Everything You to Know About Keto Rash (Prurigo Pigmentosa)

Updated on September 30th, 2020
keto rash

This is not a common problem on a keto or low carb, but it can be not very pleasant for the few individuals experiencing it: Itching.

This itching – sometimes referred to as “keto rash “– can be annoying, sometimes even disturbing sleep. The rash and itching are almost always symmetrical on either side of the body. It most often develops over the back, chest, armpits, and sometimes neck.

What is the reason for this condition, and how can it be cured?

There are various posts about this online and several different theories. Now is the time to make it simple, how to cure style. Here’s everything you need to know.

The cause of the keto rash

While there are multiple theories about this problem, each more weird and unlikely than the next, we believe there’s a straightforward answer. This is based on many individuals’ experiences and limited scientific research available.

Here are the clues and the conclusion:

  • The itching usually begins soon after individuals get into ketosis. It subsides within a day or so if people consume more carbs and exit ketosis.
  • It can often get severe in a hot climate or after workouts.
  • The usual distribution of the rash and itch match areas where sweat can pile up.
  • When in ketosis, sweat can have the ketone body acetone.
  • Acetone can be irritating at high concentrations.
  • There’s a valid reason to believe that ketones cause the itching that some people experience in ketosis in sweat, maybe as this dries over the body.

 How to cure the keto rash

Here are a few remedies you can do to cure keto rash:

1. Give It Time

The keto rash can go away on its own after a couple of weeks. If you’re a novice to the keto diet, it may just be a waiting game while your body adapts. The longer you’re into ketosis, the more your body adjusts to the release of ketone bodies.

Studies find that in patients who took no treatment, the lesions subsided immediately within weeks. However, if the rash doesn’t subside its own after a couple of weeks, it’s time to try other options.

2. Avoid Sweat

Since sweat is a significant rash trigger, try taking a few days off from the gymnasium or reducing your exercise intensity to reduce sweating.

If you decide to work out strenuously, make sure to shower immediately afterward to wash off any sweat (and the hitchhiking acetone irritants).

Rubbing can considerably aggravate the rash as well, so wear comfort-fitting workout clothes to minimize the amount of friction on your skin.

Sweating from exercise can make you itchier, making you want to scratch (excess friction), so it’s essential to keep the sweating at a minimum.

[Read: How to stop Sweating]

3. Try Stress-Reduction Techniques

Emotional disturbances can make your skin flare up, so inculcate relaxing habits that help your psychological health.

You can regulate your emotions through breathing techniques, meditation, taking walks, engaging in a relaxing activity (painting, drawing, reading a book), going to therapy, exercise, and discussing your problems with the correct people.

Emotional stress has been associated with inflammation on the skin and can worsen existing skin conditions. This is due to the dermal mast cell’s close relation with sensory nerve endings and can release signaling molecules that trigger inflammation.

[Read: How to Cope With Stress]

4. Clothing

Wear comfortable clothing for the weather, so that you don’t sweat unnecessarily. Use air conditioning when needed.

5. Shower

After exercising, it can help to take a shower – after you’re done with sweating.

6. Change exercise plans

If the itching is exceptionally annoying, you might want to avoid workouts for some days or do something like brief weight training that doesn’t cause sweating.

7. Exit ketosis

If the tips above are not powerful enough, exiting ketosis will reliably cure the issue within a couple of days. This can be done by taking about 50 grams of carbohydrates or more every day.

To still get the best of a keto diet’s advantages – at least for type 2 diabetes reversal and weight loss – you can do a more liberal low-carbohydrate diet (50-100 grams of carbs daily) and add intermittent fasting [1].

Other treatments: 

There are many different treatments recommended online, like antibiotics taken for months or weeks and dedicated creams. These will likely provide momentary relief at best. We suggest not to use oral antibiotics, as the risks and side effects are much worse than the temporary and doubtful benefits.

Anti-fungal creams, antihistamines, and steroids appear not to be effective at all. 

There’s a simple, safe, and free solution if you require it – number 7, above. Use that instead.

[Read: Natural Remedies for Heat Rash]

What’s next?

If you get cleared by keto rash by exiting ketosis, can you ever use ketosis again? The answer is probably, yes.

If you felt comfortable in ketosis and had many benefits, you may want to try again [2]. The keto rash can stay away. Few individuals appear to get it only once, or only initially in ketosis when initially beginning out on a low-carbohydrate diet (given time, the body may flush out fewer ketones in the sweat).

Remember, many individuals in ketosis don’t get the rash at all.

Keep the advice above in mind. And if everything else fails, eat a bit more carbs, and the condition will go away.

[Also Read: Natural Remedies for Skin Rashes]

How to Prevent It

If you haven’t handled the keto rash before and are worried about getting it, you’re likely wondering how you can avoid it. Again, because the exact cause is not known, there’s no straightforward remedy for avoiding the rash. However, now that you know possible inducers, here are some things you can do:

Transition into ketosis gradually. Don’t drop your carbohydrate consumption abruptly or fast for prolonged periods if you’ve never tried it before. You want to lower your carb intake slowly until you can enter and stay in ketosis without a rash. Pay attention to rash symptoms.

Increase your carbohydrate intake as early as you see signs of a keto rash to keep it from developing to more advanced stages.

Bottom Line

Remember: The tide is on your side. It’s not likely you will get a keto rash, as it occurs rarely. But even if you do, there are simple ways you can actively prevent and treat it from occurring again. Don’t let it panic you away from getting all the ketogenic diet benefits and reaching your goals.

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