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What is Keto Rash?

What is Keto Rash

The keto rash, prurigo pigmentosa, is a rare inflammatory skin condition associated with ketosis causing red itchy rashes on the neck and upper body.1  The symptoms of keto rash can look similar to dermatitis or eczema; as a result, some people may initially be misdiagnosed. Symptoms of the keto rash may include one or more of the following:

  • An itchy, red skin rash found on the upper back, chest, and neck typically occurring in a symmetrical pattern on both sides of the body.
  • Red-colored spots known as “papules,” which usually have a web-like appearance.
  • Dark spots left on the skin after the spots dissipate.

What Causes Keto Rash?

The exact cause of Keto Rash is unknown. The rash typically appears when someone has started to enter ketosis.

How to Cure the Keto Rash?

Give it Time – Some instances of keto rash may be resolved on their own by waiting for symptoms to subside. The transition to ketosis can take time for the human body to grow accustomed.

Wear comfortable clothing – If you can minimize the amount of sweat on your body, you can reduce the severity of the keto rash. Tight fitted clothing that traps sweat against the skin will only serve to make the condition worse.

Shower immediately following exercise – If you regularly perform intense workouts, chances are you sweat quite a bit. After finishing your workout, try to shower immediately if possible. This will help keep pores clear and may prevent the rash from spreading.

Adjust or quit exercising temporarily-  Regular exercise provides a number of health benefits, but if it causes severe skin conditions, consider taking a brief hiatus. Eliminate all exercises and sweat-causing activities from your routine and see if the keto rash subsides.

If none of the methods above help to resolve keto rash issues, then it’s time to take some additional steps that can help combat this dreaded condition.

Eat Sufficient Nutrients – Nutrient deficiencies can play a significant role in overall skin health. When switching to a ketogenic diet, it’s important to make sure you’re still getting vital nutrients in your diet.

Acute and chronic skin conditions can occur if your body is lacking in vital micronutrients such as vitamin A, vitamin B-12, or vitamin C.

Eliminate Inflammatory Foods – The basis of keto is low-carb, high-fat foods, such as eggs, dairy, fish, and nuts. Some of these foods contain compounds that act as allergens to many individuals, which may lead to inflammation.  When symptoms of keto rash arise, it’s important to note any dietary changes that you may have made. Eliminate potential inflammatory foods to prevent rash symptoms from worsening.

Use Anti-Inflammatory Supplementation if Needed – If the elimination of inflammatory foods still doesn’t work, try using anti-inflammatory supplementation if needed.

Reintroduce Carbohydrates into Your Diet – If the rash still isn’t going away, it may be time to add some carbs back into your diet.

Cyclical Ketogenic Diet – Although people tend to think of keto as an all-or-nothing diet strategy, the truth is another option exists.

The cyclical ketogenic diet is an alternative form of keto that allows you to stay in ketosis most of the time while consuming carbs one to two days per week.

Practice Skin Care – Your skin should be nourished and properly cared for as much as the rest of your body, especially if you are prone to certain skin conditions.

Use room temperature water to wash your body and clean with gentle, all-natural soaps. Using extremely hot water can cause the rash to become inflamed and worsen over time. Certain soaps can also cause the skin to be irritated.

Use Medication if Necessary – Dietary and lifestyle changes may not clear up skin conditions for all people.

If you have tried all of the steps listed above, a doctor may prescribe anti-inflammatory medications such as minocycline or doxycycline to clear up your skin. These antibiotics can be useful for clearing up rashes if needed.

It’s important to note that only a doctor can determine if medication is right for you.

Excerpt from


1.Maco MW, Lee E, Wu Y, Lee R. Treatment of Prurigo Pigmentosa with Diet Modification: A Medical Case Study. Hawaii J Med Public Health. 2018;77(5):114-117.