however, the symptoms can be relieved by moisturizers, topical steroids, and antihistamines (9).

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-related liver condition. It is most commonly seen in the third trimester and is characterized by severe itching. ICP usually occurs in Latina women, affecting around 5% of expectant mothers, and in the US, it affects around 1% of expectant mothers.

In females affected by ICP, bile flow in the body slows down, accumulating bile acids in the blood and tissue.

The exact cause of ICP is unknown; however, genes and pregnancy hormones are believed to play a part in causing the condition (10).

Some risk factors for ICP are (10):

• Having ICP in the previous pregnancy
• A family history of ICP
• Liver diseases such as Hepatitis C
• Mutations in ABCB11 and ABCB4 genes (gene associated with making and using bile)
• Pregnant with multiples

Some symptoms of ICP are (10):

Itchy skin all over the body; however, palms and bottoms of feet have severe itching. Itching may increase during the night.

• Dark urine
• Light-coloured bowel movements
• Jaundice (pale eyes and skin)
• Loss of appetite
• Nausea

ICP should be treated on time; else, it could increase the risk of complications in the baby and mother. Some possible complications are (10):

• Premature birth (before 37 weeks of pregnancy)
• Fetal distress (reduced fetal movement, change in heart rate, and passing meconium as the baby does not get sufficient oxygen)
• Stillbirth (babies may die after 20 weeks of pregnancy)
• Breathing problems in babies if they breathe amniotic fluid with meconium or their lungs are not fully developed.
• Heavy bleeding after giving birth (postpartum hemorrhage).

ICP may be monitored with the help of amniocentesis (amniotic fluid sample is tested), fetal heart rate monitoring (test to check the changes in heart rate), and biophysical profile (a test combining fetal heart rate monitoring and ultrasound). ICP usually goes away a few days after delivery (10).

The condition is treated with prescription medications such as ursodiol, which helps lower the bile acid, relieve itching, and reduce complications (10).

Impetigo herpetiformis

Impetigo herpetiformis or pustular psoriasis usually develops in the third trimester and resolves after delivery. However, it may reoccur in the subsequent pregnancies.

The condition presents itself as symmetrical annular (ring-shaped skin lesions) or polycyclic (many ring-shaped skin lesions) erythematous (red-colored) patches or plaques. These rashes begin in skin folds and spread to the trunk and extremities. They usually do not occur on the face, palms, and soles of the feet.

The exact cause of the condition is unknown; however, it is believed to be caused by a genetic mutation.

Impetigo herpetiformis is often accompanied by symptoms, such as fever, nausea, diarrhea, seizures, and joint pains (11).

The possible complications in the mother include:

• Improper thermoregulation
• Hypoalbuminemia (low levels of albumin protein in the body)
• Redness on 90% of the skin
• Sepsis (unwell due to bacterial infection or circulating toxins in the body)
• Cardiac or renal failure, leading to death

The possible complications in the fetus include:

• Growth retardation in the womb
• Miscarriage or stillbirth

The condition may be diagnosed by the microbiology of the pustule swab (cells of the pustule are examined), blood tests, and skin biopsy.

Impetigo herpetiformis may be treated by moisturizers, pain-relieving medications, intravenous electrolytes, and fluids. In some cases, narrowband UVB phototherapy, systemic corticosteroids, and ciclosporin (immunosuppressant drugs that reduce inflammatory conditions) are given (11).

Pemphigoid gestationis

Pemphigoid gestationis, also called herpes gestationis, is an autoimmune disease associated with pregnancy. It usually develops in the second and third trimesters or immediately after the birth of the baby. The condition is rare, occurring in around one in 50,000 pregnant women.

Pemphigoid gestationis begins with intense itching and red bumps around the navel. It rapidly spreads to trunks, buttocks, and arms but does not affect the face, palms, soles, scalp, and mucous membranes. A clear yellow fluid fills these bumps after a few weeks and turns into blisters.

The condition develops when the body’s immune system attacks itself. In pemphigoid gestationis, the PG factor (an immunoglobulin type G) binds to the BP-180 protein (present in the skin’s basement membrane). This leads to tissue damage and blistering. It is, however, believed that the BP-180 protein of the placenta triggers this autoimmune response (12).

The complications of this condition include (12):

• Preterm birth
• 10% of the babies are born with blisters; however, they resolve within three to four months.
• Secondary bacterial infection may leave scars on the mother’s skin.

Pemphigoid gestationis is usually diagnosed by examining the symptoms, blood tests, and skin biopsy.

Some treatment options available are (12):

• Topical steroids for treating milder symptoms and systemic corticosteroids for severe conditions. The dosage of medications is closely monitored to help reduce the risk to the mother and baby.
• Oral antihistamines to help alleviate itching.
• After delivery, immunosuppressive drugs may be given if required.

Prurigo of pregnancy

Prurigo of pregnancy, also known as pruritic folliculitis of pregnancy, is a non-specific, benign (causing no risk), itchy papular rash (small raised lesions). These rashes generally appear in the second and third trimesters and are seen in around one out of 300 pregnant women (13).

The characteristics of prurigo of pregnancy are (13) (14):

• Grouped papules
• Papules of size 0.1 to 1cm.
• A crust in the center of some lesions
• Found on trunk and limbs

The exact cause for the condition is unknown, but it is believed to be associated with immunological changes (reduced cellular immunity) during pregnancy.

There are no specific diagnostic tests for prurigo of pregnancy. Laboratory tests may indicate an elevated level of serum immunoglobulin E. A culture of the pustule upon testing can help rule out bacterial and fungal infections (13) (14).

Prurigo of pregnancy is treated to relieve the symptoms. Some treatment options are (13) (14):

• Moisturizers with menthol
• Benzoyl peroxide
• Topical steroid creams
• Oral histamines
• Phototherapy

What Are Some Pregnancy-Safe Home Remedies For Rashes?

Itchy skin that does not have any serious underlying conditions may be relieved using some effective home remedies. These remedies are:

• Antihistamines: Antihistamines may effectively relieve itching caused by rashes, such as hives and PUPPP. Some safe antihistamines are Allegra, Benadryl, and Claritin. However, it is important to consult a doctor before taking these medications (1).

• Pine tar soap: Pine tar has been used for several years to treat conditions such as eczema, dry skin, itchy skin, and psoriasis because of its antiseptic, antipruritic, anti-inflammatory, antibacterial, and antifungal properties. These days, pine tar is manufactured with great purity to help eliminate its toxic and carcinogenic components (15).

• Oatmeal bath: Oatmeal has been used to treat various skin conditions because of its non-irritant and moisturizing nature. It is known to balance the pH of the skin, thus relieving the itchiness. Apart from this, oatmeal is also anti-inflammatory and anti-aging. A 15-min soak in a cool oatmeal bath can relieve itchy skin to a great extent (16).

• Stay cool: Applying a wet cloth or an ice pack for ten minutes or more may help reduce the skin’s itchiness. Cooling agents such as calamine and menthol are also effective for itchy skin (17).

• Moisturize: Moisturizing replenishes the essential body oils. Always use a moisturizer free from chemicals, preservatives, and fragrance to soothe your itchy skin (17).

Most rashes during pregnancy go away by themselves; however, if the condition persists, increases in severity, or spreads to different parts of the body, it might indicate an underlying condition. In such cases, it is advisable to see a doctor (7) (17).

Most pregnant women might develop different rashes, and many of these are harmless to the mother and the child. However, it is important to keep an eye on your rashes and consult your doctor to stay away from further complications. Physical examination by a doctor and specific diagnostic tests will help you rule out any severe conditions. Suitable treatment suggestions will also help you enjoy a healthy and rash-free pregnancy.

References

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