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Prevention
Keto rash, orprurigo pigmentosa, is a rare inflammatory skin problem. Also calledNagashimadisease, the keto rash causes an itchy rash withvesicles(fluid-filled blisters). It often appears on your neck and trunk. The blisters change and crust into darker-pigmented spots that form a netlike pattern.
The keto rash is often linked to theketogenic (keto) dietor health conditions that produceketosis. In this state, your body uses stored fat rather than glucose for energy. The ketogenic diet is a low-carbohydrate, high-fat eating plan. It is most often recommended to treat people withepilepsythat is hard to control.
Treatments for the keto rash include home cures like increasingcarbohydrateintake and making up for vitamin deficiencies.Antibioticsand other drugs are often useful when these treatments don’t work.
This article explains all you need to know about the keto rash, its causes, treatments, and ways to prevent it.
Maskot / Getty Images
What Does the Keto Rash Look Like?
The appearance of a keto rash can vary based on your skin tone and texture. Most case reports are in people in Asia and the Middle East, with some reports in White or Hispanic people.Descriptions of the rash in people of darker skin tones are lacking.
The condition includes the following characteristics:
While a keto rash can affect anyone, it is most common among people of Asian descent. It affects women twice as often as men, though it may be due to a higher prevalence of dieting behaviors among women than men.
A keto rash typically occurs 31 days after starting a keto diet. For most people, the rash subsides about 18 days after ending the keto diet.
A Note on Gender and Sex TerminologyVerywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
A Note on Gender and Sex Terminology
Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
What Causes a Keto Rash?
The exact cause of a keto rash is not known. The rash is named as a result of its link to the ketogenic diet.
In addition to ketosis, the following potential triggers for the condition have been identified:
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A Word From VerywellIt’s always best to let your provider know if you plan to start the ketogenic diet since it can cause adverse health effects for some people. Also, let your provider know if you are experiencing keto rash symptoms in order to get proper treatment and eliminate other more serious causes of the rash.—JAMIE JOHNSON, RDN, MEDICAL REVIEW BOARD
A Word From Verywell
It’s always best to let your provider know if you plan to start the ketogenic diet since it can cause adverse health effects for some people. Also, let your provider know if you are experiencing keto rash symptoms in order to get proper treatment and eliminate other more serious causes of the rash.—JAMIE JOHNSON, RDN, MEDICAL REVIEW BOARD
It’s always best to let your provider know if you plan to start the ketogenic diet since it can cause adverse health effects for some people. Also, let your provider know if you are experiencing keto rash symptoms in order to get proper treatment and eliminate other more serious causes of the rash.
—JAMIE JOHNSON, RDN, MEDICAL REVIEW BOARD
How to Treat the Keto Rash
Reintroduce Carbohydrates
Research indicates that modifying carbohydrate intake with guidance from aregistered dietitian nutritionist (RDN)trained in ketogenic therapies can help achieve lower prescribed carbohydrate levels. There is evidence that maintaining these defined carbohydrate levels can reduce the keto rash without sacrificing ketogenesis.
Correct Nutrient Deficiencies
Removing entire food groups from your diet can lead to nutrient deficiencies. Research indicates that certain nutrient deficiencies manifest as skin disorders.
Consuming a low-carbohydrate diet like the keto diet increases the risk of nutritional deficiencies due to a lack of nutrients from vegetables, fruits, whole grains, and legumes. As a result, low-carb diets are often insufficient in the following nutrients:
Eliminate Food Allergens
If you have a specific food allergy, consuming the allergen can trigger or worsen a rash. It is important to have the allergy diagnosed and then avoid the specific food allergen.
According to the American College of Allergy, Asthma, and Immunology, the following eight types of foods account for 90% of all adverse food reactions:
Depending on your level of sensitivity, a food allergy can trigger life-threatening effects. Get immediate medical help if you have any of the following signs of a food allergy:
Incorporate Anti-Inflammatory Supplements
There is some evidence that certain nutritional supplements may help reduce inflammation in the treatment ofatopic dermatitis(eczema). While the research is inconclusive and warrants further investigation, symptom improvement of skin disorders has been linked to the following nutrients:
Take Care of Your Skin
High Ketones in Urine
Discuss Medications With a Healthcare Provider
Depending on your symptoms and the extent of your rash, your healthcare provider may recommend medications to treat your keto rash.
Research indicates that oral and/or topical prescription medications can resolve a keto rash within 18 days when combined with discontinuation of the ketogenic diet. A commonly used treatment is oraldoxycycline, ranging from 100 to 200 milligrams daily for two weeks to two months.
Your healthcare provider can determine the best medication for your condition, which may include the following:
Avoid These Foods to Help Treat Prurigo Pigmentosa
How to Prevent a Keto Rash
Any drastic dietary change can trigger side effects. Reducing your carbohydrate intake to a very low level very quickly is likely to increase your risk of developing a keto rash.
Summary
The keto rash is a blister-like rash often linked to the keto diet or other causes of ketosis. Ketosis is the state in which your body uses fat rather than glucose for fuel.
The keto diet is mainly used to treat drug-resistant epilepsy. However, it has also been used for weight loss and diabetes management.
Your risk of having a keto rash or other symptoms may increase as your body adjusts to a keto diet. While it may have healthful uses, the keto diet is a very strict eating plan. It is best started with the oversight of a healthcare provider.
Contact your healthcare provider if you are following a keto diet and notice any signs of a skin rash or other irritation. While a rash can be linked to the keto diet, it can also be a sign of health conditions that require treatment.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Osteopathic College of Dermatology (AOCD).Purigo pigmentosa.
D’Andrea Meira I, Romão TT, Pires do Prado HJ, Krüger LT, Pires MEP, da Conceição PO.Ketogenic diet and epilepsy: what we know so far.Front Neurosci. 2019;13:5. doi:10.3389/fnins.2019.00005
Xiao A, Kopelman H, Shitabata P, Nami N.Ketogenic diet-induced prurigo pigmentosa (the “keto rash”): a case report and literature review.J Clin Aesthet Dermatol. 2021;14(12 Suppl 1):S29-S32.
Wong M, Lee E, Wu Y, Lee R.Treatment of prurigo pigmentosa with diet modification: a medical case study.Hawaii J Med Public Health. 2018;77(5):114-117.
Wong CY, Chu DH.Cutaneous signs of nutritional disorders.Int J Womens Dermatol. 2021;7(5Part A):647-652. doi:10.1016/j.ijwd.2021.09.003
Harvard T.H. Chan School of Public Health.The nutrition source: diet review: ketogenic diet for weight loss.
American College of Allergy, Asthma, and Immunology.Food allergy.
Mohajeri S and Newman SA.Review of evidence for dietary influences on atopic dermatitis.Skin Therapy Letter. 2014:19(4).
Schlichte MJ, Vandersall A, Katta R.Diet and eczema: a review of dietary supplements for the treatment of atopic dermatitis.Dermatol Pract Concept. 2016;6(3):23-29. doi:10.5826/dpc.0603a06
Penn Medicine.Rash.
Mercy.Nine things to know before kick starting a keto diet.
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