Keto Rash – What Is It, Why You Get It, And How Can You Treat It?

by Ramona Sinha

The ketogenic diet is the most trending and one of the most Googled diets. If you are trying to burn fat, lose weight, and improve your overall well-being, this low-carb, high-fat diet can help you out. During the initial stages of this diet, your body might experience some side effects – including keto rash. In this article, you will find everything you need to know about keto rash and ways to deal with it. Keep scrolling.

What Is Keto Rash? What Causes It?


Drastic dietary changes often come with side effects, and the ketogenic diet is no exception. Keto rash or Prurigo Pigmentosa is a rare form of skin inflammation or dermatitis. It is itchy and uncomfortable and mostly develops on the upper part of your body.

This rash was first described in 1971 by Nagashima, and hence, it is also referred to as Nagashima’s disease.

Researchers are not sure what exactly causes keto rash. However, they observed that keto rash often accompanied the symptoms of ketosis, a metabolic process that occurs in your body when you are on a ketogenic diet (1).

Hence, to understand keto rash, we need to know about ketosis and what happens to your body when ketosis occurs.

The goal of the keto diet is to get your body into ketosis, a metabolic process.

Typically, your body cells burn glucose (from carbs) to derive energy. Your body is in ketosis when it does not have enough glucose to burn for energy. Since the ketogenic diet eliminates all forms of carbs, your body burns the stored fat instead of sugar to derive energy. As a result, your body also produces ketones, a type of acid.

The build-up of ketones in your blood causes ketosis. This condition may result in other conditions that could be life-threatening.

Ketosis is not only seen in people who follow a ketogenic diet but is also observed in people who have diabetes and low insulin levels. Extreme levels of ketosis may result in type 1 diabetes and a condition called ketoacidosis (when blood sugar and ketone levels are extremely high).

Apart from these conditions, ketosis may also cause keto rash. In a case study, a 43-year-old Chinese-American woman developed symptoms of keto rash three weeks after going on a ketogenic diet. The rash improved after a week and then relapsed and continued the same pattern (1).

In another case, a 16-year-old girl got pruritic rashes on her neck and trunk within a month of going on a strict diet for weight loss. Ketosis was one of the reasons for these rashes (2). A 17-year-old boy developed keto rash while he was following a ketogenic diet (3).

In addition to internal factors, a few external factors may also aggravate keto rashes. These include sweating, skin trauma, exposure to heat, and allergens. There are several symptoms of keto rash.

Keto Rash: Signs And Symptoms


The keto rash looks like raised, red bumps on the skin or appears as itchy papules. The most common site for keto rash is your upper body, and it mostly appears on the neck, back, and chest.

Keto rashes often go undiagnosed and are mostly misdiagnosed. This is because they resemble other skin conditions, such as contact dermatitis, papillomatosis, or look similar to drug reactions. When they heal, the rashes usually leave dark brown patches on your skin.

The treatment options for keto rash are debatable. This is because the actual reasons or causes of this skin reaction are still not known. However, there are a few ways that can help you treat them.

Treating Keto Rash: How To Alleviate The Symptoms


1. Give It Some Time

Often, your body needs time to adjust to the new metabolic process triggered by a keto diet. Though it might react initially, once it adapts to the new process, the symptoms may go away. Hence, do not panic. Wait for some time and let your body adjust to the new diet.

2. Start Consuming Carbohydrates

If you think that the keto diet has caused these rashes, try reintroducing carbohydrates in your diet. In two cases, researchers found that keto rashes improved after reintroducing carbs in the diet (1). If you do not want to give up the keto diet completely, try to have a low-carb diet instead of eliminating carbohydrates altogether.

3. Increase Nutrient Intake

When on a strict diet, you may miss out on vital nutrients that may trigger adverse reactions. Try to maintain a proper intake of essential nutrients. Deficiency of nutrients, such as vitamins A, B12, and C, often causes skin issues. Eat more fruits and vegetables.

4. Follow An Elimination Diet

Some keto-friendly foods may cause allergic reactions. If you are new to the keto diet and have introduced new foods or have huge quantities of a few foods, go for an allergy test. Eliminate these foods from your diet and see if the rashes heal. Some keto-friendly foods that may cause allergic reactions are:

  • Peanuts
  • Dairy (cheese, yogurt, etc.)
  • Eggs
  • Fish
  • Shellfish
  • Tree nuts

5. Take Anti-Inflammatory Supplements

Anti-inflammatory supplements help your body fight inflammation as well as prevent it. Vitamin D, fish oil, prebiotic, and probiotic supplements help improve inflammatory skin conditions (4).

If all these at-home measures fail…

6. Talk To Your Doctor

If all the above methods fail to produce any positive results, it is high time that you visit a doctor. The doctor may prescribe antibiotics, such as doxycycline, minocycline, tetracycline, and dapsone. These medicines are effective in treating keto rashes (1). If you have diabetes, the doctor may also administer insulin to reduce the rashes.

Also, try to avoid any skin irritant that might aggravate keto rash. Here are a few tips you may follow:

  • Stay away from chemicals (in skin care products, soaps, detergents).
  • Avoid scratching the rashes.
  • Avoid wearing tight clothes that might rub against the rash.
  • Avoid using skin exfoliants.
  • Do not scrub your skin too hard.
  • Avoid sleeping on the rash area.
  • Avoid excessive heat and sweating.

If you are new to the keto diet or are planning to start this diet, you might wonder whether you can prevent keto rash or not. Let’s find out.

Is It Possible To Prevent Keto Rash?

As already mentioned, if you are on a keto diet, the rashes will go away and come back and continue following this pattern. This condition will relapse despite taking medicines and preventive measures (5).

It is unclear if keto rash can be prevented altogether. However, you may avoid some possible triggers by following these tips:

1. Go Slow

Do not just give up your carb consumption suddenly. Take it slow. Let your body adjust to the low amount of carbs before you eliminate them and enter ketosis.

2. Address The First Signs Of Rashes

Increase the intake of carbohydrates the moment you see rashes appearing on the upper part of your body. Don’t let them aggravate. Once they are gone, you can lower the carb intake.

3. Address Any Nutrient Deficiency

While on a keto diet, make sure that your body is not lacking any vital nutrients. Start taking vitamin supplements after consulting your doctor.

If you follow these steps during the initial weeks of starting a keto diet, your body will be prepared to deal with the increased levels of ketones during the later part of your diet. This will lower the chances of any negative effects and rashes.


Keto rash can be a nuisance for keto dieters. Since the root cause of keto rash is unknown, it is impossible to get rid of it. All you can do is make it go away for a while. Though the ketogenic diet may be beneficial, you cannot deny its adverse effects. Hence, it is crucial to follow this diet under the supervision of a nutritionist and dietitian.

5 sources

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Ramona Sinha

Ramona is a journalist-turned-content writer. She holds a Master’s degree in English Literature and has been writing for the digital world for over five years. She specializes in writing for Skin Care. She has done a certificate course titled ‘Dermatology: Trip To The Skin’, offered by Novosibirsk State University. She believes that beauty begins with a good skin care regimen and is on a mission to eliminate all toxins from her routine. She helps and guides readers in selecting products and ingredients specific to their skin type/issue. When Ramona is not working, her books and passion for music, good food, and traveling keep her busy.