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Keto Rash: Causes, Symptoms, Treatment, and Prevention


There are many reasons people choose to go on the keto diet. Whether it’s weight loss, reducing inflammation, or improving overall brain health, research shows that keto can help many individuals. However, certain side effects can come with a change in your diet. One unusual sign that can appear is a skin rash called keto rash.

What is Keto Rash?

Keto rash is an inflammatory, uncomfortable skin condition that can appear in people who have just started following the keto diet. According to the American Academy of Dermatology, it’s also called “prurigo pigmentosa” and occurs mostly in young adult women (*).

This rash triggers red, raised papules across the upper shoulders, back, and abdomen. There are similar characteristics between keto rash and other skin conditions (such as eczema), but the keto rash is distinctive in its network-like pattern of spots.

The keto diet rash is rare, and researchers have not yet fully understood its causes. It is, however, associated with being in a state of ketosis, wherein the body burns fat for energy instead of using carbohydrates.

Uncontrolled diabetes and anorexia nervosa may also be associated with the keto rash — although keep in mind that the keto diet in and of itself does not cause diabetes and anorexia nervosa, and may even help address them.

Furthermore, keto rashes may be triggered by certain factors, such as friction from one’s clothing and sunlight, among others (*). Some people are also more likely to develop the rash than others, particularly people of Asian descent (*).

Keto Rash Symptoms

There are several distinct symptoms that characterize keto rashes. These include the following:

  • The appearance of red raised papules on the skin
  • Common areas affected include the chest, upper back, and neck
  • The rashes appear symmetrical and web-like
  • Feeling of itchiness
  • Over time, the rash leaves a brownish discoloration of the skin after the inflammation has resolved

What Does Keto Rash Look Like?

Keto rash appears as red and raised papules that affect the neck, upper chest, and back areas. Here are some keto rash pictures:

Keto Rash:
Image source: NCBI

Causes of Keto Rash

The exact cause of the keto rash is unknown, although a link has been found between ketosis and the condition (*). However, several potential triggers can lead to the rash in individuals following the keto diet:

  • Drastically reducing your carb intake. Reducing carb intake can lead to weight loss, which is a welcome side-effect of the ketogenic diet. However, doing it too quickly may lead to the development of the keto diet rash (*).
  • Excessive fasting. When blood sugar levels are low due to fasting, ketosis can start. However, this can also contribute to the development of the keto rash. Case in point, 8 out of 16 participants in a study who fasted developed prurigo pigmentosa (*).
  • Ketones. The keto diet involves entering a state of ketosis, during which the body uses fat for energy instead of carbohydrates. During ketosis, the body produces ketones that may cause inflammation around blood vessels, resulting in skin rashes (*).
  • Allergens. Consuming keto-friendly foods that contain allergens may trigger keto rashes. Examples of these allergens include eggs (both egg yolks and egg whites), dairy (due to milk proteins), and seafood (e.g. shellfish and scaly fish).
  • Skin irritants. Some external skin irritants, such as chlorinated pool water, friction from clothing, and sunlight may trigger the keto rash.

Keto Rash Treatment

Keto rash can be uncomfortable and frustrating to have. Fortunately, there are several ways to treat the condition:

  • Wait for the keto rash to subside. In some cases, a keto rash may be resolved on its own by simply waiting for the symptoms to subside. While the rash may disappear on its own, it is important to consider other treatment options (by first paying a visit to the doctor) if it persists after a week or two.
  • Reduce your intake of foods that trigger inflammation. Keto-friendly foods are good for you; however, you still need to be careful of certain foods that contain allergens, which lead to inflammation. Minimize your intake of known allergens, such as milk (both dairy and nut milk), eggs, fish, and scaly fish (*). There is no need to eliminate them unless you already have the keto rash.
  • Consume enough nutrients. Nutrient deficiencies can greatly affect your skin health. When starting the keto diet, it is crucial to ensure that you are consuming enough essential nutrients. Chronic skin conditions can occur more easily if the body is lacking in vital micronutrients, such as vitamins A, B-12, and C. Dietary modifications that address any nutritional deficiencies have been shown to prevent the recurrence of many skin conditions, including the keto rash (*).
  • Consider using supplements. If getting enough nutrient-dense keto foods is difficult, then taking multivitamins and other supplements may help. Many people on keto may need to supplement with nutrients such as vitamins, minerals, and electrolytes. Getting enough sodium, potassium, and magnesium, for example, can sustain multiple vital metabolic functions.
  • Consider adding back carbs. Unfortunately, for some keto dieters, the keto rash persists and negatively affects their daily activities. If ketone production is the cause of the rash, then modifying your diet by increasing carbohydrate intake can be one way to counteract it (*). Going out of ketosis for a few days to see if the rash improves may be necessary in this case.
  • Follow skincare tips. This includes daily habits like washing your skin with mild and gentle soap, not scratching the area, and applying a moisturizer that helps relieve the discomfort.

How to Prevent Keto Rash

Developing keto rash is uncommon, but you can prevent it by starting the keto diet with some precautions:

  • When lowering carbohydrate intake as you start the keto diet, do it slowly and gradually. Avoid dropping your carb intake suddenly as this can cause unwanted side-effects such as the keto rash. Instead, try to slowly taper carbohydrates out of your diet.
  • Drink vitamins and supplements even before starting the keto diet. This will prevent the development of any nutrient deficiencies that may cause or exacerbate the keto rash.
  • Pay close attention to any rash signs. Increase your carbohydrate intake for a few days until the rash starts to subside.
  • Given that excessive fasting may potentially lead to keto rashes, it might be a good idea to start with a shorter fast (such as a 13-hour or 16-hour fast) and avoid long durations. Note for any skin reaction.

Frequently Asked Questions

Here are some commonly asked questions about the keto rash:

How long does keto rash last?

Keto rash can last up to two weeks. If you have developed red, itchy papules on your neck, chest, and back that have persisted for a few days to a week or more, then it’s time to seek treatment.

Does everyone get the keto rash?

Only some people get the keto rash, as it is pretty rare. Still, taking precautionary measures when starting the keto diet is the best approach for preventing keto rashes from occurring.

Is keto rash contagious?

No, a keto rash is not contagious, nor is it dangerous. The best way to treat it (besides waiting for symptoms to subside) is to ensure you get enough vitamins and minerals while avoiding common food allergies. If these methods don’t help, then upping your carb intake temporarily or talking to your physician about anti-inflammatory medications can help.

My keto rash isn’t going away. What should I do?

If the above tips on treatment and prevention don’t clear your keto rash, then it may be time to talk to your physician. Some medications, such as antibiotics, may be effective at treating keto rash symptoms. However, do note that antibiotics should be the last resort as they come with side effects. This is also important to prevent antibiotic resistance.

What part of the body does the keto rash usually appear on?

The keto rash typically appears on various areas of the upper torso. You may notice red, itchy bumps on your neck, upper back, chest, and abdomen.

The Bottom Line

The keto rash may sound alarming, but remember that it is rare. As with any new diet, it helps to take precautions and ease into keto slowly. Taking preventive measures can prepare your body to handle ketosis with minimal side effects.

Even if the rash does appear, following the above mentioned tips can help with relieving the condition until it completely disappears. The risk of developing a keto rash is low, so don’t let it discourage you from trying the keto diet, especially if it can help you lose excess weight and improve your metabolic health markers.

11 References

Warren R Prurigi Pigmmentosa As The “Keto Rash”: I’M A BELIEVER. 2020 February 5

Warren R Prurigi Pigmmentosa As The “Keto Rash”: I’M A BELIEVER. 2020 February 5

Asfandyar M et al. Clinical manifestations and treatment outcomes in prurigo pigmentosa (Nagashima disease): A systematic review of the literature. 2021 April 10

Anny X et al. Ketogenic Diet-induced Prurigo Pigmentosa (the “Keto Rash”): A Case Report and Literature Review. 2021 December

Felix A et al. Keto rash following carbohydrate restriction. 2022 May 4

Y J Oh et al. Prurigo pigmentosa: a clinicopathologic study of 16 cases. 2011 September 20

Mustafa A et al. Prurigo Pigmentosa After Bariatric Surgery. 2015

Food Allergies. 2023 November 01

Basavara K et al. Diet in Dermatology: Present Perspectives

Miki W et al. Treatment of Prurigo Pigmentosa with Diet Modification: A Medical Case Study. 2018 May


25 thoughts on “Keto Rash: Causes, Symptoms, Treatment, and Prevention

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

  3. 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.

  4. 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 ????????

  5. 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.

  6. 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

  7. @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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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)

  15. 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

  16. 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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