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You have just started enjoying your morning bacon and bulletproof coffee.

And all of the sudden you don't feel comfortable in your own skin anymore.

Your face is itchy, your neck is itchy, you have bumps on your chest and back.

It starts feeling unbearable. You wish you didn't get that stupid rash.

Don't panic, you are not alone with this.

What you are experiencing is called the keto rash.

This is a not very common side-effect of the keto diet.

Depending on the severity, it can be annoying and unbearable.

It can even start interrupting your sleep.

The good news is that it's not life-threatening and you can treat it.

In this article, we cover exactly why this nasty rash happens and how to treat it.

What is the keto rash?

You may be wondering, why the hell is the keto diet making you itchy? You are in the right place to find out.

Keto rash is a pretty rare inflammatory skin disease. The scientific term for this is prurigo pigmentosa [1], which sounds more like something that came out of the Harry Potter saga.

This term was first described by Japanese dermatologist in 1971. The keto rash appears as itchy and raised skin lesions. The color of the bumps usually varies from light pink and red to brown.

the keto rash

The root cause of the keto rash is not known because there's a lack of scientific research done on prurigo pigmentosa. This makes it harder to pinpoint the exact cause and treatment.

While there is not enough research done on the keto rash topic, its unlikely to be dangerous to human life in any way.

Ketosis and prolonged periods of fasting seem to be the main appointer. [1]

The keto rash is characterized by itching and discomfort, which typically appears on the chest, torso, back, and neck. Research shows that rash is more likely to occur in younger females between the age of 20-30. It also tends to be more consistent in the middle of the body.

Another study found that women were twice as likely to be affected and the rash could come back every some time. [2] Some studies even suggest insulin resistance and type 2 diabetes are linked to the keto rash. [3]

What are the symptoms?

A keto rash looks a lot like eczema or dermatitis. It's itchy, annoying and results in raised skin bumps that range in color from light pink to brown. Although the rash is uncomfortable and even embarrassing, it's not life-threatening.

keto rash

During the early stages of the rash, it's usually characterized by skin lesions. The colors vary from light pink to brown and can look like scratch marks. Fully developed lesions occur when the sores start to fill with fluid and become infected.

Typically the keto rash appears on arms, neck, chest, back, and armpits. The rash tends to be in symmetrical patterns on both sides of the body. When the rash is in the end phase, it may look like dark spots or freckles.

This is hyperpigmentation that might last long after the rash is far gone. [4] Usually the keto rash is temporary and resolves within weeks. A small percentage of people tend to get this every time they enter ketosis.

What does it look like?

The keto rash has 4 main stages: early lesions, fully developed lesions, resolving lesions and late lesions. [5]

keto rash lesions
  • Early lesions - Patients skin shows light pink raised skin lesions that look like scratch marks. This stage is often overlooked and brushed off as a temporal rash.

  • Fully developed lesions - This is the stage when people usually get really worried. The skin shows aggressive skin lesions called papules. There have been cases when papules include liquid-filled cysts or more rarely pus-filled cysts.

  • Resolving lesions - When the rash is receding, crusted and scaly papules are observed. The color of lesions starts to get darker.

  • Late lesions - As the rash comes to an end, the skin stays covered with a net-like pattern of dark spots. This pigmentation might remain long after the rash is healed.

The severity and longevity of the rash vary between individuals. It can last from a week to several months. The final stages tend to last longer.

What triggers it?

Keto rash is called prurigo pigmentosa which is an inflammatory skin condition. [6] While there's not enough scientific proof on why this rash occurs, some research has found the link between prurigo pigmentosa and ketosis. [13]

But the exact cause of the keto rash is unconfirmed by scientific research. Fortunately, it's not an immediate threat to your health.

keto rash reasons

Here are 7 potential triggers that can be the source of rash during ketosis.

  1. Excessive fasting - A scientific study found a link between fasting and the keto rash. As the results of the study, 50% of patients developed the keto rash. When blood sugar levels are low thanks to fasting, patients bodies entered into ketosis and as the result caused the rash.

  2. Intestinal dysbiosis - In simple terms, its an imbalance of gut bacteria. A situation where unwanted bacteria has grown out of control and overpopulate healthy bacteria. This causes the production of toxins and inflammation. Dysbiosis has been correlated with skin problems like acne, rosacea, and eczema. [7]
  3. Candida - Is a normally occurring yeast that is present in most human bodies. It's totally fine in normally occurring amounts, however, if overgrown, can cause similar problems as dysbiosis. Although candida thrives on sugar, during the keto diet, you could suffer from a candida die-off. Toxins and sudden increase in inflammation may be enough to cause a reaction on the skin. [8]
  4. Toxic bile - Bile is used to digest fats to be absorbed in the small intestine and release toxins that have been processed by the liver. If you start the keto diet, then it can stimulate a rapid release of congested bile that dumps toxins into the digestive tract. This, in turn, can be the cause of the inflammatory skin rash. [9]
  5. Poor bile flow - Bile is needed to properly digest fat. The most common sign of poor bile flow is itchy skin. The reason for that could be that a sudden increase in dietary fat is simply too stressful for your liver and gallbladder. [10]
  6. Ketones irritating the skin - A ketone body called acetone. Your skin may be having a negative reaction to acetone, especially acetone in your sweat. Your body produces acetone in much higher amounts during the beginning adaption phases of ketosis. Acetone is also responsible for the famous dragon breath or the keto breath. Acetone is excreted through the sweat. This makes sense because the keto rash often shows up in body areas where sweat tends to accumulate.

  7. Toxins irritating the skin - Your body stores toxins in fat tissue. [11] And when you start the ketogenic diet, your body will burn through fat stores quite rapidly. Thanks to that, these toxins can end up in your bloodstream and they need a route to the exit. If your liver is not functioning well, then toxins can be eliminated through sweat. Again, this could be the reason why the keto rash tends to occur around areas where sweat accumulates. [12]

As the root cause of the keto rash is not clear, it may be hard to treat this condition. Next, we go over some natural ways on how you can relieve and treat this.

How long does it last?

Well, the period of how long this rash lasts depends on various factors. Even with proper treatment, the rash might not go away completely as the healing process takes more time.

Scientific studies have found that some reasons for reoccurring keto rash include dietary modification, mechanical irritation, sweating and emotional stress. [15]

The rash period can differ depending on if and how you treat your body. 

  • Do you let it run its core and hope it will treat by itself? 
  • Do you ramp up carbs and treat it with lotion and avoid friction? 
  • Or you get back to the gym and start sweating?

Most people find that the rash disappears after their body gets used to being in ketosis.

How to treat it?

The keto rash can be daunting and annoying, but fortunately, it's not harmful to your health. As there is no scientific evidence that states what is the root cause of this rash, the cure can be debatable.

However, here are some research and experience backed methods to relieve and treat the symptoms.

What to do

  • Give it some time - Most times, the rash will resolve on its own during the first few weeks. If you have just started your ketogenic journey, and it's your first time experiencing rash, then it's worth giving your body some time to adjust the changes. There is research is done, which suggests that lesions have cleared spontaneously within weeks, without any specific treatment. [16] If the rash doesn't go away on its own and its hard to live with it, then check out our next options.

  • Ramp up carb intake - Research has shown, that it's very likely that keto rash linked to low-carb diets and excessive fasting. To test if the keto diet is the trigger, try increasing carb intake to 50-100g (that will kick you out of ketosis) and see if it alleviates the rash. If it does then lower your carb intake again and see if the rash reappears. If it does then your body may be sensitive to ketone bodies. Then you should consult with your doctor. There is a possibility that you can find a sweet spot of carb intake, which allows you to stay in ketosis and ignore the keto rash.

  • Try the elimination diet - One potential trigger that can cause your keto rash is an allergic reaction to keto-friendly food. Since the keto diet will introduce new foods to your daily menu, you want to test for allergies. Some common keto foods that may trigger allergies are dairy products like cottage cheese and full-fat yogurt, eggs, different fish like tuna or salmon, tree nuts, and peanuts. Try to remove these food groups from your diet for a month and see if the rash has disappeared. After start eating again these foods and see if the rash re-appears. Try these foods one-by-one at a time. In this way, you can find what food is the potential trigger for the allergies.

What to take

  • Bone broth - A bone broth is one of the keto diet go-to foods. It's perfect to treat keto-flu, the perfect source for nutrients and contains all natural anti-inflammatory nutrients, such as glycine and proline. [19] Keto rash is inflammation skin condition, so it's important to help the healing process by eating plenty of foods that reduce inflammation and help your body to heal from inside out. [20]  

    » Check out grass fed & organic bone broth

  • Omega 3 - Wild fish, such as salmon, sardines or mackerel have a strong anti-inflammatory benefit for the skin thanks to their high omega 3 content. Fatty wish is already suggested foods during the ketogenic diet, so it's also beneficial during the keto rash. If for some reason you don't want or can't eat fish, then taking fish oil supplement will also do the trick.

    » Check out wild Alaskan fish oil
  • Selsun Blue Shampoo - Another way to relieve the itching is to use the Selsun Blue shampoo. It doesn't cure the keto rash, but it helps to minimize the symptoms. Selsun Blue makes wonders on minimizing the nasty itch because as you already know, you shouldn't scratch your itch. Keep in mind, when using any kind of lotion or shampoo, to wash very gently and dry very thoroughly.

    » Check out Selsun Blue medicated shampoo

  • Probiotics - Now, this is not for everyone. But since your microbiome will drastically shift during the process of entering ketosis, some people have seen help using probiotics during this process. Probiotics can be helpful even later on the ketogenic diet road with digestion and overall gut health. This is vital as the keto diet is known for it’s lack of fiber intake.

    » Check out keto friendly probiotics

What not to do

  • Avoid sweating - Sweating is a major rash trigger. If you are experiencing keto rash, then avoid the gym and any intense workouts to minimize sweating. If you must exercise or move then be extremely careful and shower always directly after physical exercise to avoid acetone irritants. Rubbing your body can make the rash even worse, so wear loose fitting clothes and don't scratch your body. [17]
  • Avoid friction - Okay this is a no-brainer. There's no secret that friction will make rashes worse. To avoid that, don't wear tight clothes. Especially on the rash area. Avoid exfoliants in your skin, don't scrub too hard with your bath towel. Don't scratch your itchy parts and try not to sleep on erupted places if possible. 

  • Avoid stress - Emotional stress can affect our bodies in many different ways, so it will be beneficial for your whole body to adapt relaxing habits to relax your mind. A good place to start is practicing meditation, breathing techniques and engaging in relaxing activities like drawing and reading a book. Research suggests that emotional stress is linked to skin inflammation and can make skin disorders worse. [18]

How to prevent it?

Starting a new diet, a new habit or a new lifestyle can be scary at the start. If you haven't experienced the keto rash before, then this could be also scary for you.

how to prevent the keto rash

What if you will get it? Can you prevent it?

As the exact root cause of this is still unknown, there is no one fits all solution to prevent the rash. The good news is that the odds are on your side.

As it's a fairly uncommon side-effect, it's unlikely you will get a keto rash at all.

By now, we know what can be the potential reasons why this rash can occur, we can act accordingly. Here are 3 things you can do to minimize the likelihood of the keto rash:

  • Start keto slowly - The first thing to do, when you want to start with the keto diet, is to cut out the carbs from your menu. But don't drop your carb consumption drastically if you haven't done it before. Ideally, you will want to lower carb intake gradually.

  • Keep an eye out for rash signs - Keep your eyes open on what you eat and how your body reacts to them. As soon as you see potential rash signs, ramp up your carb intake and verify if that's the root cause or not. You may have simple intolerance against specific foods nutrients.

  • Supplement your diet - The keto diet is pretty restrictive diet by itself so you will experience nutrient deficiencies sooner or later. To avoid that, consider supporting your diet with supplements which will help you avoid side effects and enter ketosis faster.

    » Check out the best tasting exogenous ketones

    » Check out grass fed & organic bone broth

The takeaway

Hey, we get it.

The keto diet can be a burden by itself, not to mention side effects like the keto rash.

Your face is itchy, your neck is itchy, everything is itchy and your body is covered with bumps. The good news is that it’s not life-threatening in any way and you can treat it.

The bad news is that there is no one single understanding (scientific proof) why this nasty rash happens, thus we don’t have one fits all cure on how to treat it.

Keto rash seems to be related to ketosis, prolonged periods of fasting, candida and different bile related problems.

Most of the time, the keto rash appears on the chest, back, neck and armpits and it tends to be symmetrical patterns on both sides of the body.

Not every rash needs to be keto rash.

The easiest treatment for this rash is to simply ramp up the carb intake, which in most cases will fix the problem. But if you still want to follow the ketogenic diet, then try the elimination diet and rule out your potential allergic reactions.

Bone broth, omega 3 and Selsun Blue Shampoo are also good choices to test out when nothing else seems to be working.

At the end of the day, if you have problematic issues with your skin, gut, rashes or overall health, then always consult with your doctor first.

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