Fetal movement has decreased; is it okay to wait and see until tomorrow?

Do not wait. If fetal movement has decreased or changed compared to usual, you must contact your attending obstetrician or the delivery room immediately, regardless of the time.

If there is a red rash, is it not cholestasis?

Cholestasis usually does not have a primary rash, but it can occur simultaneously with other skin conditions. The shape of the rash will be examined, and the need for blood tests will be determined accordingly.

Itching · scratch marks · worsening at night

Pruritus in Pregnancy

Name: Pruritus in Pregnancy Symptoms: Nighttime Itching and Rashes During Pregnancy
Published: 2026-08-23

For those who find it difficult to sleep due to nighttime itching and new rashes during pregnancy

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Current discomfort

Pruritus in pregnancy, when was it most uncomfortable?

If your current discomfort is similar to the experiences below, we can carefully determine during your consultation whether it is pruritus in pregnancy or another skin issue.

Those whose palms and soles itch every night but have no visible rash
Those who have red, itchy spots around stretch marks on the abdomen that spread to the thighs
Those who have experienced itching along with dark urine, jaundice, or changes in fetal movement

Discomfort that persists after tests and treatment

Does the same area become itchy again after you stop using ointments or medication?

The same area may become itchy and red again after a period of improvement while using medication. This does not mean that your previous treatment was ineffective. During your consultation, please tell us how much you improved, when it worsened again, and if the itching has affected your sleep or daily life.

We establish a treatment plan based on your skin condition and the pattern of recurrence. If there are causes that need to be addressed first, such as an infection or rapid worsening, those treatments take priority. Korean herbal medicine treatment considers remaining itching, heat sensations, and oozing, as well as sleep, digestion, and fatigue, to set primary goals and progress criteria; the sequence of necessary dermatological treatments is also adjusted based on your actual response. Lifestyle management is tailored to support treatment goals and minimize skin irritation.

Frequently Asked Questions

Pruritus in pregnancy, were you curious about these points?

What is checked first if there is itching without a rash during pregnancy?
Why should itching of the palms and soles be reported to the obstetrics and gynecology department?
How is the possibility of Korean medicine treatment determined after an obstetric evaluation?

Medical Evaluation GuideItching and Skin Changes During Pregnancy and Breastfeeding: What to Check FirstPlease provide information regarding your gestational age, whether you are breastfeeding, the itchy areas, the presence of a rash, whether symptoms worsen at night, and accompanying changes such as urine color or jaundice. Severe generalized itching that develops during pregnancy should not be viewed as a skin problem alone and may require an obstetric evaluation.Medical Evaluation GuideWhen oozing, pus, pain, and fever occur togetherIf there is rapidly spreading redness, pain that makes it difficult to touch, pus or yellow crusts, fever, or severe swelling around the eyes and mouth, we will first connect you to infection treatment or emergency evaluation. If you have difficulty breathing or if your lips or tongue swell, seek emergency help immediately. Once urgent issues are resolved, remaining itchiness and recurring symptoms will be managed through Korean medicine treatment.Medical Evaluation GuideWhat does Korean medicine look for when skin conditions recur after dermatological treatment?Please list separately what has improved and what still remains after dermatological treatment. If redness, oozing, or wheals have decreased or infection is controlled, record which treatment led to the improvement. If dryness, cracking, itching in the same area, or waking up at night remains, specific goals for Korean medicine treatment can be set. If there is new pain, pus, or rapid spreading, do not consider this part of the remaining recovery; seek medical evaluation first and do not change your prescriptions arbitrarily.

You can check the simple meaning first before proceeding to the detailed explanation

Terms used in the Pregnancy Pruritus Guide

PruritusPruritus refers to itching. This can include itching with distinct skin lesions as well as itching with few visible changes.Intrahepatic Cholestasis of PregnancyIf you experience severe itching during pregnancy, especially on the palms of your hands and soles of your feet, with few visible rashes, it may be necessary to check for causes such as intrahepatic cholestasis of pregnancy.Concurrent CareConcurrent care for skin diseases is a process of determining the necessary sequence of treatment by transparently sharing dermatology diagnoses, topical medications, and tests with Korean medicine care.

When herbal medicine treatment is the primary focus

If pregnancy pruritus worsens again even after treatment

Even if there is little visible rash, itching can significantly disrupt sleep and concentration. Based on a necessary evaluation of systemic causes, herbal medicine treatment can be the primary focus to address nighttime worsening and the cycle of dryness and fatigue.

Before the consultation

We ask where it appeared and when it worsened again

We examine the itchy areas and timing, skin changes before scratching, dryness and lichenification, as well as systemic changes including sleep, bowel movements, urination, and current medications.

During treatment

We check if not only the itching, but also sleep and daily life are improving

We compare the frequency of waking up during the night, scratching wounds, the duration of itch-free time, and the recovery of daily activities.

Treatment sequence

We set the goals for herbal medicine treatment by identifying the problems that need to be resolved first

If there are causes that require immediate priority, such as infection or rapid worsening, those treatments come first. Subsequently, for herbal medicine treatment, we determine the primary goal of recovery by examining current discomfort, recurring patterns, sleep, digestion, and fatigue, and coordinate the sequence with necessary dermatological treatments.

While reducing aggravating factors through lifestyle management, herbal medicine treatment determines the initial target by analyzing the pattern of lesions, sleep, digestion, and fatigue through pattern identification (Byeonjeung). Necessary skin treatments are continued in accordance with the progress.

Consult about treatment

Points to check first

Pregnancy pruritus: Symptoms and when to seek medical evaluation immediately

Itching during pregnancy can be caused by stretching skin or rashes such as eczema or PUPPP, but if you experience severe nighttime itching without a rash, including on the palms of your hands and soles of your feet, intrahepatic cholestasis of pregnancyyou must check for Intrahepatic Cholestasis of Pregnancy (ICP). Red papules or urticarial patches starting near stretch marks on the abdomen and spreading to the thighs and buttocks are clues for PUPPP. If you experience severe itching, jaundice, dark urine, or decreased fetal movement, contact your obstetrics department immediately.

Next steps by symptom

First, check for the presence of a rash and which areas itch more at night

The order of skin care, obstetric examination, and immediate evaluation varies depending on the appearance of the itching and accompanying symptoms.

Symptom Appearance	Possible classification	Next action
Red papules or urticarial patches near stretch marks on the abdomen	Pregnancy-related rashes such as PUPPP	Consult obstetrics or dermatology to confirm the rash and discuss safe treatment
Severe nighttime itching without a rash, including palms and soles	Possibility of Intrahepatic Cholestasis of Pregnancy (ICP)	Contact obstetrics immediately for bile acid and liver function tests
Worsening dryness, scaling, and redness in existing eczema areas	Skin conditions such as eczema or contact dermatitis	Medical evaluation after documenting exposure and moisturizer use
Jaundice, dark urine, or pale stools	Possibility of liver or bile-related abnormalities	Notify obstetrics on the same day for prompt medical evaluation
Baby moving less than usual or changes in movement patterns	Fetal status check required	Contact obstetrics immediately; do not wait until the next day

Director Choi Yeon-seung's Clinical Perspective

Pruritus in Pregnancy: How is the direction of Korean herbal medicine treatment determined?

If there is sudden itching on the palms and soles without a rash, jaundice, dark urine, or decreased fetal movement, we advise receiving an obstetric examination first. While continuing the evaluation and treatment schedule for ICP and other pregnancy complications, Korean medicine treatment is provided concurrently with the goal of reducing recurring skin itching, scratch wounds, and the frequency of waking up at night.

Changes to be confirmed in this treatmentWhile first ensuring obstetric safety, we support the mother's daily life and sleep by reducing the duration of itching, scratch wounds, and the frequency of waking up at night.

Chief Director Choi Yeon-seung · Korean medicine treatment since 2010

Consult about the progress of pruritus in pregnancy

Educational close-up example of hives with smooth red wheals of various sizes scattered on the arm — 01 · First, we examine the appearance of the skinSmoothly raised wheals without scaling
The key clue is whether the surface has almost no scaling and whether the wheals rise smoothly and then shift location. Please record whether the same lesion remains after several hours, along with the time the photo was taken.
Actual clinical photos and educational close-up examples are materials for comparing possible patterns and cannot be used for diagnosis alone. Mechanism diagrams have simplified complex processes.

If these discomforts have recurred

For those who find it difficult to fall asleep due to nighttime itching and new rashes during pregnancy

Itching during pregnancy may be due to dryness from stretching skin or pregnancy-related rashes; however, if the palms and soles are particularly itchy without a rash and symptoms worsen at night, Intrahepatic Cholestasis of Pregnancy must be checked. After an obstetric evaluation, we assess the mother's skin heat, dryness, sleep, digestion, and physical strength Byeonjeung (pattern identification).

Those who experience itching on the palms and soles every night but have no visible rash

When rashes on the abdomen, arms, and legs, as well as nighttime itching, persist even after an obstetric evaluation

Those whose red, itchy spots around stretch marks on the abdomen are spreading to the thighs

Despite moisturizing and lifestyle adjustments scratch marksand when sleep disturbance is severe

Those who experience itching along with dark urine, jaundice, or changes in fetal movement

When skin heat, dryness, digestive issues, edema, or fatigue occur along with itching

Educational close-up example of atopic dermatitis showing dry redness and shallow scratch marks in the inner fold of the elbow — 02 · View with the main textDryness and scratch marks in the elbow fold
We examine dryness, fine flaking, skin texture, and scratch marks in the folding areas. Contact dermatitis or infections with similar appearances are distinguished through progress monitoring and examination.

Points to distinguish first

How to distinguish pregnancy pruritus from similar-looking skin conditions

First, identify symptoms suggestive of ICP and changes in fetal movement

Nighttime itching of the palms and soles without a rash, jaundice, dark urine, or decreased fetal movement should be connected to the obstetrics department immediately.

Examine other skin conditions, such as PUPPP or eczema, differently

Determine if a dermatology or obstetrics examination is necessary by checking the starting location and shape of the rash, blisters, pain, and whether it is a new reaction or existing eczema.

Only check for supplementary treatment changes for discomfort that persists after testing

While maintaining obstetrics prescriptions and tests, consult on the possibilities and limitations of herbal medicine treatment when chronic itching or sleep disturbance recurs.

Why does it keep getting worse?

Reasons why pregnancy pruritus lasts long or recurs

First, check whether there is a rash or not

Distinguish whether there are papules or plaques on abdominal stretch marks, or if the skin looks normal but the palms and soles are itchy.

Do not delay obstetrics examinations

For severe nighttime itching without a rash, consult with the obstetrics department to see if bile acid or liver function evaluations are necessary.

Simultaneously check the mother's heat, dryness, and sleep recovery

Skin discomfort remaining after necessary evaluations is diagnosed based on pattern identification within the safety range and the current week of pregnancy.

Medical illustration comparing a normal skin barrier with a damaged skin barrier showing moisture loss, influx of irritants, and a repeating cycle of itching and scratching — 03 · View with main textSkin barrier damage and the itch-scratch cycle
This is a simplified concept showing that when the barrier that retains moisture is disrupted, dryness and exposure to irritants increase, and itching and scratching can further damage the barrier.
Conceptual reference · NIAMS Atopic Dermatitis

Things to prepare before your visit

What photos and records should I prepare before the medical evaluation?

Please prepare the week of pregnancy, photos of the rash, the time and location of itching, the color of urine and stool, changes in fetal movement, bile acid and liver function results, and current obstetrics prescriptions. This helps in safely determining if obstetrics treatment is needed first and whether Korean medicine treatment can be combined.

Please be sure to let us know if your palms and soles are also itchy

If there is itching in the hands and feet without a rash, or itching that spreads throughout the body, notify the obstetrics department of the possibility of intrahepatic cholestasis of pregnancy.

It worsens at night and interferes with sleep

ICP itching can worsen at night. Do not dismiss it as simple dryness; consult on whether bile acid and liver function tests are necessary.

Check for jaundice and changes in urine and stool color

If changes such as yellowing of the skin or eyes, darkening of the urine, or lightening of the stool occur, notify the obstetrics department promptly.

Changes to monitor during treatment

What changes should I monitor during treatment?

Gestational age, initial site of rash, and order of spread

Please record when it started and how it has changed, including the dates. To make it easier to compare before and after, take photos of the same area from a similar distance and under similar lighting.

Itching of palms and soles, nighttime worsening, jaundice, and urine color

Please leave a brief note. Compare not only the visible changes but also whether your sleep, pain, and daily life have become less uncomfortable.

Obstetric exams, medications, sleep, digestion, edema, and body heat

Please also include the dates of any medications, ointments, or procedures you are currently using. This makes it easier to compare what led to improvement or worsening.

Educational example of chronic pruritus showing dry skin, linear scratch marks, and occasional small scabs on both calves without distinct primary lesions — 04 · View with main textLegs with dryness and scratch marks rather than distinct rashes
In cases of pruritus (itching), only wounds from scratching may be visible rather than the initial lesions. Please check for new medications, systemic diseases, dry environments, and the extent of nighttime itching.

When planning herbal medicine treatment

For pregnancy pruritus, the direction of Korean herbal medicine treatment is determined based on the current prominent symptoms

After first ruling out obstetric causes for the rash, we evaluate whether the skin is red and hot, whether there is significant edema or moisture, whether it is dry and worse at night, or whether recovery is slow due to depleted energy.

Pattern identification (Byeon-jeung) in Korean medicine is not about giving a different name to a disease. Multiple patterns can overlap in one person, and as the skin changes, for example, as oozing and heat decrease and dryness or cracking remain, the prescription is adjusted accordingly.

01 · Blood Heat · Febrile Rash Type

When red papules, plaques, and heat sensations increase rapidly

Primary skin observations: We examine redness and heat in the abdomen and limbs, as well as new skin changes.
Overall body condition to check alongside skin: We check for thirst, heat in the upper body, and difficulty sleeping.
Primary considerations for herbal medicine prescription: We reduce skin heat and itching within the safety range for pregnancy.

02 · Damp-Heat · Edema Type

When itching occurs alongside edema and in moist skin folds

Primary skin observations: We look for symptoms such as oozing, swelling, and suspected infection.
Overall body condition to check alongside skin: We inquire about lower body edema, bloating, and changes in urination.
Primary considerations for herbal medicine prescription: Along with obstetric evaluation, we manage the burden of damp-heat and fluid metabolism.

03 · Blood Deficiency and Wind-Dryness · Dry Type

When the skin is dry and scratching is severe at night

Primary skin observations: We look for fine scales, cracks, and dry scratch marks.
Overall body condition to check alongside skin: We check for dryness of the mouth and skin, and shallow sleep.
Primary considerations for herbal medicine prescription: The focus is on nourishing the blood, moisturizing dryness, and restoring the skin barrier and sleep.

04 · Qi and Blood Deficiency · Poor Recovery Type

When appetite and energy decrease and wounds heal slowly

Primary skin observations: We examine scabs, color changes, and recovery time.
Overall body condition to check alongside skin: We inquire about fatigue, appetite, and dizziness.
Primary considerations for herbal medicine prescription: We supplement the mother's Qi, blood, digestion, and skin recovery.

How is the herbal medicine prescription adjusted?

Obstetric causes are ruled out first
Do not delay seeking care if you experience nighttime itching on the palms and soles, jaundice, or changes in urine color.
We examine the rash and skin stages separately
We determine the proportion of heat, dampness, dryness, and impaired recovery.
We prioritize the safety of the mother and fetus when adjusting treatment
We share information regarding obstetric care, gestational age, and current medications.

When should I consider Korean herbal medicine treatment?

When abdominal or limb rashes and nighttime itching persist even after an obstetric evaluation
When scratch marks and sleep disturbance are severe despite moisturizing and lifestyle adjustments
When skin heat, dryness, digestion issues, edema, or fatigue fluctuate along with the itching

What will be asked during the medical evaluation?

Gestational age, the initial site of the rash, and the order in which it spread
Itching on the palms and soles, nighttime worsening, jaundice, and urine color
Obstetric tests, current medications, sleep, digestion, edema, and body heat

Things to prepare before the consultationPlease prepare your gestational age, photos of the rash, the time and location of itching, changes in urine/stool color and fetal movement, bile acid and liver function test results, and your current obstetric prescriptions. This helps us safely determine if obstetric treatment is required first and whether Korean medicine treatment can be administered concurrently.

If pus, pain, or redness spreads rapidly, or if you have a fever, lesions inside the eyes or mouth, shortness of breath, or sudden facial swelling, please visit a dermatology clinic or seek emergency care first. After confirming that such urgent situations are not present, Baekrokdam provides herbal medicine treatment for chronic and recurring skin diseases.

Consult about the progress of pregnancy pruritus

Frequently Asked Questions

Frequently Asked Questions about Pregnancy Pruritus

If I have itching without a rash, is it just because my skin is dry?

That may be the case, but if you experience itching on the palms and soles that worsens at night, you should inform your obstetrician about the possibility of ICP and consult regarding bile acid and liver function tests.

What is the difference between PUPPP and Intrahepatic Cholestasis of Pregnancy (ICP)?

PUPPP typically presents with red papules or urticarial rashes on the abdomen, whereas ICP is characterized primarily by severe itching without a rash. These are distinguished through physical examination and blood tests.

If the first blood test is normal, does that mean it is not ICP?

Itching can sometimes appear before abnormalities show up in the blood. If symptoms persist, bile acid and liver function will be re-tested based on the obstetrician's judgment.

Fetal movement has decreased; can I wait and see until tomorrow?

Do not wait. If fetal movement has decreased or changed compared to usual, you must contact your obstetrician or the delivery room immediately, regardless of the time.

If my palms and soles are itchy, is it Intrahepatic Cholestasis of Pregnancy?

While these are suspicious symptoms, a diagnosis cannot be confirmed by itching alone. You must inform your obstetrician immediately and undergo liver function and serum bile acid tests.

If blood test results are normal, does that mean it is not cholestasis?

Itching may start first, and levels may change later. If symptoms persist and there are no other causes, the obstetrics department will determine the timing for repeat tests.

If there is a red rash, does that mean it is not cholestasis?

Cholestasis usually does not have a primary rash, but it can occur simultaneously with skin diseases. The shape of the rash will be examined to determine if blood tests are necessary.

References and update date

Doctor of Korean Medicine Choi Yeon-seung verified the content based on the official and professional materials below and updated it on 2026-08-23.

RCOG, Intrahepatic cholestasis of pregnancyObstetric evidence for immediate verification in cases of itching without rash, worsening on palms/soles or at night, jaundice, bile acid/liver function tests, or concerns regarding fetal movement
ACOG, Skin Conditions During PregnancyEvidence for distinguishing between the red papules and urticarial rashes of PUPPP that start on the abdomen and the rash-free itching of the palms and soles in ICP
NHS, Itching in pregnancyEvidence that itching of the palms, soles, and nighttime itching during pregnancy may be symptoms suggestive of ICP, requiring an urgent obstetric evaluation
MedlinePlus Genetics, Intrahepatic cholestasis of pregnancyEvidence regarding impaired bile flow, bile acid accumulation, complex causes involving genetics, hormones, and environment, and related risk factors
American Academy of Dermatology, Uncontrollably itchy skin

Medical Inquiry

Please provide photos of your symptoms when they are severe and when they are mild, as well as any discomfort you have experienced in your daily life.