Keto Rash: Understanding Carb Intake To Prevent It

Keto rash, also known as prurigo pigmentosa, is an inflammatory skin condition that can occur as a result of a ketogenic diet. It is characterised by itchy, raised skin lesions that are typically red, brown, or light pink in colour. The rash usually appears on the neck, back, chest, shoulders, torso, and armpit areas, and gets worse with heat, sweat, friction, and other skin irritants.

The exact cause of the keto rash is unknown, but it is believed to be linked to the presence of ketones in sweat. To treat the rash, some people choose to exit ketosis by increasing their carbohydrate intake, which often provides quick relief. Other methods to alleviate symptoms include wearing comfortable clothing, showering after exercising, and eliminating potential food allergens and inflammatory foods from the diet.

Ketogenic diet and keto rash

The ketogenic diet is a low-carb, high-fat diet. With a very low carbohydrate intake, the body can run on ketones from fat instead of glucose from carbs. This leads to increased fat-burning and weight loss. However, as with any drastic dietary change, there can be some unwanted side effects. Initial side effects of the keto diet may include brain fog, fatigue, and electrolyte imbalance, and even a keto rash.

Keto rash, also called prurigo pigmentosa, is a rare inflammatory skin condition characterised by a red, itchy rash around the trunk and neck. It is associated with the ketogenic diet.

Symptoms of Keto Rash

The keto rash is a type of dermatitis that can occur in anyone but is most common in Asian women. Symptoms of the keto rash may include:

• An itchy, red rash that occurs primarily on the upper back, chest, and abdomen
• Red spots, called papules, that take on a web-like appearance
• A dark brown pattern left on the skin once the spots disappear

Causes of Keto Rash

The exact cause of keto rash is not known. Researchers are still not entirely sure what causes it, but there are thought to be several associated conditions, including:

• Ketosis: There is a strong correlation between this acute rash and the presence of ketosis, which is how it gets its nickname "keto rash". Ketosis occurs most commonly as a result of restrictive dieting and can also be seen in diabetics.
• External factors: These include sunlight and excessive heat, sweating, friction and skin trauma, and allergens.
• Other associated conditions: These include Sjögren’s syndrome, atopic dermatitis (eczema), anorexia nervosa (eating disorder), and Helicobacter pylori (H. pylori) infection (bacterial infection).

Treatment for Keto Rash

There are several at-home treatment methods for keto rash:

• Reintroduce carbohydrates: If you believe that a recent change to your diet is the cause of your rash, you may want to consider reintroducing carbohydrates. A 2018 study found that incorporating carbs back into the diet significantly improved rash symptoms.
• Correct nutrient deficiencies: Nutrient deficiencies may play a role in certain inflammatory skin conditions. Deficiencies in vitamin A, vitamin B-12, and vitamin C have been linked to both acute and chronic skin conditions.
• Eliminate food allergens: Many keto-friendly foods such as eggs, dairy, fish, and nuts and seeds are also among the most common food allergens. With food allergies being a source of inflammation, it’s important to eliminate any foods you’re allergic to that may be worsening your rash symptoms.
• Incorporate anti-inflammatory supplements: Certain supplements may assist the body in fighting inflammatory conditions. Probiotics, prebiotics, vitamin D, and fish oil supplements have all been used in clinical studies to help improve symptoms of dermatitis.
• Take care of your skin: It’s important to take care of your skin as much as possible, especially if you have inflammatory skin conditions. The National Eczema Association recommends using lukewarm water for bathing and showering, and cleaning only with gentle soaps and cleansers.
• Talk to your doctor about medication: If home treatments fail to clear up the rash, a visit to your doctor may be necessary. Effective medications prescribed for prurigo pigmentosa are the antibiotics minocycline, doxycycline, and dapsone.

Prevention of Keto Rash

Through dietary and lifestyle changes, it’s possible to prevent and ease the keto rash. If you are considering starting the keto diet, you can take the following precautions to reduce your risk of developing a keto rash:

• Slowly lower your carbohydrate intake: Rather than dropping your carbohydrate intake suddenly, try to taper carbohydrates out of your diet slowly.
• Supplement with a multivitamin/mineral: A once-a-day multivitamin or multimineral can help you reduce the likelihood of nutrient deficiencies as you start the keto diet.
• Consult with a doctor: If you’re concerned about any of the side effects of the keto diet, including the keto rash, visit your doctor for more information. They may refer you to a dietitian who can help you transition to the keto diet safely.

Ketone bodies and keto rash

Keto rash, also known as prurigo pigmentosa, is a rare inflammatory skin condition that can occur as a side effect of the ketogenic (keto) diet. It is characterised by an itchy, red rash that typically appears on the neck, chest, back, and abdomen. The rash can also be identified by the dark brown pattern that remains on the skin after the inflammation has subsided.

The exact cause of keto rash is unknown, but it is strongly correlated with the presence of ketosis, where the body uses ketone bodies from fat instead of glucose from carbohydrates for energy. This state is triggered by the low-carbohydrate intake of the keto diet, as well as other factors such as fasting, insulin-dependent diabetes, or bariatric surgery.

One theory suggests that keto rash may be caused by the types of food typically eaten on the keto diet, which is high in fat and low in carbohydrates. This can result in the increased consumption of common allergens such as dairy, eggs, and seafood, which can trigger allergic reactions in some individuals. Another theory posits that the lack of fibre and plant-based foods on the keto diet can alter gut bacteria, leading to increased production of inflammatory compounds.

To treat keto rash, several methods can be employed:

• Reintroducing carbohydrates: Increasing carbohydrate intake can help alleviate rash symptoms and is often recommended as the first course of action. This can be done gradually, allowing individuals to still reap the benefits of the keto diet while reducing the occurrence of the rash.
• Correcting nutrient deficiencies: The keto diet may lead to nutrient deficiencies, especially from vegetables, fruits, whole grains, and legumes. Correcting these deficiencies can help improve skin health and reduce inflammation.
• Eliminating food allergens: Many keto-friendly foods, such as eggs, dairy, fish, and nuts, are common allergens. Identifying and eliminating specific food allergens can help reduce inflammation and improve rash symptoms.
• Incorporating anti-inflammatory supplements: Supplements such as probiotics, prebiotics, vitamin D, and fish oil have been found to help improve symptoms of dermatitis and reduce inflammation.
• Skin care: Proper skin care is important to manage inflammatory skin conditions. Using lukewarm water, gentle cleansers, and moisturisers can help soothe and protect irritated skin.
• Medication: In some cases, medication may be necessary to treat keto rash. Antibiotics such as minocycline, doxycycline, and dapsone have been found to be effective in treating prurigo pigmentosa.

It is important to note that preventing keto rash involves getting the body out of ketosis, as the presence of ketosis is a strong trigger for the rash. Consulting with a healthcare provider before starting the keto diet and monitoring for any signs of a rash are recommended to ensure a safe transition into this restrictive diet.

Ketosis and keto rash

Keto rash, also known as prurigo pigmentosa, is an inflammatory skin condition that can develop when the body enters ketosis. It is characterised by an itchy rash, typically on the neck, chest, back, armpits and sometimes the face and extremities. The rash is usually symmetrical and often takes on a web-like appearance.

The exact cause of keto rash is unknown, but it is believed to be linked to the presence of ketones in sweat. When the body enters ketosis, it can produce more acetone, a type of ketone, which is then excreted through sweat and can irritate the skin. Other factors that may contribute to keto rash include external irritants such as chlorinated pool water, sunlight, friction from clothing, and allergens.

Treatment and Prevention

There are several ways to treat and prevent keto rash:

• Reintroduce carbohydrates: Increasing carbohydrate intake can help alleviate the rash by reducing ketone production. This may involve temporarily coming out of ketosis or following a more liberal low-carb diet.
• Correct nutrient deficiencies: Nutrient deficiencies, particularly vitamins A, B-12, and C, have been linked to skin conditions. Ensuring adequate nutrient intake through diet or supplementation may help prevent and treat keto rash.
• Eliminate food allergens: Many common foods on the ketogenic diet, such as eggs, dairy, fish, and nuts, are also common allergens. Identifying and eliminating potential food allergens can help reduce inflammation and improve the rash.
• Incorporate anti-inflammatory supplements: Certain supplements, such as probiotics, prebiotics, vitamin D, and fish oil, have been found to improve symptoms of dermatitis and may help reduce inflammation associated with keto rash.
• Skin care: Practising good skin care habits, such as using lukewarm water for bathing, gentle soaps, and keeping the skin moisturised, can help protect and nourish the skin.
• Medication: In some cases, medication may be necessary to treat keto rash. Antibiotics such as minocycline and doxycycline have been found to be effective in treating prurigo pigmentosa.

It is important to note that keto rash is typically not dangerous and will often resolve on its own. However, if the rash persists or becomes severe, it is recommended to consult a doctor or dermatologist for personalised medical advice.

Treatment methods for keto rash

Keto rash, also known as prurigo pigmentosa, is an inflammatory skin condition that occurs when the body enters ketosis. It is characterised by itchy, raised skin lesions that are typically red, brown, or light pink in colour. The rash usually forms a symmetrical pattern on both sides of the body, in areas such as the neck, back, chest, shoulders, torso, and armpits.

While the exact cause of keto rash is unknown, it is believed to be linked to the presence of ketones in sweat. Here are some ways to treat and prevent keto rash:

Reintroduce Carbohydrates

If you suspect that your rash is due to a recent change in your diet, consider reintroducing carbohydrates. This can be done by increasing your carb intake to 50-100 grams per day, which will help you stay in a state of ketosis while also reducing the rash.

Correct Nutrient Deficiencies

Nutrient deficiencies can play a role in inflammatory skin conditions. Deficiencies in vitamins A, B-12, and C have been linked to both acute and chronic skin conditions. Eating a variety of colourful fruits and vegetables can help ensure you're getting the necessary nutrients.

Eliminate Food Allergens

The keto diet often includes common food allergens such as eggs, dairy, fish, and nuts. Eliminating these potential allergens from your diet may help reduce inflammation and improve your rash symptoms.

Incorporate Anti-Inflammatory Supplements

Certain supplements may help the body fight inflammatory conditions. Probiotics, prebiotics, vitamin D, and fish oil supplements have been used in clinical studies to improve symptoms of dermatitis. Evening primrose oil is another supplement that has shown promising results for dermatitis.

Take Care of Your Skin

It is important to practice proper skin care, especially if you have inflammatory skin conditions. The National Eczema Association recommends using lukewarm water for bathing and showering, and gentle soaps and cleansers for cleaning. Keeping your skin moisturised and protected from the elements is also crucial.

Talk to Your Doctor

If home treatments are ineffective, it may be necessary to consult a doctor. They may prescribe medications such as the antibiotics minocycline and doxycycline, or dapsone, to help clear up the rash.

Preventative Measures

To prevent keto rash when starting the keto diet, gradually reduce your carbohydrate intake instead of dropping it suddenly. Additionally, consider taking a multivitamin/mineral supplement to reduce the likelihood of nutrient deficiencies.

Clothing and Exercise

Wear comfortable, loose-fitting clothing to minimise sweating, especially around the rash areas. Shower immediately after exercising to keep pores clear and prevent the rash from spreading. If needed, adjust or temporarily quit exercising to see if it helps improve the rash.

Prevention methods for keto rash

Keto rash, also known as prurigo pigmentosa, is a rare inflammatory skin condition that can occur in anyone but is most common in young adult women of Asian descent. It is characterised by an itchy, red rash that occurs primarily on the upper back, chest, neck, and abdomen.

Although the exact cause of keto rash is unknown, it is associated with ketosis, a state in which the body burns fat for energy instead of using carbohydrates. This can be triggered by a low-carb diet like keto, as well as uncontrolled diabetes and anorexia nervosa.

Transition to Keto Slowly

Do not drastically reduce your carbohydrate consumption. Instead, gradually lower your carb intake over time until you can enter and stay in ketosis without any signs of a rash. This will help your body adjust to burning ketones for fuel and reduce the risk of a keto rash.

Address Minor Rash Symptoms Early

Increase your carbohydrate intake as soon as you notice any signs of a keto rash. This will help prevent the rash from progressing to more advanced stages. You can also try other strategies, such as increasing your water intake, taking supplements, or using skincare products to help soothe and heal the rash.

Take Supplements

Nutrient deficiencies can lead to skin conditions, so it is important to ensure you are getting all the essential nutrients your body needs. When starting the keto diet, consider taking a multivitamin or multimineral supplement to avoid deficiencies that could trigger a keto rash. Vitamins A, B-12, and C, as well as omega-3s, are particularly important for skin health.

Avoid Skin Irritants

External factors such as sunlight, excessive heat, sweating, friction from clothing, and skin trauma can aggravate keto rash. Wear comfortable clothing, use air conditioning when needed, and avoid tight clothes, especially around the affected area. Take a shower after exercising to wash off any perspiration, and avoid scrubbing your skin too hard with a towel.

Manage Stress

Emotional stress has been linked to skin inflammation and can worsen skin conditions. Incorporate stress-relieving activities into your daily routine, such as meditation, breathing techniques, yoga, or spending time with loved ones.

Frequently asked questions