Keto Rash: What Makes us Itch on keto diet and How to Deal With It

• Keto Rash is a rare disease that causes inflammation to our skin normally on the back or chest.
• Keto professionals are still not sure as to whether this rash is the same particular entity as ‘prurigo pigmentosa’ or not.
• To some, the rash heals within a few weeks, while others fight with it for quite a lot of months.
• Although the origin of keto rash is still unidentified, some factors are identified behind keto rash triggered by production of ketones.

Keto Rash: Pivotal Causes and Remedies

It’s been almost four weeks, Mr. and Mrs. Smith have adopted ketogenic diet. Mrs. Smith is very happy that she has lost a few pounds during this phase. This diet also brings joy to Mr. Smith’s life as he doesn’t get tired like before and feels some energy in his life.

On a breezy spring morning, Mr. and Mrs. Smith having a bulletproof coffee at their terrace. Suddenly Mr. Smith notices something reddish on his wife’s neck while she is itching on it. Later, they found that her body with full of rashes.

A skin diseases in the form of itchy rash she is experiencing is called keto rash. It is a very unusual side-effect among keto dieters. It can bring serious inconvenience in one’s life and feel someone in embarrassing situations. However, this is not something of grave concern as it can be easily prevented and cured.

Change always comes with inherent gifts. Keto diet certainly helps us to lose weight or boost energy that Mr. and Mrs. Smith enjoys. However, a sudden radical change in dietary habit can bring some annoying side effects and keto rash is one of them.

Keto Rash: What is it?

Mrs. Smith struggles to pronounce the word ‘prurigo pigmentosa’ (pigmented irritation) as she is surfing around the internet trying to find out the reason and solutions of this keto rash. She finds uttering it as scary as the keto rashes.

As she moves on to one page to another, she caught by surprise to know that the origin of keto rash is still unidentified, though a lot of research is going on lately. She also learns that it is a rare disease that causes inflammation to our skin.

She also comes to learn that ‘prurigo pigmentosa’ is also dubbed as ‘Nagashima disease’ as it was first reported by Japanese dermatologist in 1971.

However, keto professionals are still not sure as to whether this rash is the same particular entity as ‘prurigo pigmentosa’ or not. Though recent studies indicate that they are very identical in nature. 

As she is digging deep on the recent researches of keto rash, she finds the comment of Joshua Zeichner, M.D., director of cosmetic and clinical research at Mount Sinai Hospital very interesting:

“Still, with more people following the keto diet, there’s an increase in anecdotal accounts of the keto rash, though the condition is still considered to be very rare. Currently, there’s not enough research to understand why only certain keto-eating people are susceptible to the rash.”

After reading a few studies on this keto rash, she finds the following results:

•   Female youngsters and young grownups are more susceptible to keto rash.
•   One research showed that women affected by keto rash two times more than man.
•   Numerous studies linked three factors with the growth of prurigo pigmentosa: 1. substantial emotional stress 2. Contact to skin irritants and 3. Diets that stimulate ketone fabrication.

In general, experts draw a safe conclusion that all keto rashes are prurigo pigmentosa. However, not all cases of prurigo pigmentosa are related with ketosis. This judgment helps us big time in defining symptoms of keto rash, what causes it and how to treat it.

Keto Rash: Symptoms

Keto rash normally visible as itchy and annoying. Besides, it results in skin bumps. Depending on the stage of the disease, keto rash appears in many colors ranging from red to brown. People often mistakenly take keto rash as eczema.

Though keto rash provide us with awkward feeling, but it definitely is not harmful enough that can put our life in jeopardy.

In most circumstances, keto rash appears on the neck, chest, back, torso and armpit zones. Very rarely, it might look on face and sensitive organs. Around the rash, we observe some red spots, termed as papules. These red spots usually take shape like a web.

Keto Rash: Stages

Researchers divide prurigo pigmentosa or keto rash in four key stages:

1. Primary Lesion: during this phase, skin bumps appear like scratch marks. Besides, the skin color of the affected area turns light pink. At this stage, there is nothing to worry about and people often ignore it as minor rash.

2. Totally Developed Legion: this is the alarming phase as rashes spread all over the body and become much more destructive. During this period, noticeable red skin bumps run all over the skins and these lesions are known as papules. Sometimes this lesions may fill with liquid cysts and in extreme cases, fill with pus cysts.

3. Settling Lesion: when the severity of the rash ebbs, those red lesions turn into crusted and scaly papules. A change in the color also appear: red beginning to get brownish.

4. Expired Lesion: as the circle of keto rash about to finish, web-like shape of shady spots bigger than freckles appears on the skin, which are often termed as “reticulated hyper-pigmentation”. This dark color of the skin indicates that keto rash is on the verge of getting cured. Those web-like pattern of shady spots may stay for a bit of time after keto rash but eventually the skin will return to normalcy.

Keto Rash: How Long Does It Last

No one knows as to how long keto rash will last as lingering of it differs from people to people. To some, the rash heals within a few weeks, while others fight with it for quite a lot of months. The last two phases have a tendency to persist longer.

Generally speaking, persistence of keto rash is subject to how we approach to the causes of the rash. The smartly we deal with the cause, the earlier we get rid of this keto side-effect.

If we become affected by keto rash, we would expect the following scenario:

•   Best possible circumstance: it heals within a couple of weeks
•   Worst possible situation: consider oneself as unlucky because every time s/he reaches ketosis will experience this keto flu symptoms.

However, one should not relinquish keto diet, if s/he experiences the latter situation. Keep reading until the last, eventually you will get to know how to deal and prevent keto rash.

Keto Rash Triggers: Factors Associated with Ketones

One thing is for sure that keto diet changes the whole dynamics of our body’s food handling – with a transition from consistent carb intake to consuming meaningfully less amount. This alteration of food intake leads to ketone production. And to deal with that amplified volume of fat, our body is forced to make some adjustments to its digestive method.

Let’s find out as to how this dietary change associated with keto rash. Following are the factors that play a part behind keto rash:

ACETONE: THE SMALLEST KETONE

Acetone production in our body is natural as fats are worn out to ketones. Though acetone is of no use for our body but it helps in many functionaries working as a catalyst. Our body emits unnecessary acetone through sweat which leads to irritation on our skin.

This is a good explanation as to why keto rash every so often seems in those parts where sweat gathers the most.

The hypothesis – keto rash stems from acetone – stands more firmly if we consider the fact that acetone production is considerably higher during keto-adaptation phase.

TOXINS: BANE OF BOON FAT

We are all aware, fats are a great source of energy. However, boon and bane are the two sides of a coin. Fats are also the place where toxins gather. When we reach ketosis state, our body tends to burn its stored fat at a higher rate. But, the liver fails to deal with those amassed toxins as fast as fat burns.

Consequently, those toxins enter into the bloodstream and perhaps ultimately get rid of our body through sweating. If we take into account the logic of acetone’s role behind keto rash, this hypothesis also stand based on same ground.

BILE PROBLEMS: POOR FLOW CAUSES AN ACID EMISSION

Bile is not an individual issue rather works as a promoter but does play enough role to contribute in this issue. In order to accelerate the fat digesting process our body needs bile. Bile sprouts from the liver and is deposited in the gallbladder.

The issue is that bile flow varies from person to person and some people encounters poor bile movement. This weak bile flow leads to an augmented bile gathering in gallbladder, which resulted in a surge of phosphorylation acid.

This acid takes part in a number of procedures and considers as a powerful neuronal activator. This particular acid triggers skin itchiness.

GUT BACTERIA: IMBALANCE MAY UPSET DIGESTIVE SYSTEM

In scientific world known as dysbiosis. When our body shift its fuel source to ketones, it causes a change in gut bacteria. This shift creates a condition where unnecessary bacteria breeds out of proportion and outnumbers vigorous bacteria, resulting in the creation of toxins. This toxins upsets our intestinal system and triggers a momentary rash.

CANDIDA: FUNGUS THAT EXTINCTS WITH KETONES

This a very common fungus in our body and we can’t find a people without bearing it. Our immune system usually excretes this fungus from our body without any problem, helps keeping its number in control.

Usually, candida flourishes on glucose. However, when we adopt keto diet and reach ketosis and our body starts running on ketones instead of glucose, this fungus become vanished as it can’t hold onto anything anymore.

Extinction of candida leads to a rise in toxins and keto rash may be a reaction to that increased toxins.

Above-mentioned factors are identified and possible causes of keto rash triggered by production of ketones. There remains some causes which haven’t any direct association with ketosis but linked with lifestyle and dietary factors.

Keto Rash Triggers: Lifestyle and Dietary Factors

It is easier to defeat enemy, when we know the ins and outs of them. Scientific data finds that following factors play a part in prurigo pigmentosa development, though they are less likely linked with ketosis:

EMOTIONAL STRESS

Keeping stress in check is very pivotal in keto diet. This phenomenon is one of the main perpetrators behind many keto flu symptoms. One study conducted on 50 Korean patients to examine the medical features of prurigo pigmentosa, found that keto rash condition deteriorates two out of fifty subjects when they go through great stress.

MECHANICAL SKIN IRRITATION

Same study found that five out of fifty patient developed the rash through mechanical irritation: body scrubbing, bandage rubbing or friction from garments.

SWEATING

Sweating during exercise or due to hot and humid weather can lead to rash. On that study 3 people reported rash after perspiration.

DIETARY CHANGE

In that Korean study, when patients were provided with low-carb foods and mostly with a single meal like carrots or boiled eggs, 17 out of 50 subjects affected with rash following that alteration in diet. Those rash experienced patients described that the rash disappeared soon after they stopped that diet. Unfortunately, prurigo pigmentosa recurred in 5 patients as soon as they resume the diet.

FASTING

In another study, half of the subjects showed strong correlation between fasting and keto rash. When our body goes through keto diet along with fasting, blood sugar level take a deep dip during that phase. Consequently, our body generates excessive ketones and experiences added stress. These two issues may play a hand behind the rash.

NUTRIENTS DEFICIENCY

A nutrient shortage derives from eliminating particular foods can trigger a rash. For instance, lack of omega-3, vitamin A, niacin or B3 may prompt a rash.

ALLERGENS

Very rarely allergy contribute to this cause, but scientifically proven cases are found. Besides, some of the keto-friendly foods are reactive to allergy. In that Korean study, six patients were affected by different allergic diseases like atopic dermatitis, rhinitis and metal allergy. And experts found a link between these allergy and prurigo pigmentosa.

This list is not gonna complete any time soon and probably be kept on updating as science is digging deep on the keto rash’s origin.

Keto Rash Remedy: What to Do

Until or unless genesis of keto rash unequivocally determined, the remedy for keto rash will remain controversial and any given treatment will be a mere effort to subside the symptoms.

Do Nothing: Giving It Some Time to Heal

Without worrying much, we should focus on our daily routine, keto rash will ultimately settle on its own. This method is particularly works to new keto-dieters. If this rash is the aftermath of transitioning to keto regime, there’s a high possibility that it will go away as soon as our body acclimatize with new fuel source.

Although we might find it hard to believe, on study reported that it really works. The partakers’ legions have vanished within a few weeks without any handling.

If this method doesn’t work, there is nothing to worry about, there are other option to deal with it. Let’s try the other options.

Carbs: Give It Free Rein for a While

This remedy brings a bright smile on Mrs. Smith. She can now have her all those favorite dishes filled with carbs.

Many people expressed that incorporating a few more carbs helps improve their rash. However, it might give a spike in insulin levels and also send us on an exile from keto realm, therefore, it’s up to us to determine whether added carbs in diet worth attempting.

If integrating carbs in your diet relieves us from rashes, then it makes certain that ketosis is the culprit behind this side effect. In that case, we might try following steps to get back to ketosis fast:

•   Give a free rein to carbs to confirm that we get out of ketosis state.
•   Keep an eye on rash for a few days. If it starts to heal own its own, ketosis might trigger it.
•   Gradually put a rein on carbs intake targeting to reach ketosis again. If the rash recurs, it might be a symptom that our body is susceptible to ketones.

However, we can prevent keto rash recurrence, if we can figure out our ideal carb consumption levels. Let’s say, one consume 20-30g carbs as per standard, and now s/he give a raise to 50g. S/he might still achieve ketosis and diminish the rash indicators if finds the right spot with carb intake.

If we make a combination of this method and intermittent fasting, we can enjoy the benefits of ketosis state along with eating more carbs on a particular day.

Allergens: Eliminate It from Diet

A ketogenic diet paves the way for a variety of new foods to our platter. Also pushes us to choose certain foods over others. For example, some people finds egg a very suitable options and they give a spike on its consumption. Others opt to take a lot of nuts, vegetables or dairy. 

A list of keto-friendly foods given below that can activate allergies:

• Fish (like tuna, salmon)
• Shellfish (like crab, clams, and oysters)
• Dairy (like full-fat yogurt, hard cheese, cottage cheese)
• Eggs
• Peanuts
• Tree Nuts (like almonds, macadamia)

Keto Rash Remedy: What NOT to Do

Escape Sweating

Remember, acetone and toxins emitted through sweat. Sweating is a key rash initiator. Therefore, it would be wise if we keep ourselves away from sweating or at least evade extended exposure to sweat.

It is a fact that keeping ourselves away from sweating in daily life is next to impossible especially in hot and humid conditions. Besides, if someone is a regular gym hitter then the situation will aggravate. 

So, taking a little vacation from gym or decreasing our workout amount can help the cause. Moreover, keeping a vigil eye on hygiene issues is key like we can remove our sweat with a towel during exercise or take extra showers throughout the day.

Avoid Skin Irritants

Studies conducted on prurigo pigmentosa revealed that skin irritants like chlorinated water used in pool, may cause the rash. The clothes that we wear and detergents used to clean them hold chemical, which may flare up the rash too.

Experts recommend avoiding followings:

• Rash Scratching
• Chemicals or products that invoke irritation on our skin.
• Wearing tight clothes, especially around rash affected areas.
• Using cosmetics and toiletries on skin
• Wrapping bandages on skin

Avoiding Stress

Studies linked emotional stress with the keto rash as this stress induces inflammation on our skin. Therefore, to improve our skin health we should integrate such actions into our life that can release stress.

Following are a few techniques that can help reduce stress:

• Deep breathing method
• Meditation
• Talking walks
• Doing yoga
• Activities that soothe our mind (like painting, drawing, reading books)
• Going to therapy
• Low-intensity exercise
• Gossiping with people one loves

Keto Rash Remedy: What to Consume

Nutrients Supplements

Deficiency of vital nutrients can cause a lot of diseases. When we practice any types of elimination diets – keto certainly falls into that type – refilling miners and vitamins is key. Because elimination diets excludes a large portion of certain foods.

Minerals: three minerals have been considered as most important on keto: sodium, potassium and magnesium. While we get adapted to ketones, these minerals expelled in large amounts from our body. We have to make sure that they are refilled in due course as they are pivotal for metabolic functions and energy creation.

Vitamins: all the requisite vitamins are needed to be fulfilled, but we have to put a bit more emphasis on vitamin A as it holds significance to skin health. Most keto-friendly sources of this vitamins are:

• Spinach
• Kale
• Broccoli
• Beef liver
• Egg Yolk

However, animal sources of vitamin A differs from plant types. So, try to find out which one suits one best. Combining them appears to be a good option.

Omega-3s: Omegas-3s have been found effective in decreasing inflammation and improving skin health. Wild fish like salmon, mackerel are natural sources of omega-3. If fish doesn’t suit anyone, s/he can try fish oil supplement as an alternative.

Water: Drinking adequate water in keto diet is imperative. At the beginning of the ketosis stage, people tend to lose a lot of water, which in reaction can surge the concentration of acetone in the sweat and incite keto rash. Drinking sufficient water may help dilute the acetone so that it can’t amass on our skin while sweating.

Conclusion

The keto rash is an unexpected keto flu symptom for a lot of keto dieters. Though the genesis of keto rash yet to be discovered, there is enough scientific data to believe that achieving ketosis is of the causes of the rash.

Fortunately there are some practices that can help cure this keto side-effects and we have discussed those in details above.

If all the strategies fail, then we should consult with a doctor about introducing antibiotics to remedy the rash.

What is most encouraging is that keto rash is pretty rare and often heals on its own.