If you just started the keto diet and developed an itchy rash, don’t panic. What you’re experiencing is a rare and harmless side effect of the ketogenic diet. The keto rash is not a sign that you’re doing something wrong or that the keto diet is in any way harmful. It’s simply an unusual reaction to entering ketosis.
The keto rash is not really limited to the ketogenic diet. It happens to people on vegetarian and vegan diets as well. Scientists have also documented the rash in people with diabetes. Learn more about the keto rash in the lines below. We explain what it is, why it happens, and how to treat it.
What is the Keto Rash?
Keto rash is a rare inflammatory disease of unknown origin with a scary-sounding scientific name: prurigo pigmentosa. It can present on people who are in the early stages of ketosis and was first reported in Japan in 1971.
The rash doesn’t have an exact cause and it’s just beginning to be understood and researched in the West.
What Are the Symptoms of Keto Rash?
Keto rash is an itchy, red rash that typically occurs on the torso, back, neck, and underarms. The rash is often symmetrical and usually appears within a few days or weeks of entering ketosis.
Its appearance has been likened to contact dermatitis, eczema, and impetigo. However, keto rash has a unique netlike pattern that is present from the initial stage through its resolution.
What are the Stages of the Keto Rash?
Early lesions: During this stage, the skin shows light pink raised skin lesions that look like scratch marks. This stage is often overlooked because it just looks like a minor rash or scratch.
Fully developed lesions: This is the full-blown rash people get worried about because it is much more aggressive. During this stage, the skin is infested with pronounced red skin lesions called papules, and sometimes the papules will include liquid-filled cysts or, more rarely, pus-filled cysts.
Resolving lesions: When the rash is receding, crusted and scaly papules will take the place of the red lesions. The papules will also start to get darker.
Late lesions: The skin is left with a net-like pattern of dark spots larger than freckles, called “reticulated hyper-pigmentation”. When this happens, the rash is almost fully healed. The pigmentation might remain long after the rash is gone, but the skin will eventually return back to normal.
What Causes the Keto Rash:
While there are dozens of theories about this problem, each more weird and unlikely than the next, I believe there’s a very simple answer. This is based on many people’s experiences, and the limited scientific studies available.
Here are the clues, and the conclusion:
- The itching usually starts soon after people get into ketosis. It stops within a day or so if people eat more carbs and exit ketosis.
- It can often get worse in hot weather, or after exercising.
- The usual distribution of the itch and rash matches areas where sweat can accumulate.
- When in ketosis sweat can contain the ketone body acetone.
- Acetone can be irritating at high concentrations.
- I think there is a good reason to believe that the itching that some people experience in ketosis is caused by ketones in sweat, perhaps as this dries on the body.
How to Cure Keto Rash?
Full disclosure: The best cure for keto rash is debatable because the root cause is not clearly defined.
However, you can try these 5 research-backed methods to alleviate your symptoms:
1.GIVE IT TIME
The keto rash may go away on its own after a few weeks. If you’re new to the keto diet, it may just be a waiting game while your body adjusts. The longer you’re in ketosis, the more your body adapts to the production of ketones.
Research finds that in patients who received no treatment, the lesions cleared spontaneously within weeks.
HOWEVER, IF THE RASH DOESN’T GO AWAY ON ITS OWN AFTER A WEEK OR TWO, IT’S TIME TO TRY OTHER OPTIONS.
2. EAT MORE CARBOHYDRATES
Some research suggests prolonged periods of fasting or being in ketosis correlate with the rash [*]. Out of the 16 patients in the study, eight manifested the rash after fasting for a long period of time, and six were in ketosis.
In a different study involving 50 patients, a dietary change (either ketosis, fasting, or a low-carb diet) was the suspected trigger for 17 people.
As mentioned above, ketones, excessive fasting, and a low-carb diet are the top 3 potential triggers of the rash, so this is the first factor you should address.
To test if a ketogenic diet might be your trigger, do this:
Try increasing carb intake just enough to get out of ketosis for a few days and see if the rash lets up.
If it does, lower carb consumption and enter ketosis again.
If the rash reappears, it can mean your body might be sensitive to ketones.
In this case, consider a more liberal low-carb diet of around 50-100 grams of carbs per day and combine it with intermittent fasting. This will still provide some benefits of ketosis and fasting.
OVER TIME, YOU MAY BE ABLE TO FIND YOUR “SWEET SPOT” WITH CARB INTAKE THAT PROVIDES BENEFIT WHILE REDUCING RECURRENCE OF THE RASH.
3. TRY AN ELIMINATION DIET
The fourth potential trigger of the rash is an allergic reaction to a keto-friendly food. If you’ve recently introduced new foods or large amounts of certain foods, you want to test for allergies.
The most common keto-friendly foods that may trigger allergies are:
- Dairy (cottage cheese, full-fat yogurt). Here’s a handy guide on how to tell if you can eat dairy.
- Fish (tuna, salmon)
- Shellfish (oysters, clams, crab)
- Tree nuts (macadamia, almonds)
To find out if you’re allergic, try an elimination diet:
Remove these foods from your diet for 30 days.
Check if your rash has diminished or disappeared after this time.
If it did, introduce just one of these foods again in your diet and wait 1-2 weeks.
If the rash hasn’t re-appeared or worsen, add a new food.
Continue to add one new food every 1-2 weeks if no symptoms appear.
If the rash resurfaces after introducing a new food, that’s your trigger.
4. SUPPLEMENT TRACE ELEMENTS
To rule out any deficiency related causes, make sure to supplement your diet with vitamins and minerals that can be difficult to get when on a keto diet. Specifically, try supplementing with:
Minerals: sodium, potassium, magnesium, calcium. These minerals can diminish during a transition to a ketogenic diet. They need to be supplemented because they’re vital for cell function and energy.
Vitamins: vitamin D, vitamin A, Omega-3. These vitamins are necessary for regulating inflammation. Since the keto rash is an inflammatory response, they can’t be missing from your diet.
Bile Salts: cholic, deoxycholic, chenodeoxycholic, and lithocholic acids. Bile salts help the liver process large amounts of fat properly.
Want a quick fix? Consider supplementing with Keto Greens Powder—it has all these vitamins and minerals and a lot more.
5.Talk to Your Doctor About Antibiotics
Indiscriminate use of antibiotics is certainly harmful, but the scientific literature shows that specific types of antibiotics are highly effective against the keto rash.
The antibiotics that have shown the best results are:
- Dapsone (minocycline has been preferred to dapsone because it has fewer side-effects and results in a longer remission.)
Other medicaments that aren’t effective against the rash include antihistamines, topical steroids, and oral steroids.
Talk to your doctor about the potential risks and benefits of taking an antibiotic for your rash.
How Can I Change my Lifestyle to Cure the Keto Rash?
Since sweat is a major rash trigger, try taking a few days off from the gym or at least reducing your workout intensity so as to minimize sweating.
If you do decide to exercise strenuously, be sure to shower directly after to wash off any perspiration (and the hitchhiking acetone irritants).
Rubbing can significantly aggravate the rash as well , so it’s recommended to wear loose-fitting workout clothes to reduce the amount of friction on your skin.
Sweating from exercise can make you itchier, which makes you want to scratch (more friction), so it’s necessary to keep the sweating at a minimum.
AVOID ANYTHING THAT CAUSES FRICTION ON YOUR SKIN
Since friction also flares up rashes, avoid:
- Wearing tight clothes, especially around the area where you have the rash.
- Using any type of exfoliants in your skin, like homemade scrubs or a loofah.
- Scrubbing too hard with your bath towel after a shower.
- Using bandages.
- Sleeping over the area that is affected, if possible.
Keep the area moisturized with a cream or an oil that your skin can take. Lubrication will help prevent friction.
TRY STRESS-REDUCING TECHNIQUES
Emotional stress can make your skin flare up again, so adopt relaxing habits that support your mental health.
You can regulate your emotions through meditation, breathing techniques, taking walks, engaging in a relaxing activity (drawing, painting, reading a book), exercise, going to therapy, and talking about your problems with the right people.
Emotional stress has been linked to inflammation on your skin and can worsen over 9 skin disorders. This is because the dermal mast cells have a close connection with sensory nerve endings and may release signaling molecules that promote inflammation.
Keto rash is a side effect experienced by a small minority of people who follow a keto way of eating. The odds are on your side. It’s unlikely you will get a keto rash, as it tends to be rare. Got question? Comments? Or would like to share your experience? Join our Facebook Group!!!!