So you’ve started a new keto diet and shortly afterwards you noticed that you are suddenly itching all over, and there may be a place or two where you’ve developed a rash. This symptom is not uncommon, and it’s perfectly treatable (and it’s okay). Many people develop this keto rash. While not everyone who starts the process of ketosis actually gets this rash, there are plenty of people who do. In this article, we’ll learn how to both treat it, and how to prevent it when you start your keto transformation. We will learn the following in this article:

  • What is the Keto Rash?
  • How Does a Keto Rash Look?
  • Why Do You Get a Keto Rash?
  • How Can I Fix It?
  • How Can I Keep the Keto Rash from Happening?

What is the Keto Rash?
A keto rash is actually just an inflammatory ailment that sounds more frightening than it really is. The scientific name for a keto rash is listed as prurigo pigmentosa, which is also known as what’s called Nagashima disease. Many people who are in the early stages of ketosis can actually get this, and the first recorded cases of it occurred in Japan around 1971.

Nobody truly knows why keto rash occurs, and there are just a few people who have begun to recognize and know about it in the western hemisphere.

There was a study in 2017 with a control group of 83 Korean patients and 53 Korean patients. Out of those individuals, approximately 84.3% of these patients experienced the keto rash between the ages of 11 and 30 years. Women are more susceptible to get the rash, but some men received it. There was a female to male ratio of 2.6:1. Therefore, the study pretty much summed up that the keto rash generally affects adolescent and young adult women. While anyone of generally any ethnical background can actually get a keto rash, it is also highly uncommon, as it generally affects those with Asian descent.

The way this rash comes about is similar to eczema, or even dermatitis, and can appear on your body just about everywhere except your lower extremities and your face. It causes a rash that can appear to be light pink, red, or even brown depending on what stage it’s on. Usually, the rash appears to be light pink when it first starts, then as it starts to become inflamed, it turns red, and when it starts to heal it will darken to a more brown pigment. The rash is also affected by heat and moisture, and can be worsened by friction (such as from clothes). When you get a keto rash on one arm, it generally appears symmetrically on the other, because it distributes throughout your body evenly.

How Does a Keto Rash Look?

When you are trying to identify a keto rash, there are many factors and they’re pretty distinguishable. The rash occurs and generally has four stages. This helps to know when it is occurring and how you can treat and prevent it.

1. Early Lesions – When the rash is at this particular stage, the rash shows up as light pink. The lesions are similar to what appear to be scratch marks, and most people actually don’t even notice that this is happening because it looks like either just a mediocre rash or even a scratch/rub mark.

2. Full Lesions – Most people worry more and notice the rash in this stage as the rash is not only itchy, but also very aggressive. It spreads more, and is more pronounced. Many times it will look more and more like chickenpox or have small heads on the individual bumps. It is usually very itchy during this phase, and also more susceptible to irritation from water and friction (aside from the scratching which causes it to be worse, rather than help it feel better).

3. Resolving Lesions – In this third stage, the rash is actually starting to heal or recede, and many times the papules of the lesions will start to become scaly and replace the red lesions. They’ll start getting a little bit darker, and won’t be necessarily as irritated or inflamed, but it is still there.

4. Late Lesions – When this happens, the skin actually ends up being scarred, but the scars turn into a large pattern of dark spots that look like (but aren’t actually), larger freckles. This process medically is called “reticulated hyper-pigmentation” and during this stage, your rash is almost fully healed. The downside is that after this happens, in most cases, the skin may appear to look like this for a long time even after the rash fully disappears. Don’t worry though; your skin will get back to its normal appearance again eventually. Just be certain to take precautionary measures so it doesn’t return.

How Exactly Do You Get a Keto Rash?

There are numerous questions and answers posted everywhere on why someone gets a keto rash. Generally, the number one factor that was mentioned above was your ethnicity obviously, since it affects mostly Asians and Asian Americans. One of the main hypotheses that cause keto rash is the ketone named acetone. Other than that, we have numerous other reasons why someone can get a keto rash:

Higher ketone intake – When you have a lot more ketones that your body is creating during the process of ketosis, this can somewhat constrict the vessels in your body (your blood vessels) by causing the surrounding tissues to become inflamed. This can be one thing that has been known to cause the rash. This study is also linked to acetone, because you are consuming more of it.

Not eating enough – When you fast, you’re not getting the nutrients and carbohydrates that your body needs to avoid this process. Some studies have shown that a higher carbohydrate intake can help fix the problem, as it helps to increase your blood sugar levels. Over half of the patients in a study started fasting; they began to develop a keto rash.

Low carbohydrate intake – A keto diet is a low carb diet. Some people don’t get enough carbs in their diet, which is one of the reasons this rash can occur. Remember, keto diets are completely dependent on each and every individual. Because of this, some people may need to eat a higher amount of net carbs, while still keeping them low compared to the rest of the calories they eat.

Malnourishment – Just because you are dieting, this doesn’t mean that you are not allowed to intake nutrients. Aside from this, on a ketone diet, you are removing some items from your diet, but one must replace these with another food that is allowed in these keto diets to get that same nutrient. Lacking in an essential nutrient that your body needs is considered a form of malnourishment and needs to be avoided at all cost during a keto diet.

Food Allergies – Sometimes, a person may have an allergy to a keto-related item they are consuming in their keto diet. These food allergies have been known to have a chance to create a rash, as well as hives, and more.

Outside Chemicals – Some irritants have also been a cause of a rash, and associated with it. Studies have shown that hyperchlorinated swimming pool water, as well as acetone (such as with fingernail polish and other products), as well as even items and chemicals found in personal hygiene and makeup products can cause a keto rash.

These rashes can be constantly recurring even with treatment. Other studies have shown that the rash would not go away after simply a few days, and last weeks, or even the entire duration of their diet. This is mostly caused by external things that trigger or make your rash worse.
Korean scientists did a study and ended up finding out that some of their patients had a recurring rash every time they started their keto diet, fasted, and various other forms of dieting methods. So unfortunately, not everyone is safe, and some people have to just face the fact that you will get a rash when trying to achieve ketosis. The study also showed that irritation was increased due to scrubbing the body too clean, or having too much friction from what the studied patients were wearing (jeans, etc.)

Unfortunately, since nobody knows the exact reasons why a keto rash appears makes it even harder to cure it, but in the next section, we’ll cover some ways that this rash can easily be treated in a general sense.

So How Do I Fix a Keto Rash?

1. Let it take its course – Hopefully after just a matter of weeks, the rash will disappear on its own. While your body is transforming to utilize ketones more than carbs, you may experience the rash just during the transitional stages of your diet and nutritional plan. Once your body finally adapts to this, you may in fact be able to handle ketones better biologically and the rash will simply disappear. Remember to not get discouraged, because this can happen in a few days, a few weeks, or even longer. Just let it happen and move forward. If it doesn’t go away on its own after an extended period of time, then you may want to try different methods to make it happen.

2. Try increasing your carbohydrate intake – There have been proven studies that found that when the patients increased their carbohydrates, they were able to make the skin condition go away. If number one didn’t work for you, then this is your next plan of action and should be your primary concern when it comes to addressing your keto rash existence. You don’t have to “carbo load” like a body builder, but simply increasing the amount of net carbs you consume for a little while can help. If it goes away after a few days, try lowering your carb count again and continue work on ketosis. You can keep repeating this process until you find the low carb balance for your body. If you cannot seem to find the balance, then that means you may have a sensitivity to acetone or other ketones. The best practice for this is to then mix a generous low-carb diet combined with what’s known as sporadic and repetitive fasting. Generally though, you may be able to find the right amount of low carbs that your body won’t freak out to as mentioned above. This way you’ll be able to have a proper amount of carbs, but still be low enough to stay or enter into ketosis.

3. Try eliminating common keto friendly allergens – Since one of the common causes is actually a food allergen, it’s possible that your body is reacting to not only the ketones, but also an allergic reaction is what is causing your body to have this rash. They are not hives, so you may or may not experience hives. Many keto items contain allergens, such as milk, poultry, fish and shellfish, and various forms of nuts (especially peanuts).

An excellent way to find out if you are having an allergic reaction, try cutting out the foods for a month. If your rash disappeared after you cut the foods out of your diet, then it is very possible that you were simply having an allergic reaction trigger this. When you are trying the process of elimination, you can find out what was causing your reaction, then simply leave that food out of your diet, just remember to replace it with something that gives you the same nutrients. Fortunately, keto diets have a broad range of foods that are allowed and that contain the same vitamins, nutrients, minerals, and low carbs. Also, you’ll want to be sure not to overdo it. Don’t simply add a bunch of food that is new to your body all at once – wait about a week or two (or more if necessary). When you don’t have any rash develop after this time, then you can start to simply add more food. Remember that if at any time you get a rash again, that is one of the foods that can trigger it, so eliminate it again.

4. Find a direct supplement (or multivitamin) that compensates – If you are wanting to rule out malnourishment or vitamin deficiency from the equation (which is another main cause listed above), you can try to take a supplement along with your diet to ensure you can get all of the nutrients that your body may need. Keep in mind that while you want to be careful, it is generally a good idea to take a multivitamin or supplement anyway, because most of the time, a small amount over what you are already getting (you generally won’t get 1000% of your daily allowed iron allowance from taking a multivitamin and the foods you eat, which may cause iron oxide poisoning… if you are, then you are eating way too much anyway). So be sure to try supplementing your diet if you want to be safe, or even prevent this from being a cause (or as a means to treat it if a deficiency has been found to be causing your keto rash). Increase your electrolyte intake by drinking a glass or two of an electrolyte drink throughout your day. Take a multivitamin and maybe a fish oil capsule to ensure you are getting plenty of your omega 3 acids.  There are also ways to increase your digestion by taking salts which contain bile salts to break down your food better and help you get the nutrients you need.

One product on the market is a product called “Keto Greens Micronutrient Powder”, but if you don’t want to shell out the sixty-three dollars plus shipping and handling, you can find many items on the market at your local convenience stores, Wal-Mart, Target, or popular pharmacies. The Keto powder has all of the nutrients you need and more to help your body during the ketosis journey. There are also many guides out there on what supplements to take while on a keto diet.

If you have to take any antibiotics while trying to do a keto diet, you need to be aware that many are harmful to you. Be sure to tell your doctor you are on a keto diet and make sure that you are allowed to take the proper ones out there. There are a few antibiotics that you can take to fight the keto rash and win the battle though:

Minocycline, Dapsone, and Doxycycline all have been proven to help be extremely effective, although usually Minocycline will be advised over Dapsone due to many of the side effects, shows longer signs of working without recurrence of your rash, and more).

The absolute worst thing you can do is take things such as Benadryl (antihistamines) or any type of steroid (cream or oral capsule). These will do nothing but pump these chemicals into your body and can make your rash worse, or simply do nothing at all.

Do keep in mind that antibiotics won’t always get rid of your rash, and that they might not keep recurrence from happening. They will usually just help the process of healing it at the one time that you had to take it for the keto rash itself.

Unfortunately, most of the time antibiotics by themselves won’t completely keep your rash away, and they won’t completely fix what is mainly causing you to have the rash, as they will only keep the rash away the one time. That is why you have to try all of the different methods to find out the main cause as well. There are ways that you can further help yourself by simple lifestyle changes that can aid you in the process of eliminating your keto rash from reappearing (or appearing at all).

What Are Ways To Prevent a Keto Rash?

When it comes to prevent a keto rash, or even prevent it from getting worse, there are many lifestyle changes you can make, as well as ways to help get over it better. Remember all of the things listed above that can make your keto rash worse? Well, this section will explain some of the ways you can avoid those common triggers on worsening your rash, as well as sometimes even help you prevent getting the rash or keep it from happening over and over again. This is not a failsafe though simply because your personal genetics can contribute to whether or not this happens.

Try to keep sweat off of your rash – One of the major causes and things you can do to make it worse is to sweat a lot. Sweat from your body can interact with the rash and not only add moisture, but also add irritants from your natural body salts. Try to not exercise for a few days, or when you are exercising, take frequent breaks and don’t overdo it (try to make your exercise routine less intense) so you can keep from sweating as much as possible. If you do decide to have a heavy workout that makes you sweat, shower immediately, washing very gently (you don’t want to scrub hard as it can irritate your skin even more), and wash all of the acetone from your skin that could be secreted in your sweat.  Also be sure to avoid wearing constrictive clothes (such as jeans. Try opting for something soft like workout pants or sweat pants for a while) and keep the amount of friction against your rash as minimal as possible. This can also help you sweat less as your body has more room to breathe. When you sweat, remember this can also irritate your rash more, making you want to scratch every inch, which is bad and hard on the rash.

Try to not have any friction that could irritate your skin – As mentioned above, scratching is definitely the worst thing you can do. Wear loose clothes, don’t use anything to actually scrub your body hard when you’re washing, and don’t scrub your body with your towel after a shower. Also, avoid using bandages because not only can this cause friction, this can be tight fitting against your skin and not allow it to breathe. If you can avoid it at all costs, try not to sleep on the side of your body that has the rash either. This will help to eliminate most of the friction. You may want to moisturize your skin very lightly with a natural oil that your body can take. You can even try using vitamin E oil to try and minimize the amount of friction that the selected area may be exposed to on a daily basis.

Try to eliminate stress from your daily life – Even though we did not list this above, stress can cause a lot of problems not only for your diet and daily life, but it can also cause problems with your keto rash (and even keep it from going away). Fortunately, sometimes this can help you in battling your rash or keeping it away for good, as well as increase your state of mental health and wellbeing. Try various things that you can to do better enhance your mood. You can try meditating regularly, using breathing exercises, taking leisurely strolls, or finding a hobby that helps you eliminate your stress levels. You can even take a supplement such as St. John’s Wort to help with your mood during keto, as well as help you with your stress management levels, since stress has been scientifically proven to be a connection to inflammation of your skin. Your skin cells are connected with billions of nerve endings that can cause you to have inflammation, and eliminating stress has been proven medically to help cure and treat numerous epidermal disorders.

Can I Prevent Myself From Getting a Keto Rash?

Unfortunately, you may not be able to prevent it completely, but if you can, there are ways to try to (and they have been proven methods that have been able to eliminate recurrence). If you’ve never had a keto rash, and are afraid of contracting one, then you are like many people who have questions on how to prevent this strange skin disorder from happening. Fortunately, there are answers that can help aid your body and hopefully in your case keep you from getting a keto rash.

  1. Don’t Try to Rush ketosis – Remember that one of the first steps is that ketosis is a process that takes time, and that not everybody is the same. Some people are able to achieve ketosis in a matter of days or weeks, while other people have been known to have to follow a strict ketogenic diet for several weeks (or a few months) in order to transform their bodies to ketosis. There is a plan for you, and you will achieve it. If you try to rush the process, not only are you possibly causing harm to your body, but you can actually increase your chances of developing a keto rash. Sometimes a keto diet has to be eased into, and that’s okay too. You may have to cut down carbs slower than usual until you are able to achieve ketosis and stay in it without actually getting a keto rash.
  2. Look for Signs of Keto Rash – As soon as you start to see signs that show you are starting to get a keto rash (you may be able to actually see results soon after you convert your body towards ketosis), try to increase your carb intake. This can help it literally go away even from stage one so that it doesn’t get worse.
  3. Find a Dietary Supplement For You – As mentioned above, go ahead and start taking a dietary supplement (avoid diet pills though), vitamins individually, a vitamin packet (this usually delivers promising amounts of vitamins without a lot of the side effects people have been known to have – such as upset stomach – that a multivitamin can cause), or even a multivitamin in order to keep from getting a keto rash, and ensure that your body gets all of the desired minerals, micronutrients, and vitamins that your body needs to thrive. All excess vitamins and minerals usually are water and waste soluble, and will simply leave your body as waste anyways. Taking a supplement however keeps you from lacking anything that your body may need, which you may not be getting when you eliminate a certain food.

The Main Conclusion

Remember that with a keto diet, you alone are your own worst enemy, and your own cheerleader. When it comes to keto, you must know your own body inside and out, and most of the time you will, so don’t worry. If you do start a keto diet, you can almost rest assured that due to the rarity of a keto rash actually happening. If you are not of Asian descent, remember that you can still contract this rare disorder, but your chances are literally next to none. If you are one of the select few that can and do actually get this rash (or if you’ve experienced it before), then now thanks to this article, you’ve been able to get enough information so that you can prevent future outbreaks, or easily treat the rash so it doesn’t bother you quite so much. When it comes to being able to reach your extended goal of reaching ketosis, don’t ever let something like a minor rash cause you to not want you to attain this. As we said, the ball is in your court. You can dribble it, pass it, shoot it, throw it away (which we highly advise you not to do), or you can do what’s best. Remember to run with it, and aim for the glory that you can achieve by obtaining the goal of ketosis. Your health, mental clarity, and wellbeing depend entirely on you, and with ketosis you can definitely achieve this.

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