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Keto Rash: What to Do When Low-Carb Eating Makes You Itchy

By: Emma Rose

Keto Rash: What to Do When Low-Carb Eating Makes You Itchy

  • Keto rash is a rare, inflammatory skin condition that causes an itchy rash, usually on the back or chest.
  • While the cause of keto rash isn’t entirely understood, it is sometimes a side effect of a ketogenic diet or other high-ketone states.
  • In most cases, keto rash can be treated by reintroducing carbs to lower ketone levels.

You’ve likely heard about the keto diet by now, the high-fat, low-carb eating plan that boasts serious weight loss, sharper brain power, and boosted energy. Maybe you’re already experiencing the benefits for yourself, or perhaps you’re just gearing up to start.

The keto diet changes the way your body converts food into energy. Loading up on fat and limiting carbs puts your body in “ketosis,” a metabolic state of burning fat for fuel. This can help you shed pounds fast, slow signs of aging, and reduce damaging inflammation in your brain, skin, and gut.

But for a small number of people who try keto, this drastic diet change can also bring on an itchy, red rash known as “keto rash.”

Keto rash is rare, but it can be a serious inconvenience, and kind of scary, for the few people who experience it. Whether you’re looking to cure your own keto rash, or avoid it as you change your diet, don’t panic. Read on for the steps you need to treat, heal and prevent keto rash.

Download this 7-day keto meal plan and recipe book to get started

What is keto rash?

The scientific name for keto rash is Prurigo pigmentosa, an inflammatory skin condition resulting in an intense rash. The exact cause isn’t entirely understood, and not all cases of Prurigo pigmentosa are associated with ketosis.[1] For this article, let’s focus on the ones that are.

The rash is made up of itchy, raised bumps, generally on the back, chest, neck or armpit area. The symptoms look a lot like dermatitis or eczema, and the conditions can easily be confused. Keto rash begins with smaller pink or red lesions, but after a while, bumps may begin worsen, and to fuse into a larger, inflamed network of rashes. Usually, keto rash appears symmetrically on the body.[2]

Keto rash is not life-threatening or dangerous, but it’s definitely itchy. As the rash heals, it can leave behind a net-like pattern of hyperpigmentation (darkened skin, similar to freckles) that may last long after the rash has healed.[3]

Related: Keto Diet for Beginners — Your Complete Guide

What causes keto rash?

First of all, ketosis doesn’t cause a rash in most people. Keto rash is rare, and something most people won’t encounter.

While not caused by ketosis, cases of keto rash are often associated with a condition called “ketoacidosis.” This condition can occur when your body becomes too acidic from excess and unprocessed ketones. (Remember, ketones are acids!) This is why symptoms of keto rash are most often seen together with uncontrolled diabetes, extreme fasting, and anorexia nervosa, all conditions where unhealthy amounts of ketones can accumulate.[4]

This doesn’t mean that ketones or ketosis are bad for you. Many people successfully enter ketosis and follow ketogenic diets without ever experiencing a keto rash. So what makes some people more prone to breaking out? The exact causes still aren’t understood, but researchers are pointing to differences in hormones, gut bacteria, or exposure to allergens as potential triggers.[5]

Related: How to Start Keto and Why Cyclical Ketosis Is Better

6 tips to treat keto rash

1. Keto rash, or something else?

The first step in treating keto rash is: make sure it’s actually keto rash. Before letting out your inner hypochondriac, remember that the keto rash is a relatively rare phenomena, and shares some symptoms with other skin conditions such as eczema or dermatitis.

If going keto signalled a massive change in your diet, you may have introduced an allergen or irritating food, or you may be unbalanced in your micronutrient (vitamin and mineral) intake. As your body starts burning your fat stores for fuel, you also flush out toxins that were stored away in that fatty tissue. This can sometimes cause acne breakouts as your body begins to detox. Take a look at your new diet, and see if there are any specific foods or triggers that make your symptoms worse; you may be experiencing something other than keto rash.

2. Give it time

While not the most satisfying game plan, some instances of keto rash can resolve on their own. [6] It’s possible that your body simply needs a bit of time to adjust to burning ketones. If your symptoms worsen or do not improve within a week or so, it’s best to figure out what needs to change.

3. Bring back (some) carbs

Yup, you read that right. You don’t need a full-blown bread-binge, but if a sudden switch to a keto lifestyle brought on a rash, you may want to reintroduce some healthy, high-quality carbs like sweet potatoes, yams, carrots, pumpkin, and butternut squash. Multiple studies show that bringing the body out of ketosis can often cure keto rash symptoms, and you can still reap some incredible mental, physical, and weight-loss benefits by upping your carb intake to a more moderate low-carb, high-fat lifestyle.

If you follow a keto diet for medical reasons, or otherwise really don’t want to sacrifice your ketosis, you can try progressively upping your carbs to see if symptoms begin to clear sooner. In one study, a man using ketosis to control recurrent seizures solved his keto rash by gradually increasing from 16 to 90 grams daily. This reduced his ketone levels, but still kept him in ketosis and seizure-free.[6]

If you decide to try a keto lifestyle again after healing your rash, consider transitioning more gradually to allow your body time to adjust.

Related: How to find your ideal carb intake

4. Avoid irritants

Like most rashes, keto rash can worsen with friction, sweat, or heat. Avoid aggravating the irritated skin by wearing loose-fitting, breathable clothes, and avoiding perfumes, scented products, or sweat-inducing exercise until the skin can heal.

5. Support your skin

Whether healing or preventing keto rash, be sure to treat your skin right. Supporting your skin with anti-inflammatory foods and supplements can help boost your healing time and calm the rash. Try incorporating foods like this turmeric latte, a DHA omega-3 supplement, or these top 5 nutrients for healthy skin.

Related: How to fight eczema with food

6. Treating keto rash with medication

If dietary changes do not help, or if you prefer more immediate relief, a doctor may prescribe minocycline or doxycycline. These antibiotics help clear the rash fast, but as with any remedy, the hyperpigmentation left behind after the bumps heal can last a while longer.

Related: How to Restore Gut Flora After Taking Antibiotics

How to prevent keto rash

Although the keto rash is rare, you may want to take a few extra steps to help prevent it. If you’re taking your first dive into the world of keto, take it slow. While the incredible promises of a keto lifestyle can make it tempting to jump right in, transition slowly, and allow your body time to adjust as you taper carbohydrates out of your diet.

As you transition, and throughout your keto journey, pay attention to warning signs from your skin. If you notice a keto rash starting to develop, back off and increase your carb intake slightly to keep the symptoms from worsening. Use the suggestions above to support your skin and body in other ways too, such as avoiding irritating foods, fragrances or clothing and loading up on anti-inflammatory foods.

For some people, the best answer may be to cycle in and out of ketosis. Also known as carb cycling, a cyclical keto diet simply means going in and out of ketosis on a weekly basis. Your brain, your body, and your joints will all benefit from cyclical ketosis, and that once-a-week refuel on carbs may help to lower ketones enough to help prevent keto rash.

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