Keto Rash

The Rare Ketogenic Rash

What to do if you're one of the few unlucky one's who turn red and get lesions when going low carb. 

Keto Rash 

Ketosis. It’s that sweet spot where your body’s using its own fat as its primary source of energy. You get accelerated weight loss, and improved mood, energy levels, and focus. Unfortunately, for a rare number of people, doing the ketogenic diet also entails getting a rash. OH THE HUMANITY! It’s not the Hindenburg bursting into flames, but it is the sort of set back that might make you abandon your dietary dreams. Luckily, unlike the Hindenburg disaster, the keto rash doesn’t have to doom your entire enterprise.

What is the keto rash?

Keto rash is one of the most rare side effects of being in ketosis. It’s not life threatening nor does it permanently damage your immune system. It’s just very unpleasant. Keto rash is technically known as “prurigo pigmentosa”, which sounds like a delicious Italian meal! In actuality, it’s a red, itchy rash that appears on both sides of the body, around the neck, upper back, chest, and abdomen, which sounds like an Italian meal you’d definitely send back! Red spots known as papules litter the body in a web-like pattern, as if you were a crook apprehended by Spiderman himself! Luckily, the rash isn’t permanent, although once it goes away you are left with a dark, brown pattern, as if you were a crook apprehended by a less glamorous hero, like PigBoyMan-- the hero with all the powers of a sloppy eater!

More particularly, the life cycle of keto rash is as follows. It begins with what looks like scratch marks. Harmless enough. But then the rash reddens and there are lesions. If the rash gets really bad, the lesions might become liquid-filled cysts or even pus-filled cysts. When the rash starts to go away, the lesions become crusted, scaly, and darker. And then, when the rash has receded, you’re left with dark spots, which may stick around even after the rash has gone away. Unfortunately, there’s no consistent amount of time that the rash can last, so how long someone has it varies from person to person. Additionally, some people get the rash once and it goes away, while for others the rash occurs any time they enter ketosis.

Keto Diet What causes the keto rash?

If you’re going to develop the keto rash you will do so right as you’re starting the keto diet. So, if you’re already in ketosis and you haven’t developed the rash, congrats!  But if you’re not that lucky, then going back to eating carbs is the likeliest remedy. It’s believed by many that the rash is caused by the ketones themselves, particularly acetone. That’s why the rash gets worse during hot weather, after exercising, and generally around areas where sweat collects on your body. However, if you still want to do keto, you can try a moderately low-carb diet and see if that works.

There are competing theories about what causes keto rash.

If you end up seeing a doctor you’re likely to be prescribed minocycline and doxycycline, which are antibiotics, or the medication Dapsone. But there are some things you can try on your own first.

Sometimes rashes are caused by nutrient deficiencies. Not enough vitamin A, vitamin B-12, and vitamin C, for example, are often to blame for acute or chronic skin problems. Sailers, for example, used to get bleeding gums and open sores just from not getting enough vitamin C! But you’re not on the open seas; you’re just restricting your meal plans in order to be in ketosis. So if you find that you’re restricting your diet too much in order to be in ketosis, then your rash may be caused by insufficient vitamins and minerals.  Get those macronutrients!

It’s not just what’s missing from your diet that can cause a rash, though. It may also be what you’ve added to it. Plenty of people have allergies to eggs, tree nuts, shellfish, etc, and these are all foods that people eat more of when they’re doing the ketogenic diet. So, what you may want to try is an elimination diet so that you find out if you’re allergic to any of the new things you’ve started eating.

 How to Treat Keto Rash

There are several ways to treat the keto rash.

There are supplements that are useful in warding off epidermal disorders. Probiotics, prebiotics, vitamin D, and fish oil are often used to treat skin conditions. You also need to know how to properly wash yourself. Yes, that does sound like something a parent would say to their persistently messy child (who’s secretly been PigBoyMan this entire time!), but many adults themselves don’t properly take care of their skin.  It’s best to use lukewarm water, and to only use gentle soaps and cleansers. Avoid products that contain alcohol because they’ll dry out your skin. Additionally, moisturize your skin when its dry, and use sunblack regularly. And, if possible, sleep on satin pillowcases so as not to damage your skin.

You can also take measures to reduce the amount that you sweat. Wear clothes that don’t make you sweat more than usual, or wick sweat away from your body. Keep cool with a fan, air conditioner, and by drinking water. Shower after exercising (after you’ve finished sweating). Or cater your exercise routine to produce minimal sweating, which could mean brisk walks and strength training that’s not overly taxing. If it’s the ketones in sweat that are responsible for the rash, then you can also just not work out at all. It’s possible to do keto on the 9 to 5 without working out and still lose weight!

You can use the basic tenets of keto without going into ketosis.

Sure, you can increase your carb intake so you’re no longer in ketosis, but that doesn’t mean keto can’t inform your lifestyle. Just by cutting out sneaky foods with added sugar you’ll be experiencing improved energy levels, mood, and focus. That’s because glucose, the source of energy derived from carbs, is simply too inconsistent, leading those with high carb diets to experience crashes, lethargy, and mood swings. Additionally, by cutting down on high-carb foods you’ll be creating a significant enough caloric deficit that you’ll eventually begin to lose weight. Learn some tips to eating smaller portions and find out what you need to know about intermittent fasting, and you can have a keto friendly lifestyle without the rash!