What is Keto Rash?, It’s Causes & How You Prevent It?

While starting a ketogenic diet you may have developed a rash which you are unaware of. You might think this is bad for you and you would be thinking to stop your keto diet.

You should not panic.

The itchy thing which you are experiencing is known as “keto rash”, and it’s a normal side-effect experienced by most of the people who are new in keto.

The rash is both treatable and preventable.

We will cover everything about keto rash what is keto rash? why it happens, and how you can prevent and get rid of.

  1.  What is Keto Rash?
  2.  How Does a Keto Rash Looks Like?
  3.  Causes of Keto Rash.
  4.  How to Cure Keto Rash.
  5.  Can Keto Rash Be Prevented?

What is Keto Rash?

Keto Rash is a very rare inflammatory disease which has a scientific name - prurigo pigmentosa.

It was first reported in 1971 and is commonly found on the people who are on the early stage of ketosis.

In 2017 a research was done on 53 Japanese and 83 Korean patients. It was found out that 84.3% of the cases happened between the age of 11 to 30 years. It was also noted that women were most affected by it with the female to male rate being 2.6.

The rash is most common in female teenagers and young adults.

The rash is itchy, raised skin lesions can be red, brown, or light pink in color depending upon on its stage.

Although it’s comfortable it is not life-threatening or dangerous at all.

It is typically found on the neck, shoulders, armpit, chest, back and sometimes on the face. Keto rash forms a symmetrical pattern on either side of the body.

Keto rash worsens if the rash is exposed to heat, friction, and moisture.

How Does a Keto Rash Looks Like?

Various research shows that keto rash has primarily 4 main stages:

1. Early lesions

There is a light pink lesion on the skin which is called “urticarial papuloplaques”. It often looks like scratch marks on the body.

Most people ignore this stage and brush off as a temporal rash.

2. Full developed lesions

This is a full-blown rash on the back or any part of the body which makes people worried about. There are more aggressive red lesions which are known as papules, which also consist of “papulovesicles” which is liquid-filled cysts or sometimes puss-filled cysts known as “papulopustules”.

3. Resolving lesions

When the rash starts receding, you can observe crusted and scaly papules on the place of the rash. The lesions also start to get darker.

4. Late lesions

As the rash finally comes to an end, you can see a net-like pattern of dark spots which are larger than the freckles and is called “reticulated hyperpigmentation”. The pigmentation might still there for a long time after the rash gets healed.

Causes of Keto Rash

The exact root cause of the keto rash is still unconfirmed but various researchers show a link between ketosis and “prurigo pigmentosa”.

However, there are few potential triggers which are related to the keto diet and can make it appear:

1. Ketones

During ketosis, the body produces acetone which can cause perivascular inflammation, an inflammation around blood vessels which triggers the rash.

2. Excessive fasting

In one of the studies done on ketosis, it was found that 50% of the patients showed a major relationship between keto rash and fasting. During fasting, the blood sugar level is very low and when your body switches to ketosis, rashes may occur.

3. Low carb diet

A low carb diet where you lose a significant amount of weight in short period of time can also be the reason for the keto rash on your body.

4. Allergens

Sometimes, the keto foods and supplements which you are consuming can also trigger an allergic reaction.

5. Nutrient deficiency

When you are in ketosis, then you have to exclude some foods which can cause nutrient deficiency and thus keto rash.

How to Cure Keto Rash

The best method to cure keto rash is still not confirmed but we have listed the 5 research-based methods which will surely help you in getting rid of keto rash.

1. Give it Time

After a few weeks, the keto rash would go away on its own. If you are new on a keto diet, then your body needs time to adjust. The longer you stay in ketosis, the better your body starts to adapt to the production of ketones.

According to a research, the patients which have no treatment, the lesions cleared within few weeks.

2. Eat More Carbohydrates

If you are fasting for a long period of time, then it is seen that rashes may occur in the body.

In a study, done among 16 people, it was found that 6 people were in ketosis whereas 8 people were found to have rashes when they were fasting.

In another study were 50 patients were involved, even a small dietary change (ketosis, fasting or low carb food) triggered rashes in 17 people.

As we have already mentioned above that excessive fasting, low carb diet and ketones are the top three reasons for the occurrence of rashes.

3. Try an elimination diet

One of the main reasons for rashes is an allergic reaction to some keto friendly foods.

If you have recently started consuming some new foods or some large amount of foods, you need to test for allergies first.

Some of the keto friendly foods which trigger rashes are:

  • Dairy foods
  • Eggs
  • Tree nuts (macadamia, almonds)
  • Fish
  • Peanuts
  • Shellfish (oysters, clams, crab)

To find out if you are allergic to these types of foods, try some elimination diet:

  • Remove these foods from your diet for 30 days.
  • Notice if your rash has diminished after some time.
  • If it gets removed, try some of these foods for few weeks.
  • If the rash hasn’t appeared then you can add a new food.
  • Continue to add a new food after 1 or 2 weeks if no symptoms occur.
  • If you get the rash after adding a new food, then it might be your trigger food.

4. Supplement Trace Elements

When you are starting a keto diet you need to rule out any deficiency related cause. Hence, make sure to supplement your keto diet with vitamins and minerals.

You can try supplementing it with:

  • Minerals

Potassium, Calcium, Magnesium, Sodium, etc are some of the minerals which can diminish during ketosis. Hence, they need to be supplemented because they are important to cell function and energy

  • Vitamins

Vitamin D, A, and Omega-3 are the important vitamins which are necessary for regulating inflammation. Since keto rash is an inflammatory response hence they cannot be missed out on the diet.

  • Bile Salts

Chenodeoxycholic, cholic, deoxycholic, and lithocholic acids are the bile salts which helps the liver to process the fats properly.

5. Talk to Your Doctor

Using antibiotics in a large amount is certainly harmful but using some specific type of antibiotics are highly effective against keto rash.

The antibiotics which show the best result are:

  • Minocycline
  • Doxycycline
  • Dapsone

You need to talk to your doctors about using an antibiotic, its potential uses, and benefits.

Conclusion – Can Keto Rash Be Prevented?

If you are in ketot and haven’t dealt with keto rash before or worried about getting it, then you would like to know how you can prevent it

Since the exact cause is still unknown, there is no clear solution to the problem.

However, now you know what are the possible triggers of keto rash are, therefore, you can take these three precaution measures:

  • Go slow in ketosis

When trying to enter ketosis don’t drop the carbohydrate consumption directly or start fasting for a long period of time. You need to lower your carb intake gradually so that you don’t get any rashes while staying in ketosis.

  • Pay attention to rash signs

As soon as you see the signs of any keto rash, start increasing your carb intake. This way you can stop the rashes in advancing to more developed stages

  • Supplement

You need to start consuming supplement from the first day itself of your keto journey. In this way, you can avoid any minerals and vitamins deficiency in your body which leads to keto rash.

Follow these steps during the initial weeks of keto diet to avoid any type of keto rash on any part of the body.

Always remember that the odds are on your side and it’s very unlikely that you will get a keto rash as it is very rare.

But even if you get the rashes don’t fret, there are ways which you can use it to prevent it from happening again. Don’t let the rash scare you to reach you from your goals and getting the benefits of a ketogenic diet.

Did you ever get a keto rash? If yes, then what are the methods you used to get rid of it? Let us know in the comments section below


  • Apr 13, 2018
  • Category: blogs
  • Comments: 52
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