Keto Rash : What You Need To Know

keto rash

The ketogenic diet, also known as the keto diet, is a low-carbohydrate, high-fat diet. Since carbohydrate intake is very low, the body can run on ketone bodies in fat rather than glucose in carbohydrates. This leads to increased fat burning and weight loss. However, as with any drastic diet change, there can be some unwanted side effects. Initial side effects of the keto diet may include brain fog, fatigue, electrolyte imbalance, and even the development of a keto rash.

What Is the Keto Rash?

Keto rash is an uncommon inflammatory skin disease that has the scary-sounding name “prurigo pigmentosa” (pigmented irritation). Pigmented urticaria is also known as “Nagashima disease,” named after the Japanese town where it was first reported in 1971.

While the origin and exact cause of the rash remains unknown (and is being actively studied by scientists), it is commonly seen in people who are in the first stages of ketosis.

According to a 2017 review, there were 83 patients in Korea and 53 in Japan, with 84.3% of cases occurring between the ages of 11 and 30, with an average age of 24.4 years. In the same study, the ratio of females to males was 2:6, while another study concluded 14:2. Thus, the disease more commonly affects female adolescents and young adults.

Other studies have shown that pigmentary dermatitis occurs in people with uncontrolled diabetes and in those who fast or follow a low-carbohydrate diet such as keto. Erythema ketosis was also seen on the skin of a patient who had undergone bariatric surgery.

What are the Symptoms of Keto Rash?

Keto rash usually presents as itchy, raised lesions that may be red, brown or light pink in color, depending on the stage the rash is in. Although it is unsightly and uncomfortable, it is not life-threatening at all.

It looks similar to eczema and dermatitis (keep this in mind later when learning about the potential causes of keto rash), and it usually appears on your neck, back, chest, shoulders, trunk, and armpit areas. It can also affect your face and extremities, but this is not as common.

The keto rash usually forms a symmetrical pattern on both sides of your body in a web-like distribution. Like most rashes, the keto rash can worsen if you expose the rash to heat, sweat, friction and other potential skin irritants.

The Cause of the Keto Rash

While there are dozens of theories on this question, each one stranger and more improbable than the next, we believe there is a very simple answer. It is based on the experience of many people, as well as the limited scientific research 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 good reason to believe that the itching that some people experience in ketosis is caused by ketone bodies in the sweat, and perhaps this is dryness in the body.

Treatment for the Keto Rash

There are several at-home treatment methods for the keto rash, should you experience it:

1. Reintroduce carbohydrates

If you think a recent change in 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.

If you’re not ready to give up the keto lifestyle altogether, you can always aim for a moderately low-carb diet.

2. Correct nutrient deficiencies

Nutrient deficiencies may play a role in some inflammatory skin diseases.

Deficiencies of vitamin A, vitamin B-12 and vitamin C have been linked to both acute and chronic skin conditions.

If your diet is too strict, your body may not be getting all the vitamins and minerals it needs.

Eating an array of colorful fruits and vegetables is a great way to make sure you’re eating all the nutrients nature has to offer.

3. Eliminate food allergens

The keto diet emphasizes foods that are low in carbohydrates and high in fat. Some of the most common foods on the ketogenic diet are eggs, dairy products, fish, nuts and seeds, just to name a few.

Coincidentally, many of these foods also happen to be on the list of common food allergens.

Since food allergies are a source of inflammation, it is important to eliminate any allergic foods that may be making your rash symptoms worse.

4. Incorporate anti-inflammatory supplements

In addition to dietary changes, certain supplements may help the body fight inflammatory conditions.

Probiotics, vitamin D and fish oil supplements have all been used in clinical studies to help improve the symptoms of dermatitis.

2014 review of the current literature on herbal supplementation found that evening primrose oil may also yield promising results for those with dermatitis.

5. Take care of your skin

It is important to take care of your skin as much as possible. This is especially important if you have an inflammatory skin condition.

The National Eczema Association recommends bathing and showering with warm water and cleansing with only mild soaps and cleansers.

The organization also recommends keeping your skin moist when it’s dry and protected from outside elements, such as hot sun or cold winds.

6. Talk to your doctor about medication

If home treatment does not clear the rash, you may need to see a doctor.

Effective medications for treating pigmented skin conditions are the antibiotics minocycline and doxycycline. Dapsone may also be used for treatment.


Keto rash is not a common side effect of keto diet. Though the causes of it are not clear now, people who are suffering it can take some measures to treat it. Don’t get scared since it is temporary and not life-threatening. Consult doctors if home treatment are not effective.

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