Keto Rash: Why You’re Suddenly Itchy and How to Make it Go Away
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Keto Rash: Why You’re Suddenly Itchy and How to Make it Go Away

What exactly is "keto rash"? Discover how to detect this rare rash, why it happens, and how to alleviate symptoms and avoid getting it.

Learn everything you need to know about keto rash

If you’re starting a ketogenic diet, you may have developed a rash and don’t know why. Maybe you’ve Googled the symptoms of ketosis and think that the rash means ketosis is bad for you.

Don’t panic.

That itchy rash you’re experiencing is called “keto rash,” and it’s a normal side effect experienced by many (but not all) new keto dieters. It can definitely be annoying and somewhat embarrassing, but it’s not dangerous.

Rest assured that this rash is both preventable and treatable.

What the Keto Rash Is: Description and Symptoms

Keto rash is a rare inflammatory skin condition of unknown origin with a scary-sounding scientific name: prurigo pigmentosa. It can appear on people who are in the early stages of ketosis and was first reported in Japan in 1971[*].

The rash doesn’t have an exact cause, and it’s just beginning to be understood and researched in the West.

The rash manifests as itchy, raised skin lesions that can be red, brown, or light pink in color depending on the stage it’s in. Although it’s uncomfortable, it is not life-threatening or dangerous at all.

It looks similar to eczema and dermatitis, and typically shows up on the neck, back, chest, shoulders, torso, armpit areas, and — less commonly — face and extremities. Keto rash usually forms a symmetrical pattern on each side of the body in a net-like distribution.

Like most skin rashes, the keto rash can worsen if you exercise strenuously or expose the rash to heat, moisture, and friction.

What Keto Rash Looks Like

Research shows the rash has four main stages[*]:

  • Early lesions: The skin shows light pink raised skin lesions called “urticarial papuloplaques” that look like scratch marks. This stage can get overlooked or brushed off as a temporary rash.
  • Fully developed lesions: This is the full-blown rash people get worried about. The skin shows more aggressive red skin lesions called papules, and sometimes papules include liquid-filled cysts (called papulovesicles) or, more rarely, pus-filled cysts (called papulopustules)[*].

Photo of keto rash on someone's back

Source: Journal of the European Academy of Dermatology and Venereology

  • Resolving lesions: When the rash is receding, crusted, and scaly papules are observed. The lesions also start to get darker[*].

Keto rash: Photo of resolving lesions

Source: Journal of the European Academy of Dermatology and Venereology

  • Late lesions: As the peak of the rash comes to an end, the skin is left with a net-like pattern of dark spots larger than freckles, called “reticulated hyperpigmentation.” The pigmentation might remain long after the rash is healed[*].

Keto rash: Photo of late lesions

Source: Journal of the European Academy of Dermatology and Venereology

And here’s the kicker: How long the rash lingers varies from person to person. It can last from a couple of weeks to several months. The two final stages (resolving and late lesions) tend to last the longest.

If you are experiencing the keto skin rash, here’s what you can expect:

Best-case scenario: It goes away after a couple of weeks.

Worst-case scenario: You’re one of the few people who get it every time your body enters ketosis.

If you’re in the latter group, don’t give up just yet. Find out how to relieve and prevent keto rash.

What Causes Keto Rash?

Although research finds a link between prurigo pigmentosa and ketosis [*][*][*][*], the exact cause of the rash is unconfirmed.

However, there are several potential triggers related to the ketogenic diet that can make it appear:

  1. Ketone bodies. Acetone produced by your body during ketosis can cause perivascular inflammation (inflammation around your blood vessels) and trigger the rash[*].
  2. Excessive fasting. In one study, 50% of patients showed a relationship between fasting and keto rash[*]. When blood sugar levels are low during a fast, your body switches to ketosis and might cause the rash.
  3. Low-carb diet. A low-carb diet, especially one that causes you to lose weight very quickly, has also been related to the keto rash[*].
  4. Allergens. An allergic reaction is triggered in response to various keto-friendly foods.
  5. Nutrient deficiency. A nutrient deficiency from excluding some foods and not replacing them with nutrient-dense keto-friendly alternatives can manifest as a rash.

Causes of a Long or Recurring Keto Rash

Even with treatment, the keto rash might not go away completely after several months, or it might abate and reappear a few weeks later. This can happen mostly because of external triggers that activate your immune system and exacerbate your rash.

A study of 50 patients in Korea found that[*]:

  • Five patients got the rash again after restarting their dietary modification (high-fat diet, ketosis, fasting, low-carb, etc). This means you might experience the rash if you get out of ketosis, then go back into ketosis.
  • Five patients developed the rash once more after mechanical irritation such as bandage, body-scrubbing, or friction from clothing.
  • Three patients regained it after sweating due to exercise or hot weather.
  • Two patients developed it again after emotional stress.

Not knowing the exact cause of keto rash can make it hard to treat, but below are some of the ways you can find relief.

How to Alleviate Symptoms 

Full disclosure: The best cure for keto rash is debatable because the root cause is not clearly defined.

However, these five research-backed methods can help alleviate your symptoms:

1. Give It Time

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

Research finds that in patients who received no treatment, the lesions cleared spontaneously within weeks[*].

However, if the rash doesn’t go away on its own after a week or two, it’s time to try other options.

2. Eat More Carbohydrates

Some research suggests prolonged periods of fasting or being in ketosis correlate with the rash[*]. Out of the 16 patients in the study, eight manifested the rash after fasting for a long period of time, and six were in ketosis.

In a different study involving 50 patients, a dietary change (either ketosis, fasting, or a low-carb diet) was the suspected trigger for 17 people[*].

As mentioned above, ketones, excessive fasting, and a low-carb diet are the top three potential triggers of the rash, so this is the first factor that you should address.

To test if a ketogenic diet might be your trigger, do this:

  • Try increasing carb intake just enough to get out of ketosis for a few days and see if the rash lets up.
  • If it does, lower carb consumption and enter ketosis again.
  • If the rash reappears, it can mean your body is sensitive to ketones.

In this case, consider a more liberal low-carb diet of around 50-100 grams of carbs per day, and combine it with intermittent fasting. This will still provide some weight loss benefits of ketosis and fasting.

Over time, you may be able to find your “sweet spot” with carb intake that provides benefit while reducing recurrence of the rash.

3. Try an Elimination Diet

Another potential trigger of the rash is an allergic reaction to a keto-friendly food. If you’ve recently introduced new foods or large amounts of certain foods, you want to test for food allergies.

The most common keto-friendly foods that may trigger allergies are:

  • Dairy (e.g. cottage cheese, full-fat yogurt)
  • Eggs
  • Fish (e.g. tuna, salmon)
  • Shellfish (e.g. oysters, clams, crab)
  • Tree nuts (e.g. macadamia, almonds)
  • Peanuts

To find out if you’re allergic, try an elimination diet:

  • Remove these foods from your diet for 30 days.
  • Track if your rash has diminished or disappeared after this time.
  • If your condition improves, reintroduce just one of these foods in your diet and wait one to two weeks.
  • If the rash hasn’t reappeared or worsened, add a new food.
  • Continue to add one new food every one to two weeks if no symptoms appear.
  • If the rash resurfaces after introducing a new food, that’s your trigger.

4. Supplement With Micronutrients or Trace Elements

To rule out any nutrient deficiency-related causes, make sure to supplement your diet with vitamins and minerals that can be difficult to get when on a keto diet. Specifically, try supplementing with:

  • Minerals: Sodium, potassium, magnesium, calcium. These minerals can diminish during a transition to a ketogenic diet and are vital for cell function and energy.
  • Vitamins: Vitamin D, vitamin A, omega-3s from krill oil.. These vitamins are necessary for regulating inflammation. Since the keto rash is an inflammatory response, it’s important to get plenty of these nutrients into your diet.
  • Bile Salts: Cholic, deoxycholic, chenodeoxycholic, and lithocholic acids, akabile salts, help your body break down fat into usable fatty acids.

Want a quick fix? Consider supplementing with Keto Greens Powder — it has all these vitamins and minerals and a lot more.

For more information about what supplements you should be taking while on the keto diet, check out this Keto Supplement Guide.

5. Talk to Your Doctor About Antibiotics

Indiscriminate use of antibiotics is certainly harmful, but the scientific literature [*][*][*][*][*][*][*] shows that specific types of antibiotics are highly effective against the keto rash.

The antibiotics that have shown the best results are:

  • Minocycline
  • Doxycycline
  • Dapsone (minocycline has been preferred to dapsone because it has fewer side effects and results in a longer remission.)

Other medications that aren’t effective against the rash include antihistamines, topical anti-inflammatory steroids, and oral steroids.

Talk to your doctor about the potential risks and benefits of taking an antibiotic for your rash. You might consider following your antibiotic treatment up with a round of probiotics in order to help your body replenish your microbiome.

A word of caution: Despite antibiotics being extremely effective at getting rid of prurigo pigmentosa, they won’t prevent a relapse. A study in 50 patients found that[*] “although oral minocycline, with or without dapsone, was very effective in inhibiting the appearance of new lesions, these drugs did not prevent recurrence.”

This means they won’t fix the root issue of your rash, they’ll only make the current episode go away. That’s why you need to take additional measures to prevent a future relapse, like the ones outlined above and the lifestyle habits below.

Lifestyle Habits to Avoid a Flare-Up

Finding your internal triggers and avoiding them is an important first step. However, your rash can worsen or come back if you don’t pay attention to external triggers that exacerbate it.

As mentioned above, the main external factors that can make the rash return are sweating, friction, and emotional stress.

Adopt these simple habits to prevent a new rash:

Avoid Sweat

Since sweat is a major rash trigger, try taking a few days off from the gym or at least reducing your workout intensity to minimize sweating.

If you do decide to exercise strenuously, be sure to shower immediately afterwards to wash off any perspiration (and the hitchhiking acetone irritants).

Rubbing can significantly aggravate the rash as well[*], so wear loose-fitting workout clothes to reduce the amount of friction on your skin.

Sweating from exercise can make you itchier, which makes you want to scratch (more friction), so it’s necessary to keep the sweating at a minimum.

Avoid Anything That Causes a Reaction on Your Skin

Since friction also flares up rashes, avoid:

  • Wearing tight clothes, especially around the area where you have the rash
  • Using any type of exfoliants on your skin, like homemade scrubs or a loofah
  • Scrubbing too hard with your bath towel after a shower
  • Scratching
  • Using bandages
  • Sleeping over the area that is affected, if possible

Keep the area moisturized with a cream or an oil that your skin can take. Lubrication will help prevent friction.

Try Stress-Reduction Techniques

Emotional stress can make your skin flare up, so adopt relaxing habits that support your mental health.

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

Emotional stress has been linked to inflammation on the skin and can worsen existing skin disorders. This is because the dermal mast cells have a close connection with sensory nerve endings and may release signaling molecules that promote inflammation[*].

How to prevent the keto rash

How to Prevent It

If you haven’t dealt with keto rash before and are worried about getting it, you’re probably wondering how you can prevent it.

Again, since the exact cause is unknown, there’s no clear solution for preventing the rash. However, now that you know possible triggers, here are a few things you can do:

  • Transition into ketosis slowly. Don’t drop your carb consumption drastically or fast for long periods if you’ve never done it before. You want to lower your carb intake gradually until you are able to enter and stay in ketosis without signs of a rash.
  • Pay attention to rash signs. Increase your carb intake as soon as you see signs of a keto rash to keep it from advancing to more developed stages.
  • Supplement. Start supplementing right away to avoid deficiencies on your keto journey. Keto Greens Powder can provide you with vital micronutrients.

Follow these steps at least during the first few weeks you start on the keto diet.

Remember: The odds are on your side. It’s unlikely you will get a keto rash, as it tends to be rare.

But even if you do, there are simple ways you can actively treat and prevent it from happening again. Don’t let it scare you away from reaching your goals and getting all the benefits of the ketogenic diet.

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25 thoughts on “Keto Rash: Why You’re Suddenly Itchy and How to Make it Go Away

    1. After being on keto of three bottles I witnessed a itch twice but disappears twenty minutes later but I am having trouble losing weight can you outline the routine for me there is something I am doing wrong with my diet confused tks

  1. Wish I didn’t get that stupid rash. I was fine for 6 months and then I became sensitive to ketosis. I’ve tried to start like 5 times now each time the rash beat me down immediately. I loved keto 🙁

    1. OMG I’m in my 3rd week and just a couple of days ago I got the rash. ALL OVER. It’s almost unbearable! I’m really hoping it will go away as this diet is really working for me.

  2. I wish I didn’t get this rash either. I felt great but overall if my liver is not processing the fats and giving me a rash something is telling me its not good to continue the diet. Some say its ok but it can’t be if your body is rejecting the fats we eat. Its also not ok if my liver cannot process it…..

    Did anyone try liver detox and then come back to keto diet? any thoughts?

    1. I have the same concerns!! I thought something was biting me as new welts came daily.
      This article had yips i will try.
      Looking for feedback from others.

  3. I too had this red, itchy. Scaley rash that wouldn’t go away no matter what I used. I developed this rash about 8 weeks into ketosis. I tried alovera gel, benedeyl and neosporin one at a time for days apart, to no avail neither worked. I looked through my medicine cabinet and found this cream that I was prescribed by my ENT Doctor for a sinus virus and allergy infection and WOW!! My rash started to clear within 30 minutes. The next day it was totally gone. This medicine is called Mometasone Furoate Cream USP 0.1% to be used twice a day on the affected area. It worked for me so you may want to call your Medical dr or pharmacist to see if you can get this for your Keto rash. Hope this works for you, good luck 👍🏾

  4. Stumbled on this article in desperate google search for an answer to the cause of a 3 week rash that will not go away and has now consumed my entire body including face. It is unbearable. I did not associate it with keto diet since after week 2 (which was 3 weeks ago) I stopped keto because the rash pushed me over the edge and I reverted to old food habits. Had no idea it could be keto induced. Will not risk this going away(please go away anytime now) and having to go through this again.

  5. Thanks Sally I had d keto rash just 1 week into keto thank God I stumbled upon ur comment the mometasome furate cream is working for me unfortunately I saw your comment late as the rash was already all over my body. didnt stop me from continuing the keto diet though

  6. @nope – Just because you got a bad allergic reaction doesn’t mean it is an unhealthy diet for everyone. Some people are super allergic to strawberries…that doesn’t mean they are unhealthy for everyone just because a few are allergic. Also you claim bacon and processed meats are the same level “carcinogens” as asbestos and even plutonium?! That is just flat out wrong. They show a correlation, NOT causation of cancer. Huge difference. Even a charred piece of organic vegetable is technically a carcinogen.
    Also, this rash is rare. So the vast majority of people don’t even get the rash. I developed a small patch of the lesions, but I also know my liver is fatty so it’s not performing at peak right now. But since I’m losing weight and about to start a liver/gallbladder cleanse, I’m positive it will help clear the rash up.

    Now to relate my LIFE CHANGING experience with keto. (since you are intent to bash this way of eating…) I started keto 3 months ago… Here is all the health benefits so far:
    -Within the first week I didn’t need ANY insulin anymore for my diabetes.
    -After 2 months:
    -my a1c is well controlled, WITHOUT insulin.
    -Labs showed my cholesterol and triglycerides improved…all in normal ranges.
    -Labs for my liver are now in normal ranges
    -My constant achy pain from fibromyalgia that I’ve dealt with for almost 20 YEARS…GONE!
    -Depression, constant carb and food cravings that I’ve had my entire life…GONE!
    -Fatigue and anxiety have decreased a lot.
    -I’ve lost over 20pounds and counting.

    So when people say Keto is “unhealthy”, it realllllly gets under my skin. This has been the single biggest life changing thing for my health ever. What is really unhealthy is all the processed chemically laden food they allow these food corporations to make and advertise targeting children especially. It’s disgusting. And the factory farms churning out horrible quality meat.

    1. I agree. I’m on only 1 metformin now. Dropped glucose 70 points. IBS GONE. 20# down. Feeeeel better all over.
      I got the rash in my groin on one side right where the elastic of my panties hit. Keeping sweat off. Drying throughly after shower and using coconut oil were the remedies.

  7. I’m on my second round of Keto. During the first I broke out into a rash that got progressively worse and I had to stop it itched so much.

    This time I did not get it. The reason I believe I was successful this time around is that through running my DNA through a health report, I discovered I have a gene polymorphism in my FTO gene which leads my body to interact with saturated fats in a negative way. I switched my keto diet to keep my saturated fat levels between 25% – 30% of my total fat intake, and the rest is all Polyunsaturated and Monounsaturated fats.

    To test the theory, at the end of my second week, I changed my fat to be ~50% saturated fat. Within a day the rash started to appear. As soon as I saw it, I switched back to lower levels of saturated fat and it receded within a day. I don’t think that everyone who gets the keto rash has an FTO gene polymorphism, but I’m hoping that this will help others to investigate why their bodies may react to Keto in a negative way.

    Additional information is that people who have gene polymorphisms with the PPAR gene also have issues with a high fat diet. I do not have a gene polymorphism with PPAR so I am not as versed on the issue.

  8. I have keto rash going on for 3. weeks it comes and goes… But I’ve lost 7 lbs in two weeks. I got my menstruation back after almost 2 years without it. Im 54 and thought I was in premenopause. I must have alot of inflammation. I wont give up… Ill just do more carbs and see what happens.

  9. I have a history of psoriasis flare ups and I think of it as my body detoxing through my skin. The keto rash reminds me of my psoriasis, very similar. I have read somewhere that toxins are stored in your fat cells – when we start burning our stored fat we are also releasing (this is a good thing) the stored toxins also – some do so through their skin. My advice for relief from the psoriasis / rash: arnica cream / aloe vera / coconut oil / frankincense essential oil / helichrysum essential oil – a combo of the above topically – the most useful I find is the arnica and the helichrysum specifically – usually if caught early enough the rash subsides within a few days. Taking activated charcoal internally also would help as it sops up toxins in your gut. Good Luck! I did keto in the past and was very effective at losing weight and just starting again now after a few years break.

  10. IMO, it isn’t the diet, it is the way your body processes the fat. Remember our fat cells are storage units in our body, and these fat cells don’t just store fat, but any environmental chemicals as well. And on this diet when you start using your fat stores all those chemicals or free radicals are not loose in your body and for some, like myself we have an allergic reaction to these chemicals. For others it is the acetone that is created and escapes the body in sweat that can cause the rash. Stopping Keto can help, but then again you are reverting back to the toxic combination of sugar/carbs and fat, which is why most people end up with so many diseases and chronic cardio problems.
    Give the diet time, for some it is a matter of weeks, for others it is a matter of months, even a year. Your body will adjust, just like it did when you were on the SAD (Standard American Diet). Make sure you are eating plenty of veggies, a wide variety, and your supplements. Taking bile salts (ox bile) will help with your liver and gallbladder with the processing of the fats in your system.

  11. i am not happy that they didnt warn us about this rash its terrible and itchy. I have it on my neck and face, unbearable. I dnt want to stop keto but i might coz of this rash. Thank u sybil will definately get the cream you suggested.

  12. Did anyone experience Keto rash pretty late into their Ketosis journey? I’m at ten months and have an unexplained full body rash that presents just like this explanation of Keto rash. Just strange that it showed up 10 months in. I have significantly increased protein…

    1. Hi Carrie, this could be a result of you releasing some stored toxins from your fat cells but it could also be a result of a reaction to certain foods like dairy.

  13. Thank God I’m not alone!

    For me I know it’s not keto, per say. I’ve been in keto a very long time, and in very deep states, and nothing like this has happened to me before.

    I’ve got my rash-ish problem the day after my 5 DAY WATER FAST, right after I broke it: collagen peptides in a homemade vegetable broth (broccoli, carrots, cauliflower, asparagus, turnip). It’s the longest I ever went on water only.

    A lot of people get this after long water fasts but never just from their ketosis.

    Location: It started on the sides of the chin-mouth, spread over the chin next day, and now going up following the smile lines in a triangle, all the way to the edges of the nose.

    My skin problem looks similar to a regular pruritus rash, though itch is not the main sensation but pain and very high inflammation.

    It’s also bumpy on the chin & sides of the nose (some cycst-like and some tiny pus filled ones.) That might explain the pain.

    What I do:
    -I have noticed that I get more inflamed if I have tomatoes, or kiwis, or lemons (not orange).
    -I tried carbing up but it is still spreading.
    -Cold water splashes are soothing.
    – buro-sol (aluminum acetate & benzethonium chloride) compresses help. It comes in envelopes to mix with water & apply.

    (pics available)

  14. I’ve had a rash on my stomach for a couple of weeks and had no idea it was because of keto until now! I’ve been treating it with tea tree antiseptic ointment and clove essential oil for the past five days and it has improved. It’s almost gone except for the initial small rash I had before it spread. Now that I know what it is, I’m not sure if it’s the essential oils or time or both that caused the healing but it seemed to improve after using tea tree for a couple of days

  15. Some have mentioned a combo of Black Seed Oil applied topically to the rash and taking bile salt supplements can stop the keto rash!

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