You started the low-carb ketogenic diet and then you started itching. And we mean REALLY itching. What’s going on? It is eczema or dermatitis? Actually, although it’s not common, some people new to keto experience an inflammatory skin condition called prurigo pigmentosa, which, in relation to keto, is called “the keto rash,” although there are other possible reasons people get it. What is keto rash and why do some people get this common “keto-flu” symptom? Let’s explore the symptoms, theories, and steps you can take to help remedy or avoid it.
Keto Rash Symptoms
If you’re feeling an itchy rash, are new to keto, and are wondering if you have a keto rash, consider these telltale signs:
- Your rash looks light pink and symmetrical (on both sides of your body), most commonly over the areas of back, chest, and neck, but also perhaps on your arms and legs.
- You began experiencing moderate to intense itchiness and skin irritation shortly after starting a keto diet (within the first few weeks) and the itch is intense enough to interrupt your sleep and is worse with exercise and sweating.
- Your rash may (or may not) look like red bumps with fluid (not like papules, which are solid), that darken in time.
Why Do Some People Get Keto Rash?
So what causes this bothersome keto rash? The exact cause is still unknown, and there hasn’t been much in the way of research from the dermatology field to pinpoint the origin. But there are several theories suggesting why this happens when starting the low-carb diet and significantly lowering your carb intake. Some common theories include:
Acetone, a type of ketone that can be excreted through your sweat as your ketone levels rise, might be overabundant during a transition to ketosis. This may irritate the skin.
The ketone bodies circulating in your body as a result of getting into ketosis may have an inflammatory effect on some people.
An underlying autoimmune condition, such as Sjogren’s Syndrome, or an infection may have gotten “fired up” with the dietary change.
An imbalance in gut bacteria (dysbiosis), meaning you may have more bad than good gut bacteria, may have triggered a skin reaction.
Side Effect of Diabetes
A sudden exacerbation of existing diabetes from ketosis may trigger a rash.
How to Prevent or Remedy a Keto Rash
There are a number of things you can do to help prevent or cure a keto rash:
Acetone levels typically go down when your body becomes more efficient at burning ketones. So, if the rash is related to acetone in sweat, it should clear up (just like breath acetone clears up) once you are fully in ketosis (up to three weeks, but usually sooner).
Eat More Carbs
The quickest way to end a keto rash is to up your carbohydrate intake a little. The problem is, eating less keto-friendly foods may kick you out of ketosis and thwart your progress. The best course of action is to add a little more carbs back into your diet to see if that helps the inflammation to subside. If you cannot eliminate the rash any other way and simply can’t take it anymore, introduce carbs back into your diet, wait for the rash to clear, then try keto again; many people new to the diet are able to go back on keto after their rash clears without any issues.
Clean Up after Exercise
Don’t stay in your sweaty workout clothes after you work out. In fact, you may want to take a shower after exercising to get the sweat off your skin. Otherwise, the acetone in the sweat (and the sweat itself which contains bacteria) may instigate a rash or irritate one that already exists, which prolongs the time it takes to heal.
Dress for Success
We all know that friction, heat, and restricted clothing make a rash even more bothersome. Tight clothes will only restrict a rash, causing further irritation, so wear cool, loose, lightweight, comfortable clothing (especially around the rash areas) so your skin can breathe and is not further irritated.
Consider Food Allergies
Food allergies can cause an inflammation-related rash. If your keto rash is due to food-related inflammation, it’s starting in your gut and is caused by foods that aren’t agreeing with your body. To remedy the situation, review your meal plan and try removing some of the common food allergens from your keto diet and consider testing your glucose and ketones to see if you are reacting to foods you’re consuming.
Add a Supplement
If your rash is triggered by an imbalance in your gut bacteria, take a quality probiotic to help increase your beneficial bacteria. Most of us can benefit from a probiotic even if we’re not having problems. You might also want to add in probiotic-rich foods, such as fermented cabbage (kimchi), which also contain beneficial bacteria and enzymes to help you digest your food.
See Your Doctor
As we mentioned earlier in this article, one of the causes of keto rash can be inflammation from an underlying condition. If you’re not finding relief in other ways, you may want to discuss your rash with your doctor. Some doctors will treat keto rash with antibiotics due to their anti-inflammatory effects.
The Final Word
If you are new to keto and experiencing a keto rash, we recommend taking some of the tips from above as well as talking with your doctor to rule out other underlying conditions. If you feel really good while keto dieting and are experiencing some of the health benefits, like weight loss, lower blood sugar, improved mood, and better skin, don’t be discouraged; hopefully, you can get to the bottom of it and get back on track with your high-fat diet.