Keto Rash: Can It Reoccur And What To Do?

The keto rash, or prurigo pigmentosa, is an inflammatory skin condition that can occur as a result of the ketogenic diet. It is characterised by itchy, red skin and raised papules, usually on the upper body. The rash is rare and tends to affect young women, particularly those of Asian descent. The exact cause of the rash is unknown, but it is believed to be linked to ketosis. The rash can be treated by reintroducing carbohydrates into the diet, correcting nutrient deficiencies, and eliminating food allergens. In some cases, medication such as antibiotics may be prescribed by a doctor. While the rash usually goes away on its own, it can come back if the underlying causes are not addressed.

What is keto rash?

Keto rash, also known as prurigo pigmentosa, is an inflammatory skin condition that can develop as a result of the ketogenic diet. It is characterised by an itchy rash that typically appears on the neck, chest, back, and upper body. The rash is red and can take on a web-like appearance.

Keto rash is a rare form of dermatitis, or skin inflammation, and is not life-threatening. However, it can be uncomfortable and unsightly. The rash usually forms a symmetrical pattern on each side of the body and tends to affect the torso, back, chest, neck, shoulders, and underarms. In rare cases, it may also appear on the face and extremities.

The exact cause of keto rash is unknown, but it is believed to be linked to ketosis, the state in which the body burns fat instead of carbohydrates for fuel. Other possible causes include hormonal changes during pregnancy and menstruation, fasting, and diabetes. The rash typically affects female teenagers and young adults more than males.

Keto rash typically goes through four stages: early lesions, fully developed lesions, resolving lesions, and late lesions. In the early stages, the rash may appear as light pink raised skin lesions that resemble scratch marks. As the rash progresses, it becomes more aggressive and can include red skin lesions (called papules) that may be filled with liquid or pus. In the resolving stage, the papules become crusty and scaly, and start to darken. In the final stage, the skin is left with a web-like pattern of dark spots, which may remain even after the rash has healed.

The duration of keto rash can vary, lasting from a few weeks to several months or even years. In some cases, the rash may come back even after treatment.

What does keto rash look like?

The keto rash, also known as prurigo pigmentosa, is a rare inflammatory skin condition characterised by an itchy, red rash. It is associated with the ketogenic diet and is more common in women, especially Asian women, and typically affects the upper body.

The rash can appear anywhere on the body but is most common on the chest, back, neck, torso, and armpit areas. It can also affect the face and extremities, but this is less common.

The rash typically goes through four stages: early lesions, fully developed lesions, resolving lesions, and late lesions.

During the early stages, light pink raised skin lesions appear that look like scratch marks. This stage is often overlooked as it can resemble a minor rash or scratch.

The fully developed lesions stage is when the rash becomes more aggressive, with red skin lesions called papules, which may include liquid-filled cysts or, more rarely, pus-filled cysts.

As the rash starts to recede, the resolving lesions stage begins. The papules become crusty and darker in colour.

Finally, the late lesions stage is when the rash is almost fully healed, leaving a net-like pattern of dark spots larger than freckles, called reticulated hyper-pigmentation.

The keto rash can be distinguished from other skin conditions by the network-like pattern of the papules, and the brownish discolouration of the skin that remains after the inflammation subsides.

What causes keto rash?

The exact cause of keto rash is unknown, but it is thought to be associated with several conditions, including:

• Ketosis: There is a strong correlation between the 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.
• Sjögren's syndrome
• Sunlight and excessive heat
• Sweating, friction and skin trauma
• Allergens
• Emotional stress
• External irritants such as chlorinated pool water and acetone

Keto rash typically appears when someone has started to enter ketosis, and it is more common in females than males.

How to treat keto rash

Keto rash, also known as prurigo pigmentosa, is a rare inflammatory skin condition that is characterised by an itchy, red rash on the neck, back, chest, shoulders, torso, and armpit areas. It is associated with the ketogenic diet and can be treated in several ways.

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. Eating an array of colourful fruits and vegetables is a great way to ensure that you are getting all the nutrients nature has to offer.

Eliminate Food Allergens

The keto diet places an emphasis on low-carb, high-fat foods. Many of these foods are also on the list of common food allergens. With food allergies being a source of inflammation, it is important to eliminate any foods you are allergic to that may be worsening your rash symptoms.

Incorporate Anti-Inflammatory Supplements

In addition to dietary changes, 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 is 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. Keeping your skin moisturised when dry and protected when exposed to the elements, such as hot sun or cold wind, is also important.

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 and doxycycline. Dapsone may also be used for treatment.

Let It Heal on Its Own

The keto rash may go away on its own after a few weeks. If you are new to the keto diet, you may just need to wait until your body adjusts to burning ketones for fuel. However, if the rash doesn't start going away on its own after a month, it's time to try other options.

Increase Your Carb Intake

For some keto dieters, it doesn't matter how good they get at producing and using ketones—the rash will still stick around. If this sounds like you, then you may need to increase your insulin levels to help the rash heal.

Try Eliminating Allergens from Your Diet

Many diet changes will increase the risk of provoking food allergies. Simply by introducing new foods to your diet or eating large amounts of certain foods, you can trigger a reaction that is responsible for your keto rash. The most common keto-friendly foods that may trigger allergies are dairy, fish, shellfish, and tree nuts.

Supplement with Vitamins, Minerals, and Other Nutrients

To rule out any deficiency-related causes, make sure to supplement your diet with vitamins and minerals that you may not be getting enough of. For example, you may need to supplement with minerals like sodium, potassium, and magnesium, as well as vitamins like vitamin D, vitamin A, and niacin, which are essential for skin health and preventing skin inflammation.

Eat More Anti-Inflammatory Foods

Without an inflammatory response, keto rash would not occur. Consider adding the following foods to your keto diet to help tame your inflammatory response and reduce the severity of your rash: animal skin, collagen, bone broth, wild fatty fish, virgin olive oil, low-carb vegetables, and low-carb fruits.

Avoid Skin Irritants

A couple of studies on prurigo pigmentosa found that skin irritants, like chlorinated pool water, may trigger the rash. The chemicals in your detergent or the clothes you are wearing may be causing your rash to flare up as well.

Add Stress-Relieving Techniques to Your Daily Schedule

Emotional stress has been linked to inflammation of the skin and can worsen over nine skin disorders, including keto rash. Studies have also found emotional stress to be associated with the keto rash. Incorporate activities into your life that help relieve stress, such as meditation, breathing techniques, taking walks, doing yoga, engaging in a relaxing activity, low-intensity exercise, going to therapy, and spending quality time with loved ones.

Talk to Your Doctor About Antibiotics

The scientific literature has consistently shown that specific types of antibiotics are highly effective against the keto rash. The antibiotics that have been found to help are dapsone, minocycline, and doxycycline. Antibiotics can treat the rash but they can't prevent it from coming back if it continues to be triggered by your diet and lifestyle. Therefore, antibiotics should only be used as a last resort if you are still struggling to get the rash under control after exhausting all other options.

How to prevent keto rash

Keto rash, also known as prurigo pigmentosa, is a rare inflammatory skin condition that occurs when starting a ketogenic diet. It is not life-threatening, but it can be uncomfortable and unsightly. The good news is that it is preventable and treatable. Here are some tips to prevent keto rash:

• Transition into ketosis slowly: Instead of drastically dropping your carbohydrate consumption, gradually lower your carb intake over time until you reach ketosis. This gives your body time to adjust to the new diet and may reduce the risk of developing keto rash.
• Pay attention to minor rash symptoms: If you notice any signs of a rash, such as itchy, raised skin lesions, increase your carbohydrate intake immediately. This can help prevent the rash from progressing to more advanced stages.
• Supplement your diet: Ensure you are getting all the necessary nutrients by taking supplements such as vitamins, minerals, and omega-3s. This can help avoid nutrient deficiencies, which have been linked to skin conditions.
• Wear comfortable clothing: Choose loose-fitting clothing to minimise sweating, as sweat can irritate the skin and make the rash worse.
• Shower immediately after exercising: If you engage in intense workouts, try to shower as soon as possible afterward to keep your pores clear and prevent the rash from spreading.
• Adjust or temporarily quit exercising: If the rash persists, consider reducing the intensity or frequency of your workouts. This may help reduce sweating and skin irritation.
• Eat a balanced diet: Ensure you are getting enough nutrients, especially vitamins A, B-12, and C, which are important for skin health. Eat plenty of vegetables and low-carb fruits, or consider taking a multivitamin or supplement to meet your nutritional needs.
• Eliminate inflammatory foods: Some foods commonly consumed on the keto diet, such as eggs, dairy, fish, and nuts, can act as allergens for some people. Identify and eliminate any potential food allergens from your diet to reduce inflammation.
• Use anti-inflammatory supplements: If eliminating inflammatory foods is not enough, try incorporating natural anti-inflammatory supplements like probiotics, prebiotics, vitamin D, and fish oil.
• Reintroduce carbohydrates: If the rash persists, consider adding healthy carbohydrates back into your diet, such as sweet potatoes, yams, fruits, whole grains, or carrots. This can help move your body out of ketosis and alleviate the rash.
• Consult a doctor: If the rash does not improve with home remedies, seek medical advice. A doctor may prescribe medications or antibiotics to help clear up the rash.

Remember that keto rash is rare, and there is only a small chance of developing it. Even if it does occur, you can use the above strategies to treat and prevent it effectively.

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