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-ers. It can definitely be annoying and somewhat embarrassing, but it’s not dangerous.

Rest assured that this rash is both preventable and treatable.

In this article, we’re going to explain what the keto rash is, why it happens, and how to get rid of it.

Keep reading and you’ll learn:

Keto Rash 101: Description and Symptoms

Keto rash is a rare inflammatory disease of unknown origin with a scary-sounding scientific name: prurigo pigmentosa. It can present 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.

A 2017 review that took into account 83 Korean and 53 Japanese patients found that 84.3% of the cases happened between 11 and 30 years of age and women were the most affected, with a female to male rate of 2.6.

In other words, the rash affects most commonly female teenagers and young adults.

The rash manifests as itchy, raised skin lesions that can be red, brown, or light pink in color depending on the stage it’s on. 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 your 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 rashes, the keto rash can worsen if you exercise strenuously or expose the rash to to heat, moisture, and friction.

What Does Keto Rash Look Like?

Research [*] shows the rash has 4 main stages:

  1. 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 temporal rash.
  2. 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).

keto rash

Source: Journal of the European Academy of Dermatology and Venereology

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

keto rash

Source: Journal of the European Academy of Dermatology and Venereology

  1. 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

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 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. We’ll teach you how to relieve and prevent keto rash later on in this guide.

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 a fewf  potential triggers related to the ketogenic diet that can make it appear:

    1. Ketones (e.g., 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 causes the rash.
    3. Low-carb diet. A low-carb diet, especially one that causes rapid weight-loss in a short amount of time, 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 manifests 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 go and reappear a few weeks later. This can happen mostly because of external triggers that exacerbate your rash.

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

  • 5 patients got the rash again after restarting their dietary modification (ketosis, fasting, low-carb, etc). This means you might, unluckily, experience the rash if you stay in ketosis for too long.
  • 5 patients developed the rash once more after mechanical irritation such as bandage, body-scrubbing or friction from clothing.
  • 3 patients regained it after sweating due to exercise or hot weather.
  • 2 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 Cure Keto Rash

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

However, you can try these 5 research-backed methods to 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 you’re body adjusts. The longer you’re in ketosis, the more your body adapts to the production of ketones.

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 3 potential triggers of the rash, so this is the first factor 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 might be 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 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

The fourth 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 certains foods, you want to test for allergies.

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

  • Dairy (eg. cottage cheese, full-fat yogurt). Here’s a handy guide on how to tell if you can eat dairy.
  • Eggs
  • Fish (eg. tuna, salmon)
  • Shellfish (eg. oysters, clams, crab)
  • Tree nuts (eg. macadamia, almonds)
  • Peanuts

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

  • Remove these foods from your diet for 30 days.
  • Check if your rash has diminished or disappeared after this time.
  • If it did, introduce just one of these foods again in your diet and wait 1-2 weeks.
  • If the rash hasn’t re-appeared or worsen, add a new food.
  • Continue to add one new food every 1-2 weeks if no symptoms appear.
  • If the rash resurfaces after introducing a new food, that’s your trigger.

4. Supplement Trace Elements

To rule out any 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. They need to be supplemented because they’re vital for cell function and energy.
  • Vitamins: vitamin D, vitamin A, Omega-3. These vitamins are necessary for regulating inflammation. Since the keto rash is an inflammatory response, they can’t be missing from your diet.
  • Bile Salts: cholic, deoxycholic, chenodeoxycholic, and lithocholic acids. Bile salts help the liver process large amounts of fat properly.

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 our Keto Supplement Guide.

  1. 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 medicaments that aren’t effective against the rash include antihistamines, topical steroids, and oral steroids.

Talk to your doctor about the potential risks and benefits of taking an antibiotic for your rash.

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 [*] 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 a fantastic 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 3 external factors that can make the rash come back are sweating, friction and emotional stress.

Adopt these simple habits to prevent a new rash:

1. 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 so as to minimize sweating.

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

Rubbing can significantly aggravate the rash as well [*], so it’s recommended to 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.

2. Avoid Anything That Causes Friction On Your Skin

Since friction also flares up rashes, avoid:

  • Wearing tight clothes, specially around the area where you have the rash.
  • Using any type of exfoliants in 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 are moisturized with a cream or an oil that your skin can take. Lubrication will help prevent friction.

3. Try Stress-Reducing Techniques

Emotional stress can make your skin flare up again, 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 your skin, and can worsen over 9 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[*].

keto rash

Can Keto Rash Be Prevented?

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 3 things you can do:

  1. Transition to 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.
  2. 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.
  3. Supplement. Start supplementing to avoid deficiencies since day 1 of 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 this: 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, know there are simple ways you can actively treat and prevent it from happening again,o don’t let it scare you away from reaching your goals and getting all the benefits of the ketogenic diet.


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Responses (18)

  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 🙁

  2. 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.

  3. This is my 2nd time got the rash.. this time it’s really itchy especially at face and neck area..

  4. 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?

  5. It is completely insane that after getting an aggressive rash all over your body that you would not stop this diet immediately. I was on a whole food plant based diet, have not been sick in years. Thought it would be cool to see what keto was like, vegan-style.

    Seven days in, the rash – which isn’t MENTIONED ANYWHERE ELSE on a MILLION keto pages, appears and it is the most horrible immune reaction of my entire life.

    There is NO WAY this is a healthy way to live if this is how the body responds. NO WAY.

    Whole food plant based is a proven thing. If you care more about being skinny than taking care of your health and immune system, this is just another form of eating disorder.

    Also – World Health Org now ranks processed meat at the same carcinogen level as asbestos, plutonium and nicotine. So maybe think twice before eating bacon like lunatics.

    I’ll do everything I can to get the word out that this is a dangerous fad diet with horrible health consequences.

  6. 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 👍🏾

  7. 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.

  8. 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

  9. @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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

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