What You Need to Know about the Keto Rash

If you’re thinking of starting the Keto diet you’ve most likely done some research into what it entails and the potential downsides of Keto.  If so, you’ve probably come across mention of Keto rash.  The following article will help you to fully understand what the Keto rash is and what can be done about it so that you feel comfortable making the switch to a Ketogenic diet.

What is the Keto rash?

The scientific name for the Keto rash is prurigo pigmentosa and it was discovered back in 1971.  The first case of the Keto rash was in Japan and very little research has been done in North America.  However, with the rising popularity of Keto, scientists are beginning to take a closer look at this rash that seems to be tied into the beginning phase of Keto.

Documented cases of the Keto rash appear to be in people who are in their first month of making the switch to an ultra-low carb diet.  The rash is itchy, bumpy and it can be red, brown or pink. The rash can last anywhere from a few weeks to a few months depending on the person and the circumstances surrounding the rash.  This is similar to how the symptoms of the Keto flu can vary from person to person.

Not everyone who begins Keto will develop the rash.  It’s unknown at this point what percentage of people new to Keto will develop it.  However, there seems to be a good chance of you avoiding this uncomfortable rash, especially if you follow the advice listed below. The good news is, even if you do develop the rash it’s not considered dangerous in any way, it’s more of a nuisance than anything. 

If it does develop it will most likely be seen on the upper body, specifically the neck, back and torso and chest.  It can appear on the shoulders and arms and occasionally it’s been seen on the face.  The rash has been compared to eczema and dermatitis in terms of appearance.  It’s always a symmetrical pattern on the body.

The four stages of the Keto rash

There are four main stages to the Keto rash.  In the first stage you might not even realise that you have a rash at all.  It might appear as benign as little pink scratch like marks on the skin. 

After this the second stage appears where the light pink rash turns into full blow lesions on the skin.  Despite the nasty term, the lesions aren’t dangerous.  They’re likely to be raised red bumps that are filled with either liquid or pus.

After this comes the third stage where the rash is beginning to heal, and the lesions start to recede.  At this point the skin may feel crusty and scabbed over depending on how severe the lesions were in the second stage.  The lesions should have lost their bright red color and darkened to a more subdued, less visible brown shade.

The final stage of the rash is when the rash is healed.  At this point the lesions should be gone and the skin will return to its smooth state.  However, there might still be evidence of that rash for a few more months in the form of little brown dots slightly larger than a freckle.  

How long each of these stages lasts is determined by the individual who has the rash along with their methods for treating it.  Unfortunately, there is no one-size fits all answer to the timeline of the Keto rash.  As mentioned above, there’s a good chance that you won’t even develop it at all. 

What causes a Keto rash?

There definitely seems to be a connection between the Keto rash and the beginning stages of ketosis; however, scientists have yet to determine a concrete cause. The best that can be determined with the information that is available today is that there are some possible links and triggers for the rash.

The first of these is the presence of ketones in the body.  Ketones are an important part of ketosis and if you’re following the Keto diet correctly your body is going to have ketones.  The presence of ketones can lead to your body producing acetone which has been known to trigger inflammation around the blood vessels of some people.  This doesn’t happen with everyone and it’s a difficult thing to prevent. 

Another possible cause is that you might have a nutrient deficiency.  If you’ve cut out some essential nutrients due to the restrictions of your Keto diet and you haven’t replaced them with Keto-friendly alternatives, then you might develop the rash.

You might also want to take a look at your diet and see if the rash isn’t triggered by foods that you’ve added in to support your Keto.  If you’re allergic to any of the new foods, then this could cause a skin rash as well. 

Having prior health conditions might be a factor as well in developing the rash.  If you have Still’s disease, Sjögren’s syndrome or an H. pylori infection then you should speak with your doctor before beginning Keto.  They’ll be able to advise you on how best to avoid getting a rash.

What can you do to treat a Keto rash?

Keto rash is uncomfortable and itchy, and it might cause you a little bit of embarrassment if you develop one.  However, it’s not dangerous to your health.  If you’re worried about the look of the rash or you’re being driven nuts by the itching, then there are a few things that you can do to relieve the symptoms.

If you feel as though the rash is a side effect of your Keto diet then you might want to consider re-introducing carbohydrates.  A study that was completed in 2018 noted that the re-introduction of carbs made significant improvements in the symptoms of the patients experiencing Keto rash.  You should speak with a doctor before taking this step because re-introducing carbs might cause more problems that it solves if your body has begun to get used to using ketones as energy. 

Make sure that you treat any nutritional deficiency that may have been caused by your switch to Keto.  Pay special attention to the vitamins A, B-12 and C since a deficiency of these important nutrients can lead to skin problems.  An easy way to get enough of these vitamins is by eating a diet rich in leafy greens and including a variety of colors of fruits and veggies with your meals.

The Keto diet is high in eggs, fish, nuts and seeds.  These just happen to be some of the most common foods that people can develop an allergy to (besides carbohydrates which the Keto diet eliminates).  It makes sense that you should look for intolerances to the new foods you’re eating in order to reduce any inflammation in the body that could be contributing to the rash. 

If your diet is working well and you don’t need to make any changes but you’re still battling with a rash you might want to add some anti-inflammatory foods or supplements into your diet.  Probiotics, prebiotics, fish oil and Vitamin D are all great anti-inflammatories that might help reduce any irritation caused by the rash.

Be sure to stay out of the sun, avoid hot water and try not to sweat.  These are all things that can aggravate any type of skin irritation and they can make the Keto rash worse.  Take care of your skin by keeping it moisturized and protected from harsh conditions as well as using only gentle soaps.  This will help soothe your skin and the rash that’s on it.

What can you do to prevent a Keto rash?

It’s difficult to prevent the Keto rash since nobody knows exactly what triggers it.  However, there are a few steps you can take to lower your risk.  For starters, if you’re thinking about beginning Keto you should try to do it slowly rather than jumping in with body feet.  This will allow your body to get used to the lower levels of carbohydrates and it might stop it from going into shock.

You should also consider taking a multivitamin or some supplements when beginning Keto to ensure that you’re not missing out on any essential nutrients.  It might take you a little while to figure out exactly which Keto foods you can eat in order to get all of the nutrition that you used to get through carbohydrate rich foods.  A multi vitamin can help you cover your bases while you get accustomed to your new diet.

You should always talk with your doctor if you have any health concerns.  It’s important to speak with your doctor before you make any major dietary changes.  They can help you lower your risk of negative side-effects from the switch to Keto.  When you keep them informed as to what changes you’re making it allows them to better know what potential problems to watch out for in the future.


Although it’s unknown as to what exactly triggers the Keto rash there’s a very good chance you won’t have to worry about it when you make the switch to Keto.  There are a few precautions that you can take to lower your risk of getting the rash and if you do get it there are easy steps that you can take to ease any discomfort while you wait for the rash to heal.

Leave a Comment