Prurigo Pigmentosa – The Ketosis Rash Nobody Warned Me About

Prurigo Pigmentosa 1In early December, about a week and a half into my nutritional ketosis experiment I started to develop a rash on my body.  It began in my abdomen, near my collar bones, and my lower back.  It was only slightly itchy (I’ve attached a few pictures that I took from that time showing what it looked like as it was beginning).

Over time it gradually spread to cover much of my trunk (unfortunately I didn’t take pictures of this), but it looked like this.

I thought it might’ve been related to a viral infection or something (even though I never felt sick), because I know that
sometimes certain virus’ can give you rashes (the general term  for this is a ‘viral examthem‘).

When it didn’t go away after two weeks, I figured I should get myself checked out by a dermatologist.  He diagnosed me with a skin condition called ‘pityriasis rosea.’  This is a condition that presents with a rash that only covers the trunk (exactly like mine), but the cause is unknown.  No treatment is really needed, and it is supposed to go away by itself in 5-8 weeks.

Prurigo Pigmentosa 3One of the questions the dermatologist asked me was whether there was any thing new in my life.  I mentioned that I’d been trying a ketogenic diet and have been in ketosis for the past few weeks.  When I asked if there could be a connection, he emphatically said, “No.  There is no relationship between your diet and this rash.”

Since he was so confident, I took what he said at face value and continued to chug along hoping for the rash to disappear.  By the time week 5 rolled around the rash had waxed and waned a bit, but never really went away.  About 8 weeks later it almost completely went away.  I was pretty relieved at this point.

Prurigo Pigmentosa 2Unfortunately about a week later it came back with a vengeance.

The week when the rash started getting better and almost went away was when I was staying in NYC and started cheating there, eating a bunch of carbs (hard to resist NY cheesecake), causing me to fall out of ketosis.  Then when I came back home and dug back into my n=1 nutritional ketosis experiment getting my blood ketones back up, that’s when the rash reappeared!

So I did what any rational person would.  I turned to google and found few interesting links.  This was the message thread that gave me my ‘Aha!” moment.  The picture that was posted was almost identical to mine!

Turns out there is a skin condition that presents with the same rash that I had AND it can be brought on by ketosis!  It’s called pruritis pigmentosa.

I had to prove this to myself, so I did what any diligent n=1 experimenter would do:  I ate more carbs.  The following morning, that rash got better.  I ate more carbs.  The rash got even better.  This pattern continued for a few days until the rash had almost completely disappeared… and my ketones went waaaaaaay down.

Since there isn’t really much written about this condition, I did a quick literature search on pubmed and will write brief summaries on the relevant papers:

Here is some general background:

Prurigo Pigmentosa (PP)

  • The rash is usually symmetric and predominantly located on the trunk involving the back, chest, and neck.
  • The cause of this is still unknown however there are many suspected causes:
  • Most of the research has been focused on exploring the relationship between diet / ketosis and the rash
  • It usually starts off as a red raised rash and over time as it goes away it turns darker in color.
  • The rash can last from anywhere from months to years.
  • The best treatment for the rash thus far appears to be with antibiotics such as minocycline, dapsone, or doxycycline.  Treatment usually lasts around 2.5 weeks.
  • This most recent study from 2012 found that 7 of 22 patients with PP tested for urinary ketones had elevated ketone levels.
    • “The mechanism by which dietary modifications provoke PP is not yet clear, but there are several previous reports of an association between ketosis and inflammation.”
  • Another study from 2012 found that 6 of 21 patients with PP had showed recent weight loss due to strict dieting.
  • This study from 2012, perhaps one of the most interesting found that 6 out of 10 patients with
    J Eur Acad Dermatol Venereol. 2012 Sep;26(9):1149-53Oh YJ, Lee MH.

    J Eur Acad Dermatol Venereol. 2012 Sep;26(9):1149-53
    Oh YJ, Lee MH.

    PP who had their urine tested had elevated ketones in their urine, and 2 out of 4 patients who had their blood ketones tested had elevated blood ketones (3.2 mmol/L and 1.65 mmol/L, well within the range for nutritional ketosis).  Most of these patients were ketotic due to dieting and/or fasting.

    • “Our findings also support the argument that ketosis produced by fasting or dieting may play a role in the pathogenesis of prurigo pigmentosa. Therefore, physicians need to warn that excessive fasting can cause prurigo pigmentosa.”
  • This study found that menstruation made symptoms worse for 1 of 11 patients.
  • Here is a case report of a ‘fatty young man’ who developed soft-drink ketosis (a type of noninsulin dependent diabetes and ketosis induced by too many soft drinks) and then had PP. The PP went away after he cut out the soft drinks.  I like the fact that they described him as a ‘fatty young man.’
  • Another case report of someone with type 1 diabetes and ketosis who developed PP.  5 days after the ketosis was treated with insulin the rash went away (this seems to be the pattern typically found in the early literature)
  • This study from 1996 found that 8 of 10 patients with PP were in ketosis (due to dieting, loss of appetite, or diabetes).  The rash cleared when ketosis diminished.  In one patient the rash came back when he fell back into ketosis.

It’s interesting that despite the association found with ketosis, no clear explanation exists as to why.  Why do ketones cause this rash?  Is it because of the ketones themselves?  Or because of some other factor that occur with the changes in metabolism seen with ketosis?

It seems like the answer to these questions is fairly far off.  In the mean time, at least there are some effective treatments.


My Recommendation Based On My Own Experience and Research

I felt it was important to gather all this information in one place in case anyone else out there doing a very low carb or ketogenic diet has the same rash.  I don’t want anyone else to be misdiagnosed, especially since there isn’t any lay literature out there, and many doctors don’t really know about this (as in my case).

If you’re in ketosis, the best way to treat this rash is simply to eat more carbs!  It’s simple and cheap and it worked with me and many of the other individuals in the scientific literature, and hopefully it will work for you.  If that doesn’t work, you can consider having your doctor try some of the medications listed above.  Feel free to send them to this post since I tried to provide easy links to the source papers.


I wrote a followup article I wrote with a photo journal.  If you want to read any of my other thoughts on the keto rash and any new posts I wrote you can check them out here.

UPDATE 9/15/2014:

Just launched which is where I will continue to post the most up to date research on this topic.  I want to make it the most comprehensive resource available on the keto rash.  I’ve also setup forums and a facebook group for people to discuss their own experiences.  Head on over to check it out.

226 Responses to Prurigo Pigmentosa – The Ketosis Rash Nobody Warned Me About

  1. […] nutritional ketosis called Prurigo Pigmentosa and thought it might help some of the folks here. Prurigo Pigmentosa – The Ketosis Rash Nobody Warned Me About – The BJJ Caveman It took me a while to figure out what was going on, and since I know some folks here are also […]

  2. Dale says:

    Thanks for that heads-up on the rash. Luckily that’s one malady I’ve been able to avoid (so far). I do get a wintertime (low humidity) rash which I “treat” with a cool mist humidifier, but that presents not only on the trunk, but also on the ankles (places where there’s not much body hair).

  3. Cmans says:

    Is it possible that the ketogenic diet was producing a herxheimer effect and your skin reflected the expelling of stored toxins which were being released in the process? Personally, I would have handled it differently . Derms rank on the low end imho. I’ve been in ketosis since early February and definitely experienced herx/detox but endured, stayed in deep ketosis and have never felt better in my life.

  4. Doctor Timothe says:

    I am a surgical ER Doctor thats been following you for a while, but I am no Dermotologist. I have been in ketosis for almost 2 years, and i maintain High cardio exercise, and have never had such a problem, nor hear of it.

    You didnt post many pictures, so i cant really diagnose, or guess to much. But let me take a few swings, I know you do Martial arts and you use a Gi ( is it clean? how often do you clean it? and partners you spar with may of has a rash you got from them?)

    Carbs may of been the treatment, But the question is why would flooding your self with sugars be the answer? I dont think it is, I think the inflamatory properties of the ketosis foods vrs the carb rich foods is the answer.

    Could you of been deffecent in any vitamins or minerals? you are eating a normal ketosis diet right? not VLCD ?

    • Doctor Timothe says:

      Would also like to add this my be directly related in some ways to overdosing with some Vitamins and minerals, specifically I mean heavy metal poisoning, Lead, Nickel, Copper, arsenic.

      You did not mention being sick or stomach cramps. Intestinal problems would likely be the first sign on those kinds of overdoses, But we are all human and are not thinking in such a manner and will pass it off.

      Now Heavy metals stay in the body for a long time, and you ate carbs and found relief. I theorize that, in ketosis you my of had concentrated abouts of Heavy metals, But with carbs your body’s water composition increased greatly, thus kinda diffusing the toxicity levels.

      In addition, you stopped eating carbs, body water concentration went down, rash came back with the increased concentration of metals. Then went away again, with carbs.

      The toxcity levels would stay till your body metabolized the metals, or excreeted, or due to biological halflife…

    • Dea says:

      I am a 46 y.o. female who started the keto diet about 2 1/2 weeks ago only taking in about 5% of my daily calories in carbs. I noticed bumps on my chest about three days in, ironically after reading about the keto rash through Diet Doctor. I noticed my back started to itch and sure enough I had red bumps on my back as well. The symptoms weren’t horrible or that annoying until yesterday when I notice the bumps had increased, itching increased and now I have them all the way down my legs. TMI I just started my menstral cycle and I believe that is why. Just self diagnosing from the studies posted above. I have not changed laundry detergent or any other soaps or lotions. Pretty sure I have the keto rash.

  5. Kristin says:

    Thank you for sharing your findings! I have exactly the same kind of rash. Was on the LCHF diet last year but quit because of the itching rashes on my chest.
    Now i’ve tried intermittent fasting for a month – perfect for my body and mind, but terror for the skin…
    But I think I’ll endure till I hit my goal weight, or can it become permanent if I keep on going you think?

    • BJJ Caveman says:

      According to all the papers I’ve read the only potential permanent consequence is hyper pigmentation where the rash is. Dermatologists have a term called “Post inflammatory hyperpigmentation” which means your skin gets darker in the location where there is an inflammatory process.

      An example is a pimple, which is an inflammatory process, that can sometimes leave a dark spot after it goes away. Over time it can lighten up but sometimes it doesn’t.

      I think this is what CAN happen with prurigo pigmentosa as reported in the literature.

      While in my case I don’t have any left over dark spots, I suspect that if it went on too long that it can increase the chance of those dark spots occurring.

      If I were you I’d probably experiment with it a bit. Up your carbs for a week and see if the rash stops itching and goes away. If it stops itching but leaves dark spots, then it’s probably better to take a break from ketosis to let your skin recover, and then experiment with ketosis again once your skin recovers.

      Hope this helps! Keep us updated on what happens! There really aren’t that many reported cases so the more we know the better it is for everyone else in the community.

  6. Noelle says:

    Oh man, thank YOU for this well-thought-out and researched post, and for putting a name on this problem. I’ve been doing low carb since March this year and have gotten this rash on my chest off and on since I started. I did Atkins way back in the mid-2000s and I had the rash real bad back then, which I remembered as soon as it popped up again while doing low carb now.

    I had thought when doing Atkins it was Splenda (or the maltodextrin they mix in there) because many in the low carb community report Splenda giving them rashes, so this time when it happened again I switched to liquid sucralose to rule out the maltodextrin in the Splenda. Still the spots appeared. Then I tried a period of NO sucralose whatsoever (but they still appeared randomly) and a period of LOTS of sucralose (and again, just random appearance). There didn’t seem to be any correlation. I’ve kept track of what I’ve been eating and had theories about allergies to random foods I’ve been having like almonds and blueberries, but after more experimentation there didn’t seem to be a correlation between any foods I’m eating and the rash.

    But after some googling around and reading others’ experiences with this low carb rash and especially your post, I’m fairly confident it has nothing to do with food. My diet isn’t very different now than before I was doing low carb except less carbs, obviously. But I ate almost the same kinds of foods before as now, and the only two times in my life I have experienced this same localized rash on my chest is while doing low carb diets.

    I also think it must be related to ketosis specifically because back when I was doing Atkins, I was in ketosis almost all the time, and I had the rash almost all the time. (Part of the reason I gave the diet up.) Now, I’ve been low carbing since March, and it’s just popped up randomly for a few days at a time here and there over the past 4 months. I think it’s because I am not aiming for ketosis with my current eating habits. My goal is just 100 carbs per day or less. I know there are many days where I am near or at that level (far above ketosis) and then there are days where I am much below that and I’ve inadvertently hit ketosis.

    The rash came on again last night, and this seems to correlate with my eating habits again. On the 4th of July I indulged in all the usual carby holiday goodies, using it as a cheat day, and since then I’ve gone down to very strict low carb eating in order to get myself back on track. I haven’t been tracking my carbs very closely but knowing what I’ve eaten (lots of salads, low-carb vegetables, meat), I find it very likely I put myself in ketosis again. I’ll have to up my carb intake and see how it affects the rash. I feel like I can do some more helpful experimentation with my diet now that I have a better theory to work with.

    Obviously my story is anecdotal, but I spent hours googling this and reading various forum threads and it seems to be a very common side effect for many people doing low carb. The research you’ve cited seems to back that up. (Also the study showing that menstruation made it worse for one patient is interesting; my rash showed up again yesterday, and I also started my period yesterday. I will have to keep note going forward of any relation to my period and the rash. I would point out though that it seems that my weight loss in general affects my period a lot, causing it to start early and go for longer while I am losing weight. I have heard it has something to do with fat cells releasing estrogen into the body though I haven’t done any real research into that. But if so, it might be the ketosis that ended up causing both my period and the rash to happen on the same day, rather than my period affecting the rash directly.)

    As a side note I do get that pigmentation afterwards, some of which fades (very slowly), but not all of it. I think I must be lucky though because although my rash is irritating, it only happens in a small 2-3 inch square area on my chest.

  7. John says:

    I also developed this skin rash after going into ketosis. After a couple of misdiagnoses I now even have a histopathology report that would support the diagnosis of prurigo pigmentosa (though no dermatologist I spoke with was aware of the association with ketosis). I did not look into the diagnosis until now, because it went away with sun exposure quite rapidly leaving behind hyperpigmented areas that are slowly fading away. I also had a low 25(OH)D level (Vitamin D) at that time. I have been sunbathing almost daily around solar noon ever since. My diet hasn’t changed. Has anyone had any luck with sun exposure? I would be very much interested in any ideas about the pathophysiology of the association between ketosis and prurigo pigmentosa.

    • BJJ Caveman says:

      Next time you see a dermatologist, feel free to print out my post… and the research articles that I’ve linked to. It’s not that common so I wouldn’t expect them to know about it. Mine didn’t know about it.

      None of the articles that I’ve examined going back to 1996 ever looked at association with sun exposure… so the jury is still out on that. All of the articles that discuss treatment only mention that it improved with antibiotic use or with re-introduction of carbohydrates into the diet.

      Regarding the pathophysiology you’ve given me cause to think…. and I’ll write a post on my thoughts.

    • BJJ Caveman says:

      I also tried using sun exposure and even though I got tanned, the rash didn’t go away.

    • kevin says:

      Hey John, I also have what i believe is keto rash on my shin. I also noticed that sun exposure does help reduce inflammation. Your not alone on that one. I found beer makes it worse. especially large brew (molson kokanee etc) which could be the extra sugar added to sweeten large company beers. If you ever do drink, try a microbrewery that uses natural fermentation and carbonation techniques. You’ll find that its got less sugar. not that In recommend drinking on this diet

  8. […] because the current medically recommended treatment is to use antibiotics, as I discussed in my prior post (my own feeling is still to try adding carbs back, and only turning to antibiotics if carbs […]

  9. Boris says:

    Also have the rash while in ketosis. Some things that I observed:

    1. Only comes when I get strong ketosis. For me that is usually triggered by high-intensity, prolonged exercise (e.g., 3 hour MTB ride). Once it is there, the only way that I found to get it go away is by lowering my ketosis by either stopping any exercise (e.g., for a week) or by eating carbs.

    2. When the rash is itching, one effective remedy that I found is to drink water. Sometimes I wake up in the middle of the night from itching, drink a glass of water, and the itching subsides almost immediately. Itching starts again if I don’t drink any water for a while (I normally drink about 2-3 liters a day). While upping water intake helps with itching, unfortunately it doesn’t seem to make the rash disappear (or maybe I just didn’t make myself drink enough).

    I find this last point the most promising. Could it somehow be related to kidney function? Maybe strong ketosis diminishes kidney’s ability to filter out toxins while drinking water helps with that?

    • BJJ Caveman says:

      I myself haven’t noticed anything with water intake. Perhaps other commenters can chime in on this?

      Regarding kidney function… who knows! Anything is possible at this point.

      • Ali says:

        Neither doctors nor dermatolists understand detox. Rashes are due to purging. The skin is the ‘third’ kdney. It is interesting you mentioned that drinking water stops the rash itching, Boris.

        It is no coincidence that Dr. Atkins advocated drinking plenty of water when on his diet. Being in ketosis allows the body to burn some of its own fat. In many people fat is a toxin storage facility. Carbs, sugars, chemicals, etc., all generate by-products – that have often in the Western diet been ingested in greater quantities than the body can process them.

        If there is not enough water available to flush the toxins through the kidneys, it will tend to come out through the skin. Enough water – usually 2-2.5 litres per day is required when in ketosis, for the body to process the extracted toxins. It needs to be plain, preferably spring or mineral water with nothing added. Juices and ‘sports’ drinks are full of sugar and do not properly hydrate the body.

        ‘Allergies’ can also suggest a need for more water. I have discovered in myself that drinking half a litre of water over 10 minutes or so can halt and gradually reverse an impending typical allergic reaction of swollen glands, blocked nose, prickly eyes, etc.

        • Ali says:

          P.S. Consuming carbs halts the detox process, which is why the rash went away. All it does is prolong the inevitable. Just persevere, drink enough water, stay in ketosis and the rash should clear up by itself when the body has finished its housekeeping.

          We just don’t realise how much garbage we consume in the Western diet. We are not bottomless garbage disposal systems. Fill it up faster than it can process the waste and something has to give. Our bodies are awesome toxin-processing machines, but they struggle to cope with the huge plethora of modern ‘foreign’ substances that are thrown at us every day. Our bodies often need more of certain elements to process them than we provide which is why deficiencies are so rampant now, too.

          • DEBORAH Barr Stevens says:

            Thank you Ali. Purging toxins from our system makes sense. I have been IF’ing for about 4 months now. The rash started about a month ago and I thought it might be yeast purging from my body, but it didn’t smell like yeast. And I have an inverted nipple that is prone to yeast build up that is actually clearing up. I realize now that I need to drink more water and persevere. Because I am very happy with the results of this way of eating on my body and my overall health. I will be sharing this information with my nutritionist.

        • Jasmine says:

          Ali, you’re awesome. Thank you so much for commenting and for inspiring me to get back into ketosis. Because of ketorash I would give in and opt for carbs. But you’re absolutely right that I’m only halting the detox process and prolonging the inevitable.

          Thank you, thank you, thank you!

  10. KetoRashGuy says:

    I’ve had the “keto rash” and this is what helped me:

    Doxycycline. It’s an antibiotic that also helps suppress inflammations (I’m guessing this is the key property we want).

    My story:
    After a couple months into keto and also intermittent fasting, I began to notice these god awful hive-like rashes on my body. Doctors weren’t helpful, and no wonder, there’s almost no research on this. The research material Mr. Bjjcaveman posted was pretty much the same thing I found online. After a lot of digging and cross-referencing the sources, I found a lot of their research suggested Doxycycline as a treatment. After that it was pretty gravy. I went to a doctor, showed them the 20 pages of research I had on this bullshit, told them to give me a prescription, and less than a week later, I was fine. You do get a little bit of “scarring” as the rashes go away, but it completely disappears after awhile, and I was able to continue keto dieting and losing weight. Note: I’m Asian. And as the research suggests it’s “not uncommon” among us slanties when ketones are present in our bloodstream.

    Hope this helps.

    • BJJ Caveman says:

      Thanks for commenting. It’s great to see confirmation that Doxycycline is an effective way to treat it.

      After you treated it with doxycycline, did the rash ever come back when you entered ketosis?

      This would go a long way in figuring out the cause because

      1. If the rash never came back after your doxycycline therapy then it would suggest that there was an infectious cause…. that was eradicated with doxycycline.

      2. If the rash still returned… then we’d be back at square one.

    • says:

      May I ask how long your treatment last?

    • Wenchypoo says:

      My doctor said it was chafing from not showering after exercise–SAY WHAT? Se said it was basically trapped fungus from sweat, so I did what immediately came to mind: fungus = bleach. I got a white washcloth out, drenched it in straight bleach, then proceeded to wipe down affected area. I then followed up with coconut oil to moisturize where the bleach was going to inevitably dry the skin out.

      It worked…for a time. The rash moved from inside a leg to an armpit–I don’t even have hair under there any more (menopause), so sweat ain’t the issue. I repeated my bleach-followed-by-coconut oil (has anti-fungal properties), and it, too is receding. My legt only took 3 treatments before it got back to normal–the armpit is taking more and longer.

      I don’t know where all this fungus is coming from–I bathe, I no longer have yeast, I never had any kind of foot fungus issues, and I have multiple food allergies for which I’m avoiding all the proper foods. I’ve been low-carbing for about a year, but serious keto and rapid weight loss only started happening about 3 months ago.

      Try the bleach/coconut oil treatment–the itching stops ON CONTACT, and the coconut oil is so soothing.

  11. Mika says:

    Have exactly the same rash, I get it a week after starting eating low carb (third time now). Suspecting it’s Candida die-off/herxheimer! Will lower the carbs even more, no dairy for a couple of weeks and see what happens.

  12. MK says:

    Thanks for this nice and thorough write up. I did Keto for the first time and started getting this rash. I got worried and went right to a clinic (on the weekend) and then later my doctor. Both had no clue what it was but said “No, I don’t think it is Shingles”. I figured it was triggered by stress (from Keto but mostly from other things in my life at that time). Honestly Acyclovir knocked it out really fast. When it would come up I could start taking Acyclovir and beat it back within a day or 2. But eventually (so long as I was still on the diet) It would just start to come back. I stopped being on the diet for about 6 months (no rash at all). I then went back on the diet for a very short time and in that short time I saw very slight signs of the rash which made me think it is Keto related. Went off diet for about 2 months and then went hard Keto diet. The rash came back heavily! I did a quick search for “Keto Rash” and “Atkins Rash” on google just yesterday and now i’m 99% sure it is Keto related (even though my friend/dad don’t have this problem at all) and life stress is not exactly playing a factor.

    • BJJ Caveman says:

      Looks like it was pretty reproducible in your case! What have you decided to do now? Are you just going to avoid going into ketosis because of the rash?

  13. Aisha says:

    Really useful article. Every time I enter ketosis, about 2 days later, a rash that looks very similar to PP appears on my face and always in the exact same spots.

    Its really frustrating because dieting ketosis is easy for me. I’ve tried a few things to prevent the rash, like anti inflammatory creams, but nothing ever works. I just end up with this ghastly rash. What do you think about the use of macrolide antibiotics in the treatment of PP? I seen some scientific papers that say it cures it.

    • BJJ Caveman says:

      Most of the articles I’ve come across that mention the use of antibiotics for treatment use either doxycycline, minocycline, or dapsone.

      So I’m not sure about the use of macrolide, but if you can forward me those articles, I’d love to take a look at them.

      I’m generally hesitant to use antibiotics given the potential side effects as well as alterations in gut flora that can arise. But if that were the only option then it’s something I would definitely explore.

      I’m not sure if there is any literature out there that explores what happens after the rash is treated by antibiotics in regards to recurrence.

      We know that in many people the rash can reproducibly come when they enter ketosis, and then spontaneously disappear when they consume carbs (as in my case).

      But what would happen if I entered ketosis, the PP rash came, and then I treated it with antibiotics, while being in ketosis the entire time? Would the rash come back? Would it be gone forever after the antibiotics no matter how ketotic I am?

      If one treatment with antibiotics could make the PP rash disappear forever then it seems like it would be worth it.

      • John says:

        The following suggets that it could disappear forever with antibiotics: “Both of our patients were successfully treated with minocycline 100 mg/day for 2 to 3 weeks with resolution of lesions and no recurrence to date (Length of follow up: Patient #1: 3 years, Patient #2: 10 months)”

        “The treatments of choice for prurigo pigmentosa are tetracyclines such as doxycycline and minocycline, as well as dapsone. The prognosis is excellent. ”

        Wouldn’t this also mean that PP is caused by some kind of bacteria?

        While researching what drug therapy seems to be most promising I came across the following article. I don’t have access to the fulltext though:
        Doxycycline – an emerging therapy for prurigo pigmentosa

        • BJJ Caveman says:

          Thanks for bringing those two articles to my attention. Here are my initial impressions of these:

          1. It is good that both patients in the first article had their symptoms and rash remit with the use of the antibiotics. The thing to note is that a cause for PP was not found in either patient. Neither patient was suspected of being in ketosis. In fact, the first patient had a normal blood sugar and no evidence of ketones. In regard to the second patient, they write: “Although Patient #2 was not tested, there were no clinical signs or symptoms to suspect abnormalities of serum glucose or ketones.”

          2. I was able to access the entire article for the second like you provided. It is a single case report about a 16 yo girl who had a 4 tear history of recurrent rash triggered by excessive sweating during exercise. After being treated with doxycycline, her rash resolved within a month and didn’t come back for the following 5 months (they don’t mention how far out they followed her).

          In both papers the rashes went away with antibiotics, which is great. The important thing to note is that none of these patients had prurigo pigmentosa as a result of being in ketosis! So, at least in my mind, I’m not quite ready to extrapolate similar conclusions with regard to ketotic patients.

          I’ve found a couple recent articles published in 2013 on prurigo pigmentosa. I plan on doing an updated post to include the findings from these most recent papers.

          In the mean time, if anyone out there has any experience with this rash, and has been treated with antibiotics, please let us know how things are going. Before treatment, did the rash predictably come back when you were in ketosis? Did the antibiotics remove the rash completely? Can you now be in ketosis completely rash free?

          • John says:

            I found just another article in German which states the following: In about half of the Prurigo Pigmentosa cases that were associated with Diabetes Mellitus or malnutrition (probably referring to the presence of ketones because of fasting or “dieting”) treatment with Minocyclin was successfull.
            The authors give a couple for references for that statement:
            17. Kobayashi T, Kawada A, Hiruma M, Ishibashi A,
            Aoki A (1996) Prurigo pigmentosa, ketonemia
            and diabetes mellitus. Dermatology 192:78–80
            18. Murao K, Urano Y, Uchida N, Arase S (1996)
            Prurigo pigmentosa associated with ketosis.
            Br J Dermatol 134:379–381
            19. Kubota Y, Koga T, Nakayama J (1998) Bullous
            prurigo pigmentosa and diabetes.
            Eur J Dermatol 8:439–441
            20. Nakada T, Sueki H, Iijima M (1998) Prurigo
            pigmentosa (Nagashima) associated with
            anorexia nervosa. Clin Exp Dermatol 23:25–27
            21. Teraki Y, Teraki E, Kawashima M, Nagashima M,
            Shiohara T (1996) Ketosis is involved in the
            origin of prurigo pigmentosa.
            J Am Acad Dermatol 34:509–511
            22. Watanabe C, Sakuma M, Shaku F (1999)
            2 cases of prurigo pigmentosa. Hifu Rinsho
            41:1905–1909 (in Japanese)
            5. Amenomori M, Nishigaki I, Ogino K, Yamashita
            S, Baba M (1989) A case of prurigo pigmentosa
            in insulin dependent diabetes mellitus. Nihon
            Tounyoukaishi 3:547–551 (in Japanese)

          • BJJ Caveman says:

            Thanks! Ya, there appears to be a lot of success in the literature with the use of the tetracycline family of antibiotics, which include both doxycycline and minocycline.

  14. Adrian says:

    Hello ,
    I came across your article and I was relieved to finally get some answers. I suffer from a similar issue. I tried a low carb/high protein diet about 5 years ago and I was able to loose a considerable amount of weight (with no rashes or anything).

    When I tried the same diet 2 years later I couldn’t go through it as the rash appeared early on (1 week into it). The rash was all over my back and my chest (lower area and Belly and my neck). The rash was very itchy and it started on my back. I went to a dermatologist and they took some samples however they weren’t able to come up with anything conclusive other than classify the type of rash but they did not know its causes(useless). I tried topical creams but they did not do anything.

    The minute I re-introduced carbs back into my diet the issue went away but so did my diet.

    I gave it a few years and I tried to start the diet again… but my rashes are re-appearing .

    This time I tried not to eat any red meats and I’ve been sticking to mostly white (chicken). This made no difference.

    My diet today consists mostly of dairy (cheese(s), eggs), meat (mostly chicken), vegetables (tomatoes, salad) and even fruits (one a day – apple or prunes or pears).

    The percentages of the above are probably:
    30% – dairy (cheese – brie, feta, blue, sour cream, eggs)
    40% – meats (chicken mostly)
    25% – vegetables (tomatoes and salad)
    5% – fruits

    The solution may be to change the above percentages and doing something like:
    25% – dairy
    25% – meat
    40% – vegies
    10% – fruits

    Obviously it’s the high protein/ketones in the diet that are bringing this on so obviously changing the diet is pretty important since science is not helping here.

    I’m curious what others have already tried (aside from giving up the diet completely). This diet does work but I’m guessing that for select few (including myself) some side effects do occur I do not want to introduce additional sugars into the diet (as a lot of foods/fruits already contain sugars).

  15. Chris says:

    I had a similar rash (although not very extensive) break out on my stomach and lower rib cage the first few months I was in ketosis, and although I have now been in ketosis for almost a year and a half now, the rash hasn’t returned. I don’t know whether it just ran its course, or if the fact that I seriously upped my calorie intake to slow my weight loss helped. Or maybe something else.

    In other news, thanks for posting about all this – this is a fantastic and useful blog. I’ve been trying to figure out what to do about my own high LDL numbers (although my HDL and trigs look great!)

  16. […] As you know, the past couple of months have been a bit of a whirlwind. During this time I wasn’t trying too hard to eat low carb… unlike the militant way I was counting carbs during my initial n=1 experiment.  I know there were a some weeks when I was definitely eating very low carb and spent at least a few of those days in ketosis (I hadn’t been testing my blood ketones these past few months), and there were other days when my carb intake increased due to social situations as well as my desire to avoid the keto-rash: prurigo pigmentosa. […]

  17. MArtin says:

    My rash always seemed to get worse overnight to the extent that I suspected allergic reaction to the pillow. Now I understand this is due to ketones naturally increasing during the overnight fast. My take is that I include some low glycemic index carbs before sleep and some high GI carbs (spoon of sugar in the tea?) in the morning to prevent ketones increasing. Is there some non antibiotic and non sugar solution to this problem?

    Also any idea why some people develop PP while others do not? Would be great to fix the root cause to be anle to take benefit of ketosis when needed.

    • BJJ Caveman says:

      Please let us know how things turn out after trying to add some low glycemic carbs before you sleep. I suspect this may still throw you out of ketosis though.

      In regards to a non sugar and non antibiotic solution, there isn’t anything in the research literature to suggest a possible solution. One possibility… although this is very very dangerous, would be to use insulin directly. If this helped, it would show that it is actually the presence of insulin that makes the rash goes away, independently of the carbs. Of course, this is dangerous, and could lead to life threatening hypoglycemia… which isn’t really worth the trouble.

      I’m in the middle of an experiment that may yield some interesting results.

      I have no idea why some people develop it and some don’t… but as you can see from the commenters here and the people described in the research, the number is not insignificant. I have some ideas as to the ‘root cause’ which I wrote about here, but at this point it’s all just speculation.

  18. John says:

    Thanks for your extensive reply. I just had a look at that you also quoted in the blog post. A couple of patients there were treated with minocycline and had their ketone levels measured. The authors write “Most patients responded well to minocycline.” I cannot figure out from Table 1 which patient responded well and which did not. What does “HP stage” mean? However, patient 15 and 16 had significant serum ketone levels and were treated with minocycline.

  19. dieter says:

    Thanks so much for this blog post.

    Your blog post pretty sums up what I am going through now.

    I have been dieting for the past 6 months using intermittent fasting and the technique of “if it fits your macros” and have lowered my carbs. My macros are 40% carbs, 40% protein and 20% fats which gives me around 196 carbs/ 196 protein and roughly 40 grams of fat.

    In the past 3-4 months or so I have been experiencing a very intense itch whenever I lift weights or where my surroundings are really hot (as I live in Asia).

    I know 196 carbohydrates are a high intake but every since I have dropped below 210 I have been itching like crazy.

    I just came back from the gym earlier and wore a t-shirt to lift weights and while I was changing my whole body had red patches. It looked terrible.

    I am going to up my carbs as you said and will see how this goes.

    * I am also take whey protein as well. I don`t know whether it might be it but I have been taking it for close to 5-6 years and have only developed the itch in the past 3 months or so.

    • BJJ Caveman says:

      In the literature they have mentioned that sweating and exercise can be a trigger as well.

      I’m not sure if increased carb intake would help in your case since ketones probably aren’t a trigger for you since with the amount of carbs you’re consuming you’re not likely to be in ketosis. I probably should clarify that I think upping carb intake would only help if you think ketosis is the underlying trigger.

      If you truly have prurigo pigmentosa caused by exercise or sweating, then the antibiotic approach may be more effective.

      In any case, let us know how things go! I’m certainly interested in how things turn out.

  20. Martin says:

    I will post couple of status updates as this blog seems to be the only resource on an annoying condition I had for over a year

    1. I tend to agree that it is not of fungal origin. Usual antifungal cremes had zero effect on the condition for me

    2. By simply increasing carbs my rash does not go away. 2 applications of mometasoni fuoras 1g crème 24 hours apart does the trick. The carbs however keep it away – on a low carb diet the rash would be back within a week

    3. The carb level threshold for getting the rash back seems to be fairly high – well above 150g of carbs/day. The day prior to getting it back I have eaten generally very little, only some simple sugars, no starches. Could it after all be linked wiith some nutrient deficiency rather than sugar deficiency? I do have fairly small muscle size to store glycogen in – can that play a role?

    4. On the occasion when the rash came back (one so far) my morning urine ketones were not detectable.

    • BJJ Caveman says:

      Interesting that a steroid seems to make it go away… but it still comes back after?

      I’ve also found that I need to eat at minimum 150 gm carbs to make the rash go away.

      Regarding your last two points, I plan on writing a post soon about my recent personal experience with the rash which I hope will help.

    • Casper says:

      You can’t conclude it is not of fungal origin just because antifungals put on the rash don’t work.

      The rash may be caused by an immune reaction caused by a fungal infection – or, rather, caused by the toxins released by an infection that is starved because of lack of sugar.

      So that is fungal origin, although indirectly.

      This doesn’t have to be the cause, of course – just one possibility among others.

  21. Erlinda says:

    THANK YOU, THANK YOU!!! I thought I was losing my mind. I broke out in that same rash on my chest the second week into Ideal Protein diet (in maximum ketosis). It was horribly itchy and in the shower burned (in a itchy good way) when the hot water hit it. It took more than a month for the rash to calm down and another two months for my skin to get back to it’s normal color. I was panicked. Thought I was scarred. I realize now the rash started to calm as I backed off IP. A year later, I tried Atkins. SAME THING – a perfect necklace from my collar bone, down and over the top of my breasts and back up the the other collar bone formed. It then occurred to me that like IP I was consuming these no-doubt chemically processed foods and that was likely the culprit. Stopped Atkins, another two months to return to normal. I started IP again two weeks ago. The necklace has started only I opted for the minimally processed products and was confused what the hell could be going on. BTW, I’m now in maximum ketosis (deepest red on the pee stick). On a whim I Googled “ketosis rash” and whoala – your article came up. I’m certain this is the issue – DAMN! Still, thank you, thank you. I am not alone!!!

    • BJJ Caveman says:

      Thank you for your very kind words.

      Messages like this make me so glad I decided publish that post. Hopefully we can get the word out to others out there too!

  22. Leigh says:

    I too got this rash on my chest and shoulders (with a tiny bit on my stomach) shortly after starting a Keto diet. I have been very strict with keeping carbs below 20 to 25 grams a day, and was not eating any dairy for the first few weeks of the diet, during which the rash first appeared. I was also not exercising other than walking at a moderate pace during that time. Since then, in the last couple weeks my rash has subsided. I have been doing much more intense exercise (jogging and weight lifting) and added dairy into my diet during the past two weeks. I have no idea if these effected the rash or if something else did. I note that I still have a little bit of the rash, but it is much better than before. I am female, 32 years old.

    • BJJ Caveman says:

      What kind of dairy did you add back to your diet? Does it contain enough carbs to push you out of ketosis?

      • Leigh says:

        Initially I just added some Kerrygold Dubliner cheese, then I added some Polly-o string cheese and heavy cream to the mix as well. I stayed in ketosis.

  23. Misty says:

    Here is an interesting citing

    Has anyone looked at or considered H-Pylori?

    • BJJ Caveman says:

      Thanks for pointing out the article to me. I just picked up the full article and will read through it. I have a list of a few more prurigo pigmentosa journal articles that I’ve been meaning to put together into another post.

  24. LC says:

    Just a thought, have you considered that you may have an intolerance to salicylates. May be worth taking a look at the type of fruits and vegetables your eating. I have an intolerance to salicylates and foods like olive oil, avocado, tomato, all berries, most fresh herb etc are out, all the good stuff. If I eat to much of these high salicylate foods I come out in the same itchy rash.
    Just something to consider.

    • BJJ Caveman says:

      Thanks for the thought.

      I don’t think it would apply to me since my rash goes away when I add in carbs as the only change in my diet. Same exercise, same other foods…. just carbs.

      I did an experiment last week where I ate carbs 3 days of the week (one of these days was me falling off the wagon), and now my rash is almost all gone! Everything else I normally eat stayed constant.

      It’s not to say that the salicylate reactivity isn’t a cause in others (since there are a whole list of potential causes)… just probably not in my case.

  25. Leigh says:

    Well my Keto rash has re-emerged over the last two days after going away for over a month. The only thing I can think of that has changed is that I’ve eaten a bunch of avocado in the course of those couple days. I’m still eating a bunch of cheese, so I guess that’s not what had been keeping the rash away. Who knows…

  26. Nat says:

    Thank you so much for your research! This has helped me a lot!

    I found an oval pinkish mark under my boob and didn’t think of it too much until it started to grow bigger. My first thought was ringworm. The thing that made me sceptical to ringworm was the fact that I got tiny red/pink dots everywhere else but around the mark so I started a google-investigation!

    I’ve been eating a ketogenic diet now for 4 weeks and it’s really working for me. Looking at pictures of PP rash and reading about it really makes me sure it is PP. There is still some questions that pops up tho:

    1) Why does the antibiotics work?
    2) If too many ketons in the blood is the reason, does the antibiotics then slow down the ketosis in the body?

    One thing that calmed down the rash was to clean the area with a low pH shower gel (3,5 pH) and then moisturize the area. I’ve used this shower gel for my acne and my acne is gone!

    • BJJ Caveman says:

      I wish I knew why antibiotics worked… I’m currently reading over a few different papers, and will write a post about my findings.

      I haven’t come across any link between ketones and antibiotics from what I’ve read… but that doesn’t mean a connection isn’t there. I’m in the same boat as everyone else here, I really wish we knew more about why this happens and what are the exact mechanisms that set it off.

  27. Chris says:


    I have a very similar rash, and I sometimes get it while doing keto. I’ve done keto for 3 months with no rash while pretty much only eating protein shakes, eggs, cheese, meats, avocados and veggies. I have been in keto for about a month now, and the rash has flared up worse than it ever has. I used to get a little rash at my sternum area, neck and inside elbow creases on both arms. This time, when I entered keto I waited three weeks to resume exercising to give my body time to adjust. Last week is when I went back into exercising quite a bit, either lifting or doing 30 minutes of HIIT for 6 of 8 days. I’d say it started on Saturday and has been getting worse every day. However, I was out of town when the rash flared up, so I haven’t worked out since Friday.

    The time I did keto and did not develop the rash, I was pretty much eating at least half an avocado a day, as well as quite a bit of spinach and bacon. I have not been doing that this time, so I am starting to think I am either consuming too much protein compared to fat, or my magnesium/potassium levels are too low (which the avocados and spinach were providing).

    I used to think it occurred when I was eating too many nuts/peanut butter, but that is not the case. I’m going to start taking some vitamins, and up my consumption of avocados and spinach. If the rash doesn’t start to go down, I’ll have to get off keto unfortunately.

  28. sherman says:

    I too get the “rash” every time I go into ketosis after reducing my carbs. It has happened numerous times from following atkins. most recently was not even trying for ketosis just to eat healthier which I did by reducing to almost eliminating carbs, sugar, processed foods. one day my husband said my breath smelled like I was in ketosis and the next day I notice the rash starting.

    just my opinion but I firmly believe it is fungal, candia and/or h. pylori. the only reasons I haven’t gotten treatment is I only want to go to a physician who already has knowledge of it and who will also hopefully try and treat me first without use of antibiotics. also, I am unsure what type of physician to see: infectious disease, gastroenterologist, autoimmune? I am going to make some phone calls and see if I can find a physician in order to pursue this.

    • BJJ Caveman says:

      The only reason I think evidence for fungal or candida is weaker is because treatments with antiobiotics are used and have been shown to be effective, and antibiotics don’t really treat fungal infections.

      I think a dermatologist would be a good place to start…. but since this entity is so unknown, I’m not sure how much help they would be. They certainly weren’t much help for me.

      Maybe a functional med doc would be good? Whoever you choose, might be a good idea to print out my post and some of the studies that I linked to in case they don’t believe you.

      • swedish dude says:


        Im also one of those who gets prurigo pigmentosa on lowcarb diet. 30-40g carbs a day seems to holding it back for me.

        Anyways back to reply-topic about the fungalstuff. I found in a swedish forum a girl who used a cream for footfungal, the active substance is called klotrimazol (

        Anyways, this does not cure it but it is the best thing so far that ive tried since the itch goes away for a long time.

        Any news on if antibiotics is treating it for good or does it come back if diet still goes lowcarb? Anyone in here tried antibiotics??

        If it would treat it forever I would not hesitate to go for it.

        Cheers for a great page caveman.

        • BJJ Caveman says:

          Thanks for the kinds words. Glad to see that you found a cream that helps with the itching.

          I haven’t come across anything that definitevely states that antibiotics makes the rash go away forever and ever. I’ve been hoping some of the folks who visit this site will have tried it and can get back to us.

          I have some more travel coming up so I won’t be able to do any prolonged experiments, but when I get the chance I definitely want to do about of strict keto to bring out the rash, and then take some antibiotics, to settle once and for all, whether they will make the rash disappear for good… at least in my case.

          • sherman says:

            just read something interesting:

            For patients with hypoglycemia, the diligence in trying to increase glucose levels to a healthy balance can often lead to excessive blood sugar levels which further support the growth of candida. If you are hypoglycemic, it is important to know when your risks for candidiasis may be on the rise.

            Now thinking that maybe I am not keeping blood sugar at a good level and it is causing a candida overgrowth, not dieoff, which is causing rash.

            BJJ Caveman – In your circumstance, do you feel that maybe you could have had low blood sugar levels which caused a yeast overgrowth which in turn caused the rash?

        • sherman says:

          again, I think it is candida, yeast related. candida dieoff releases histamine which causes a rash in areas where a person sweats. I believe it only happens to certain people because they have a candida overgrowth in their system and not to people who maybe already restrict their sugar intake.

          recently found through searching that nursing mothers get a rash similar to mine that is a yeast infection. the antibiotics used to treat are antifungal. and yes, I have found antifungal ointment does give some temporary relief as well as antihistamine at bedtime.

          • BJJ Caveman says:

            Excellent! Can you send me some of the links to those nursing mothers studies?

          • sherman says:

            Think I might have figured this out:

            People who have candida overgrowth in their system exacerbate the problem by going low carb and into ketosis which then causes candida intergrigo in certain people.


            People who have fungal/parasitic infections do horrible on low carb (I’ve seen many on SCD with this experience) because these feed on both glucose and ketones which are produced by the body on a low carb diet. For people with these infections, eating some carbs that you can digest is best. Too much and the bad bugs get to feed on the leftovers, too little and they feed on ketones. A good amount is probably around 100g carbs per day. So if you’re doing low carb and getting worsening symptoms like toe nail fungus, yeast infections, oral thrush etc, try adding some carbs back in.

            Dr Lauren Noel notes that other than a few minor cell types, “all tissues can run on ketones,” and supposes this refutes the need for dietary carbohydrate. However, although the brain can run on ketones, it turns out that ketones don’t diffuse well to the cortical areas of the brain, and the brain always requires some glucose even in extreme ketosis. Also, while ketones can replace glucose as a fuel, they cannot glycosylate proteins, or generate ROS in the manner needed by immune cells.

            Dr Noel believes that eating white rice and sweet potatoes will aggravate Candida infections. Dietary carbs can feed Candida in the gut, but they also feed competing probiotic bacteria and promote intestinal barrier integrity and immune function, and thus their effect on the gut flora is complex. More importantly, ketosis promotes systemic invasion by Candida and glucose is needed for the immune defense to Candida, so a moderate carb intake is helpful to the defense against systemic Candida. As Candida is an effective intracellular pathogen that can flourish systemically, this is a very important consideration. No one with a Candida infection should eat a ketogenic diet. Dr Noel might wish to consult our “Results” page for a few cases in which fungal infections were exacerbated on very low-carb diets and cured on our diet.


            This condition is one of sensitivity to yeast in the diet occurring in foods such as bread, alcohol, mushroom and malt, as well as to yeast germs which normally live in the intestines, particularly candida albicans. Approximately 25 percent of hypoglycemic patients suffer with candidiasis. The symptoms are almost identical and are mainly tiredness, vagueness, poor concentration, poor memory and depression. People with candidiasis need to follow the rules recommended for hypoglycemics but must also avoid yeast foods and in most cases do better with antifungal agents such as Nystatin prescribed by the doctor as well as acidophilus capsules obtainable from health food stores.

  29. sherman says:

    also, swedish dude – if it is yeast related it is treated with triple antibiotics which unfortunately also kill off beneficial bacteria in your system. then after treatment if you return to a lifestyle with too much sugar it can return.

    • swedish dude says:

      Sherman, I hope you are right! Although if so it does not feel nice to have candida in the body :/

      So then, if it really is candida how to get rid of it without antibiotics. It would be awesome to be able to kill it without such poison 🙂

      I have read on another swedish forum that the rash has gone away after months/weeks, could it be that the candida finally got blown away thanks to lowcarb? What I have understood is that candida likes sugar, and if it does not get it it will finally starve/die after X time.

      • swedish dude says:

        I just read that a girl had success with eating “grapefruit seed extract”.
        Seems that grapefruit seed extracts is a classic fungus killer.


        • BJJ Caveman says:

          Interesting… do you need to eat it? or can you just rub it on your skin?

          • swedish dude says:

            Yeah you eat it.


            “The 1990 study of grapefruit seed extract (published here in the Journal of Orthomolecular Medicine) found GSE to be “highly effective against different yeasts and molds (Candida, Geotrichum, Aspergillus and PeniciIlium sp.)”. GSE’s antifungal properties help it to combat Candida infestations by killing the yeast cells that have taken over your intestines.”

  30. Rash... says:

    […] a little more research and have discovered Prurigo Pigmentosa, the "ketosis rash", see: Prurigo Pigmentosa – The Ketosis Rash Nobody Warned Me About | The BJJ Caveman "pain is inevitable but suffering is optional" Start weight – 16st 1lb Week 1 […]

  31. sherman says:

    I am going to try just eating a well balanced diet with some whole grain carbs, protein and fruit. make sure not to let myself go into full blown ketosis and eat often enough to keep my blood sugar steady. Also going to try some supplements. supposedly there is always candida in your body it is just when it gets out of control that it wreaks havoc. just trying to get healthy and lose some weight but health is more important to me than the pounds. feel the rash has something to do with either the candida and/or blood sugar levels.

  32. Martin says:

    Update from my side
    1. I have been tested negative for Helicobacter pylori
    2. I am looking into the possibility of histamine intolerance. The reports of PP going away with antibiotics might support that as some intestinal bacteria strains can create histamine (while others degrade it)

  33. Casper says:

    While I haven’t had this rash, I have been on ketogenic diets a few times, usually with herxheimer symptoms.

    I believe this origined from candida die-off because I had the exact same feeling when on antifungal drugs. It was worst the first times, then substantially less, and during my third course of antifungals I felt nothing. This would suggest the fungal infection had diminished a lot by then.

    Also, my reactions when on a ketogenic diet were worst the first time, but less so (and with later onset) during subsequent diets.

    I never dieted in order to lose weight – I am skinny already – but only as a remedy (somewhat desperately) against candida. I had some very bad years where I would react from all kinds of simple carbs, and since doctors didn’t help me a lot, I had to find something myself. In the end, however, my GP did prescribe fluconazol for a month which helped.

    I did have a rash once, however. All over my torso when I was 22, 16 years ago. My doctor first thought this was pityriasis rosea, a common and harmless rash. Then I got transferred to a dermatologist who diagnosed psoriasis, but at that time, the torso rash had disappeared. Since then, I have had a litle psoriasis on my elbows, but rarely elsewhere.

    Skin rashes are often a sign of immunological changes – and of infections, of course, as we know from common childhood diseases. (But isn’t the rash of e.g. measles caused by the immune reaction, rather than directly from the infection itself?)

    But regarding that many of you had a month or year-long and stable rash when being in ketosis, there might be other causes.

    As I understand, the effect of doxycycline here is not as an antibiotic, but because doxycyline has a direct impact on neutrophils (a sort of white blood cells).

    It is also well-known that kidney disease can give skin reactions. But were any of you tested for kidney subfunction?

    My humble guess as to the cause of this ketogenic rash is:

    1. A herxheimer reaction cuased by the dying of certain infections (many of them release toxins, or get particulary aggressive when ‘starved out’).

    2. A kidney-related issue.

  34. John says:

    For those who are considering taking Doxycycline as treatment for PP, please be aware that it can have possible severe effects on mood that aren’t listed as side effects such as anxiety, depression and suicidal ideation in susceptible people. Be vigilant!

    I experienced loss of appetite, felt disconnected from reality and isolated, had a depressed mood and lost total interest in activities I usually enjoyed. I didn’t make the connection at first, but eventually stopped taking Doxycycline because of these effects.


    Doxycycline and suicidality, BMJ Case Reports 2013;

    Nevertheless the Doxycycline had a good effect on PP and made it disappear in a matter of days. It’s too early to tell whether it’s gone for good or will resurface in a couple of weeks.

    For those who entertain the idea of Candida albicans as a cause for PP or another type of rash I would suggest to see a dermatologist and get a fungal culture and a skin biopsy. Just because you have a rash does not mean you have Prurigo pigmentosa. You need to establish a diagnosis first before you can start a treatment.

    PP is difficult to diagnose clinically. However, there are certain histopathologically criteria that would support a diagnosis (Boer’s criteria). They are listed in the following article:;year=2006;volume=72;issue=6;spage=405;epage=409;aulast=Boer
    If you’re suspecting to have PP you could print it out and bring it to your dermatologist, so that he/she knows what to look for.

    Criteria for the diagnosis of PP:

    Clues to the diagnosis of PP:

    There is also a new article out about “Prurigo Pigmentosa after a Strict Ketogenic Diet”
    It does not offer any new insights though, because the patient was prescribed Doxycycline AND was told to eat a carbohydrate-replete diet.

    • BJJ Caveman says:

      Thanks for all the new sources. Looks like I’ll have to type up an updated post soon. Something I’ve been putting off. I have articles on my desktop that I’ve read that haven’t gotten around to putting together into an updated post yet…

      Your’e correct about all the potential side effects of doxy, which is one of the reasons I’m hesitant to take it.

  35. Christine says:

    Hi there BJJ,

  36. Christine says:

    Sorry, the comment got posted before I could finish typing out what I wanted to ask. But I noticed that I got the same bumps between my breasts around the second week of ketosis. However, it did not itch until the night time and my body would itch all over.
    I added back carbs into my diet for the past two nights and have been able to sleep but it seems that the rash has become more defined and red in shape. I also now am out of ketosis. How long did it take for your rash to go away appearance-wise after eating carbs?

    • BJJ Caveman says:

      When I added carbs back, I really slammed them back. Clean carbs like lots of rice and potatoes made it go away. Also lots of pasta and cheesecake and other non-paleo stuff also made it go away.

      The rash would progressively lighten and completely disappear in 3-4 days.

  37. swedish dude says:

    I have tried to do carb load every 3 days like on the bulletproof diet. It kinda worked the first week but as of today I got a big rash on both sides. I did not load enough last time it seems :/

    However! I have now ordered the grapeseedextract-pills and I will make a report here when I have tried them out.

  38. Jasmine says:

    I’ve been checking your blog for a few months now, wondering if I’m suffering from the same thing. Here’s my post about my mystery rash

    I’m strict Paleo since March 2013 and I’ve been in ketosis for a few months now. The very first time I experienced this rash was 2010 when I was detoxing with Ayurvedic herbs, and another time I did a 10-day juice fast. My doc at the time said the rash was toxins leaving my body.

    I’m scheduled to see an immunologist next week to hopefully get a proper diagnosis, as well as figure out if I can remove something I still may be sensitive to in order for the rash to dissipate naturally. But if it’s suggested I need weekly allergy shots, or that I use a medicated cream or go on antibiotics, I won’t be returning, and I’ll simply try adding more carbs.

    What’s been holding me back from increasing carbs: I’ve experienced many positive results by going Paleo, except I still have chronic headaches and bad hormonal migraines. After hearing that Ketogenic Diets help Neurological problems like Epilepsy I was hoping it would also do wonders for my migraines, since they’re also neurological. My Paleo MD said I had to reach at least 4.0mM blood ketones, but since I can’t consume dairy that’s been very difficult for me to achieve.

    I have a feeling the immunologist won’t be thrilled with my diet 🙂

    • BJJ Caveman says:

      Thanks for the link to your website (which is looks great btw).

      How did things go with the immunologist?

      In my experience, I’ve noticed that since I’ve been in ketosis for a while, my body is already ketoadapted and shouldn’t longer than 3-4 days to get back into ketosis. This was demonstrated pretty well in my Carb Nite Solution experiment, in which I would eat massive carbs (like 300+ gm) and be able to get back into ketosis after 3-4 days.

      It also made my rash go away each time!… but when I would get back into ketosis, the rash would come back.

      Your body may respond similarly. I hope this helps to dispel some of your fears about adding carbs back in.

      You wouldn’t need to add it back for every meal of every day. Just try it once and see what happens to the rash. If it makes it go away… then you have your answer. Then you can experiment with consuming carbs every 3-5 days to maximize ketosis… while suppressing the rash.

      Let me know how things go!

      • Jasmine says:

        I saw the Immunologist today and she believes I have Tinea and that Paleo / Keto isn’t the cause. She said antibiotics weren’t necessary, and that I should see results with a prescribed, topical anti-fungal.

        • BJJ Caveman says:

          Fantastic! Sounds like an easy fix for your issue. Thanks for the followup!

          • Jasmine says:

            Finally saw a Dermatologist and had a biopsy. The Diagnosis: Confluent and Reticulated Papillomatosis of Gougerot and Carteaud.

            Of course, I purposefully went out of ketosis before my follow-up so I could show the Dermatologist how the rash disappears – even hyperpigmentation lightens – and his eyes got all big.

            Is it possible ketosis just isn’t for me, or could my body’s reaction while in ketosis be a clue as to what’s going on with my body (still dealing with chronic headaches, hormonal migraines, sensitivities to certain foods). I hope my Paleo doc is better able to help me figure things out now that I’ve been properly diagnosed.

          • herman says:

            found on net – an abnormal host reaction to fungi or bacteria. fungi! to me still sounds like candida dieoff. only hits certain people who have too much candida/possible sugar addiction in their body. goes away when you refeed your body carbs which turn to sugar. anyone else agree?

          • John says:

            Confluent and Reticulated Papillomatosis was one of my differential diagnoses. As mentioned earlier I had 3 skin biopsies each with a different diagnoses. The last one mentioned Prurigo pigmentosa as a possibility. Depending on the stage of the lesion (earlier, later) it might lead to different diagnoses. Just because the histopathologist came to the conclusion that it looks like Confluent and Reticulated Papillomatosis this time does not mean that this is really the correct diagnosis. The reproducible occurrence while in ketosis and remission afterwards suggests otherwise.

            Did you show the dermatologist the criteria I mentioned in my earlier post?;year=2006;volume=72;issue=6;spage=405;epage=409;aulast=Boer

            PP is difficult to diagnose by one skin biopsy alone (quote is from the article linked above):

            “For clinicians unfamiliar with PP it is necessary to be fully aware of the dynamics of an eruption lasting no more than a week from beginning to end. By way of clinicopathological correlation, the disease can be diagnosed with confidence at any stage of the process, but histopathological features are diagnosable with specificity much more easily at the beginning and at the summit of the eruption, than at a time when the lesions resolve. If a patient is agreeable, at least two biopsy specimens should be obtained, one of which should be taken from an urticarial lesion that has been present less than two days. Urticarial lesions are usually present for less than 48h and, therefore, a dermatologist should take the biopsies on the day when a patient is seeking consultation for the first time rather than giving him or her a new appointment for taking the biopsy a few days later.”

            You could contact the first author of that article via email. She was very helpful when I contacted her. She might be able to tell you whether the characteristics of your skin biopsy would fit a certain stage of a PP lesion.

            I had no reoccurrence of the rash after taking Doxycycline for 11 days without any change in my diet. That was 3 months ago. In order to avoid antibiotic-associated diarrhea I took Saccharomyces boulardii (Perenterol) together with the antibiotic.

          • BJJ Caveman says:

            Thanks so much for the excellent information you’ve been providing!

            Also it’s great that you’ve been able to keep the rash at bay after antibiotics. Looks like in your case the antibiotics were the end-all be all cure! And now you can stay in ketosis as long as you want without the rash coming back.

          • BJJ Caveman says:

            Have you noticed whether your symptoms change in relation to whether or not you’re in ketosis?

            As in, if you spent one week in ketosis and one week out of ketosis, would there be a change in your chronic headaches, etc.?

            The more I read and the more I experiment, the more the results or ketosis seem heterogeneous. Where some people will have tremendous success, others might not!

          • Jasmine says:

            Herman, I’ve had issues with Candida many years ago (white tongue, abnormal pap smears, inflammation, no rash, discharge) – way before going strict Paleo and more recently Paleo Keto – and I’m taking an experienced guess that I’m not dealing with the same thing now (it is possible, of course, but I have none of the old symptoms).

            John, I’m going to share that PP article with my doctors next time I see them – thank you. All three of my biopsies (same day, three different sites) had the same diagnosis of CARP. What you said about needing to take biopsies at different times makes total sense. I’m not sure if the Dermatologist (or my insurance) would be down with that, though.

            BJJ, Unfortunately, I haven’t noticed significant, consistent changes to chronic headaches or hormonal migraines in ketosis versus out. I think my Paleo doc thinks I blame ketosis for the rash, but it could very well be an underlying issue that’s literally coming to the surface when I reduce carbs and/or increase fats/protein.

          • BJJ Caveman says:

            Well, I really hope you figure things out. The fact that your symptoms do not vary with your state of ketosis suggest that it’s an independent process. Glad that you’re seeing a paleo doc.

  39. Jo says:

    I was low carb for 4 years as diagnosed diabetic – no probelems (that l realised at the time) until things spiralled out of control with not only emotional siturations but l couldn’t cope at all with these emotional events like l normally would have been able to.. then the rashes started… at first on my neck then my body then my face…. no one knew what was wrong with me l was finally put on steroid tabs and cream and a drug given to heart transplant patients!!! (Which after 6 mths l took myself of as it wasn’t doing anything)… l gave up work and basically hibernated in my flat feeling incredibly embarresed and literally no energy whatsoever. I finally came across a nutritionist who said he can help me… got me eating every 3 hours in a 40/30/30 percentages of carbs to fat and protein… and we finally worked out that l have to eat 3500 calories a day to keep my rash at bay (its HARD). I think what has happened is the liver has all the stored sugar and when you stop eating carbs and continue exercising and going through emotional events it uses up all your sugar and goes into your stored sugar. It also raises your pulse rate (stress on the body) and lowers your temperature – check out yours. Pulse should be between 75 and 85 beats per min and temperature should be 37.Life was hell for me but this has got me to a place where l can take life back up and am on the track to getting my health back. I have now moved back to Australia too! Also heat brings out my rash – ie winter time heating is awful.. even in aus the heat here does the same… its all to do with temperature regulation in the body – l cant quite remember but the body needs a certain amount of insulin/carbs to be able to regulate our body temperature. As soon as l eat properly my body temperature comes back up and the itching and rash wear off. Hope this helps some of you – maybe do some of the tests as above 🙂

  40. Paula Cochrane says:

    Thanks BJJ Caveman…..I read this blog as well as few others…..and wanted to report back/share that what’s helped me over the past 2 x days with my rash. Because of the tie up between candida & ketosis & this rash…..I cut out the mushies (mould forming) I would have for breakfast each day….then topically I started using Tea Tree oil on the rash which has helped immensely! Fingers crossed it stays improved!

    • BJJ Caveman says:

      What’s mushies? Is that short for mashed potatoes? You’ll have to forgive my ignorance…

      Has the tea tree oil had a lasting effect? Do you have to put it on every day? Or is just once enough to keep it at bay?

      Thanks for keeping us posted.

      • Paula Cochrane says:

        Haha….sorry mushrooms!

        Yes the tea tree oil has helped immensely……taken the itch away and because of antiseptic properties….it helps kill any bacteria that may reside from us scratching!

        Unfortunately we all carry staph & other bugs under our nails, in ears and noses….so when we scratch an open sore then that in turn can get bugs in it too!

        I use the tea tree oil twice a day….certainly before bed to stop scratching during the night…..and in the morning.
        I found the rash improved after just one application! cheers!

        • BJJ Caveman says:

          Excellent! So the rash is gone now while you are still in ketosis? Do you find that when you stop applying the tea tree oil it returns?

          • Aisha says:

            Hm it looks like Paula’s rash was due to candida and not being in ketosis. Not very much help to those whose rash is due to being in ketosis….shame

  41. Aisha says:

    Hi there again,

    I just wanted to report that as an experiment, I decided to once stay in ketosis regardless of the awful rash it caused on my face. Strangely, after about 2 days of doing so, ( and the rash looked really bad at this point) all weight loss ceased! I couldn’t even lose an extra pound. It seemed that with the severer form of rash, came no more weight loss. I was baffled to think what my body was using for energy as I was only consuming fat. I was on the fat fast diet, in which you lose a pound a day because the body is forced to burn fat at a crazy rate.

    I’ve tried anti fungal creams, steroid creams…I’ve even done a water fast to see if it was due to any food. Nothing worked. The only thing I haven’t yet tried is antibiotics….will have to give in. The frustration is killing me!

    • BJJ Caveman says:

      You know, I’m sorry I didn’t catch it before, but you mentioned that the rash is on your face… in all the articles I’ve come across, most of them mention that prurigo pigmentosa is generally limited to the trunk (both front and back), the fact that it’s on your face may suggest that it’s something else.

      Have you tried adding carbs back in? Just go 3-4 days of eating carbs and see if the rash improves.

      If the rash does get better with carbs, then you know for sure it’s keto-rash.

      If not, then it’s probably not the keto-rash. 3-4 days of carbs will only bump you out of ketosis for a little bit, and since it seems you’ve been keto for a while, you’re probably already keto-adapted and so will be able to go back into ketosis fairly quickly.

      In my case, I can go back into keto within 4-5 days despite eating carbs for 2 weeks straight!

      But regarding the rash, if it still persists, you can consider seeing a dermatologist to make sure it isn’t something else.

      • Aisha says:

        Hi there,

        yep the rash is definitely due to being in ketosis. Every time I added back carbs the rash started to recede. I have no problem going into ketosis, but every time I do so the rash on my face begins in the exact same places, as it would have done previously. I did think it strange that PP was not found on the face in most cases, but the rash I get on my face looks just like it!

        • Aisha says:

          I did forget to mention that when I had tried atkins years ago, the rash I got was slightly different. It was on my body and only began to appear on my face a couple years later when I tried the diet again…strange.

  42. Kim says:

    Hello ~ this has been a very informative site regarding ketosis rash. I began the Atkins diet less than 2 months ago, first time ever low-carbing, ketosis, etc. Loved it, but broke out with the rash in week 4. Long story short – after extensive web searching, the only answer that made sense to me was increasing the carbs. Some of the posts lead you to believe that you have to abandon the diet, get out of ketosis, etc. I successfully eliminated my rash by SLOWLY increasing my carbs, exactly as the Atkins diet tells you to do. I realized I had deviated very little from an induction diet other than fruit twice a day, so I introduced whole grain bread (net carbs 12 per generous slice) at breakfast with a hot ham and cheese. Sometimes I had another 1/2 slice with a meal later in the day. I have also added 1/2 of a sweet potato either nuked or toasted in slices, added grapes to my fruit twice a day, and dark chocolate as a treat once a day (72%). This was all introduced one thing at a time for a period of 3-4 days before moving on to something new. I don’t have insane cravings, I am still in ketosis, and I’ve lost another 3 pounds since moving on and introducing carbs very slowly. Best of all, the rash is rapidly fading and is no longer an issue. I think the rash was my body’s way of telling me to move on and raise my carb percentage, but I’m so glad I don’t have to discontinue the diet, as I think I will be good to go for life on this WOE. I’m down 14 pounds with 5 to go and I’m not itchy anymore (happy dance) Hope this helps someone, it sure worked for me.

    • BJJ Caveman says:

      Great solution. Looks like you found a really nice sweet spot with your carb intake… low enough to remain in ketosis, yet high enough to avoid the rash.

      Seems like a good alternative solution!

      • herman says:

        sorry if this has aleady been mentioned. when anyone has had the rash, have they had any food allergy testing done?

        • BJJ Caveman says:

          Some have and some haven’t, and I’m not sure any clear relationship has been identified. If you search through the comments, I think there are some anecdotal reports where relationships are suspected… but nothing definite.

  43. […] Prurigo Pigmentosa – The Ketosis Rash Nobody Warned Me About […]

  44. swedish dude says:

    I found this post on reddit

    “I suffered from Keto Rash as well! Holy fuck it was itchy. But the reason it gets so bad is BECAUSE we itch! I stopped keto after I got the rash the first time because it was getting so bad (at least your rash is in hidden areas… mine was all over my neck and upper chest for the world to see). About a week and a half after I stopped keto, the rash went away. However, a few months later I started keto again and after about a week, I felt that tingly itch start up again. This time, I knew what was coming so I didn’t itch — AT ALL. I didn’t touch it no matter how itchy it felt. After a few days, the itch went away and there was no rash so… I think one solution is to try and ignore the itch as much as possible and not touch it to avoid getting the rash. Also, I concluded that the rash was due to me eating EGGS!! I’d be fine and nothing would be wrong, but then I’d eat some eggs for breakfast, and the next day I’d feel that tingling again. I tried experimenting with it (not eating eggs, then eating eggs, controlling for all other variables) and yeah, it was the eggs. You say it’s not a dairy or egg allergy so I’m not sure if the culprit for me would’ve been the same for you, but you could always try experimenting with things like I did — just DON’T ITCH.”

    Have you tried being in ketsosis while eating 0% eggs? I have not.

    • BJJ Caveman says:

      well I’ve done it without eating eggs for 3-5 days which made no difference in the rash, but not sure if that is long enough for a 0% egg challenge.

      The thing that’s interesting is that if I skip eggs for 2 days the rash is the same. Whereas if I eat carbs for 2 days, the rash immediately starts to disappear…

      • swedish dude says:

        True true
        I was thinking about what Dave Asprey have said on several occansions, that he became allergic to diffrent things while in ketosis.

    • Robert M says:

      Actually I have been eating almost just mayonnaise as my source of fat for the last two weeks. Which I have never done before. In my whole life I have never eaten eggs cause I could never stand it. Except for mayo.

      This could really be my solution!

      Gonna try and get back.

      Gonna miss aioli, thou.

    • Jasmine says:

      I went completely egg-free for two months, while in ketosis, and it didn’t prevent the rash.

  45. Robert M says:

    Hi everyone,

    I’m a LCHF since a little bit over 3 years and NOW I get this @£$£@ rash?!

    Why now? Anyone else with similar conditions.

    I have lost almost 20 kilo and are now stabile 77-78 kilo.

    My problems started around 2 weeks ago on the middle of my back, on the lats on right side.

    The things that have changed in my life is more cardiotraining and i have also doing som intermittent fasting (eating between noon and 8 pm) 16 h approx.

    Now it’s spreading and itching more and more.

    Went to the doctor who was clueless.

    Thank you for all tips and thoughts on the matter.

    I’m gonna try some grapeseedextract at first, secondly some more carbs when I do my cardio.

    • BJJ Caveman says:

      Thanks! Keep us updated!

      My only thought is that maybe doing LCHF you’ve been borderline ketosis but not in deep ketosis… were you doing any blood or urine ketone testing?

      And then recently adding more cardio and IF pushed you over the edge into deep ketosis, and emptied your hepatic glycogen stores… bringing on the onset of the rash.

      Just thoughts… who knows if this is true or not!

  46. herman says:

    question – has anyone gotten the rash while being on a gluten free and dairy free diet or had it when doing an elimination/chemical free diet? wondering if when in ketosis your body has an extreme reaction to food sensitivties and allergies that would otherwise cause such mild symptoms that they are not noticed.

    • BJJ Caveman says:

      I was gluten free during my strict ketosis experiment. Wasn’t quite dairy free though.

      When I carbed up after 90 days and it made my rash go away, i was eating gluteny things like danishes, cakes, donuts…

      In my case, I don’t think the two were related..

    • swedish dude says:

      Im gluten free, still get it. Im gonna try being egg free for a while now 🙂

      • Robert M says:

        Been egg-free a couple a days but no relief.

        Any luck for you?

        • swedish dude says:

          I will start next week since our supply of eggs in the refrigirator have to be eaten 🙂

          My “plan” is to eat carbs for a week without eggs and then lower the carbs again to ensure my system is totally free from eggs.

          • Robert M says:


            I’m feasting on eggs almost everyday and no rash =)

            I upped my carbs a bit and no more intermittent fasting. Still fit and a healthy fatburning machine! Rash-free=)

          • BJJ Caveman says:

            Congrats! Seems like you really figured it out for yourself!

  47. Amber says:

    Zyrtec has given me a lot of relief in the last few days. I’m remembering now when my son was young while on antibiotics he developed an egg allergy, not a permanent one but I imagine if he were on that medication again it would return. At the time the information I found supported a lowered immune system was more susceptible to underlying allergies. I may have to try to do with out egg, and see where that leaves me. I don’t use splenda. I’ve already gone with out cheese vinegar and mushrooms. No relief. There’s another website I found though not as helpful; they are looking at this from completely an allergy standpoint … or so it seems.

  48. […] this point I was also dealing with a sky high LDL-P and the keto-rash (prurigo pigmentosa), so my thought was that I could kill all three birds with one stone by adding carbs back into my […]

  49. Elemeno says:

    One thing that most people don’t realize is that the body naturally wants to heal. Think about it! You cut your finger and platelets in your blood will clot while the wound heals. One thing I have learned in my health journey is that the body heals from the Top-Down from the Inside-Out. When you cleanse, your body is working out all the garbage and damage from years of poor nutrition. Rashes are a part of the healing process (albeit a very frustrating process… Currently dealing with this rash myself) but let the body do what it knows how to do and let it heal. Drugs can suppress the problem and hold your body’s progress down.

    If you listen to your body, you will heal!

  50. […] (CARP), I believe my issue is related to Prurigo Pigmentosa, which I first read about on The BJJ Caveman‘s […]

  51. swedish dude says:

    So, ive been googling again 😉

    I just read another interesting thread on a swedish board, this guy who suffers from same rash as we all do (lchf guy) found some fishoil-dude on the net that recomended taking LARGE doses of omega3.

    Apparently it has worked for him, the rashes has stopped itching and is now withdrawing. I dont think carbloading is the case since he knows that carbs = no rash.

    He did not use capsules but liquid form, took 6 teaspoons. He was recomended to take 12(!!!)

  52. Rachel says:

    Hi, I’ve been in ketosis for about 3 weeks now. I have this awful rash and managed to get a doxycycline prescription based on the merit of the article you published here. However I have also been reading this : Which makes a lot of sense to me. I’m also going to try puriteze anti histamine pills to see what the effect is.

    • BJJ Caveman says:

      Great! Let us know how things turn out!

      May be worthwhile to try the doxy first and then the histamine thing after… Or the histamine thing first and the doxy after… To give you a better sense of what’s causing it… So you’ll know how best to treat it in future.

      • Robert M says:

        I’m a little curious about the keto culture in the US. Is it based on paleo without heavy cream and crème fraiche?

        Cause I think adding this can give you enough carbs to avoid the rash, unless you exercise a lot. Then you might need to add some low GI carbs after exercise.

        Cause you can still benefit from a lchf lifestyle without hard-core ketosis.

      • Rachel says:


        Sorry, I ended up taking the Doxycycline with the anti-histamine for the past week. I noticed that when I ever ate any bacon it gave me crazy indigestion (which I’m sure is related to histamine). At the moment my rash is practically gone with some discolouration left. I only had 1 week of antibiotics and antihistamines so I will let you know if the rash comes back. If it does, I will try the antihistamine on it’s own to see if that helps it. By the way, my doctor recommended only certain types of antihistamine, apparently not all of them will help the urticaria that develops from a histamine intolerance. I have been taking Piriteze as it contains Cetirizine.

        • BJJ Caveman says:

          Thanks for the followup!

          Hopefully the changes will last! Either way, please give us an update in a few weeks.

    • swedish dude says:

      Please Rachel, if you take the doxycycline try to eat as few carbs as you can and continue in deep ketosis and report back on your progress 🙂
      It would be interesting to see if the rash vanishes for atleast 3 months as reported in other cases. Even 6 month report would be interesting. Also a year 😉

  53. X400 says:

    I was on the Atkins diet a year ago and after about 1 month of being in ketosis I began developing a rash and it spread all over my torso and behind my knees, it was incredibly itchy but calamine lotion dealt with the itch.
    I decided to get off of Atkins and the moment I started loading on carbs the rash disappeared, some of the more serious areas developed a darker skin splotch which eventually faded over several months.

    I started dieting normally and everythings been great but I wanted a little boost for this summer so I went on atkins again and after 1 week the rash has reappeared (faster than before) sigh

    When I first had the issue I couldn’t really find anything relevant to the issue online (it happened before your post my family doctor and my acclaimed dermatologist were surprisingly of no help.

    So thanks for your post!

    • Robert M says:

      Try a little less strict low carb diet with safe starches instead? Sweet potatoes etc.

      • X400 says:

        Hi thanks for your suggestion, that’s kind of what I’m trying to do now by upping the veggies I eat but I didn’t want to add potatoes of any sort because of the high carb count? I’ll Google what you mean by safe starches, sorry I’m not knowledgeable on that at all.

        I was considering adding something like Winter Melon in large quantities since it has such a low carb count
        I was deciding on simply going to a veggie smoothie diet while keeping the carbs as low as possible.

        • Robert M says:

          By safe starches sweet potatoe is better than regular potatoe. Brown rice, carrots, parsnip etc can be added in smaller amounts to kill off the deep ketosis. Also heavy cream contains 3-5 grams of carbs per 100 grams.

          That’s been my solution, still being low carb and feeling fine, don’t have to deal with high/low bloodsugar/eating every 3:d hour.

          If you wan’t some good LCHF tips go to the swedish guru, Andreas Eenfelts english site,

          • X400 says:

            thanks so much! will give that a read right now thanks

          • Kim says:

            Me too – I have an earlier post on this, about finding your carb tolerance and still enjoying a low carb lifestyle minus the rash. Still working for me! No rash here, and the only thing “carby” I have is a piece of whole grain bread with breakfast, some dark chocolate, and higher carb whole fruits & veggies, ie the occasional sweet potato. Staying out of “deep keto” works for me as well.

  54. herman says:

    just read interesting theory. started reading about diabetics getting candida albicans rahses. which lead me to read again about paleo and then read that candida (fungi) feeds on ketones. in other words, by going into ketosis you feed the candida to the point of experiencing the rash. keeping healthy carbs and no ketosis could eliminate rash. can read more here.
    guy they mention is paul jaminet.
    any thoughts?

    • BJJ Caveman says:

      Thanks for chiming in. I know candidiasis is one of the working theories floating around, but I haven’t seen anything to convince me that it is THE correct theory yet. Questions that I would like to answer that could show me this are:

      1. What is the population of candida in the skin prior to going into prolonged ketosis?
      2. Can candida be shown to increase in the skin when in ketosis and rash appears?
      3. Once carbs ingested, and rash starts to disappear, can candida population be shown to decrease?
      4. Does doxycylcine or minocycline effectively treat candida? If not, then how to explain rash disappearing with use of antibiotics?
      5. Why don’t topical antifungals work if primary problem is proliferation of candida?

      If anyone has data answering these I’m all eyes!

  55. Emme says:

    Thank you so much for this post, and for all of the comments. I read each one.

    I’m in the camp that believes it’s a Herxheimer effect resulting from toxins that are released from the fat cells during deep ketosis. The body attempts to rid itself of waste through all channels of elimination — the skin being a major avenue.

    I’ve low carbed, and even no-carbed, before without any problem. But over the past 18 months I’ve eaten horribly — non-stop sugar feast. Two weeks ago I went cold turkey into a water fast. No food or supplements. Deep ketosis. The rash came on about a week into the fast. Upper chest, stomach, and some welts/hives around my armpits. Lymphatic site?

    I ended up stopping the fast at day 10 because I also experienced shortness of breath and extreme fatigue — potential symptoms of acidosis. My body was just overloaded. Too much too soon.

    After three days of re-feeding I feel great but still have the rash.

    I’m going back on a modified version of the fast (with MCT oil and supplements) and will drink much more water than I did during the initial fast. I hope to stay on top of the detox reactions by flushing out as much waste as possible without upsetting electrolyte balance. Maybe a short sauna and skin brushing thrown in. I’ll check back here and post an update. Any bit of information helps. 🙂

    • BJJ Caveman says:

      wow… it’s impressive to be able to fast for 10 days at all only on water! I don’t think I could handle that.

      The fact that you got short of breath and possibly acidotic is pretty serious though.

      Has the rash abated after longer refeeding?

      • Emme says:

        Back to report that the rash is now gone. It started to abate within a week of refeeding and as of this morning it is totally gone — but I do have some marks on my chest where it was pretty bad (had been crusted/weeping bumps). Hopefully they will disappear over time.

        My dilemma: I really liked how I felt in a fasted state (in the first five days of the 10-day fast) — great energy, clarity, focus, and mood, in addition to the weight loss (I have about 30 pounds to lose).

        I’m now experimenting with intermittent fasting. I’m on my second round of a 40-hrs fast followed by two days of 20-hrs fast. If the rash reappears, I will report back here. My body seems able to keep up with this cycling of eating and fasting. Feeling really good!

        • BJJ Caveman says:

          Sounds like you have the classic case of the keto rash.

          Now you know without a doubt that increasing the amount of carbs in your diet will remove the rash…. the hard part will be to titrate the amount of carbs needed to keep the rash at bay… while at the same time bringing along all the benefits you’ve experienced with ketosis.

          This may require increasing the baseline amount of carbs… say from 30 gm to 50 gm… or maybe a weekly carb re-feed.

          Let us know how it goes! Best of luck, and thanks for reporting back!

  56. Carrie says:

    I started LCHF 14 weeks ago. No rash but I suspected a candida problem because of a yeast infection and my ears and belly button began to itch and I crust (sorry, TMI). I did a little digging and found out about caprylic acid. I treated my ears and brb with organic apple cider vinegar. My bb was better immediately, but it did not work on my ears. I treated my ears with cortisone cream. It took awhile, but the itching is gone. OK, so back to the caprylic acid. It was definitely killing off the excess candida because I began to feel awful! I decided to start taking 2 Tbl of zeolite clay in water to detox from the toxins, due to the candida die off. I did this for 2 weeks and it dis rid my body of the toxins. Now, 2 weeks ago, I got a slight sunburn… Bam! A freakin’ rash on my upper chest and back. I ran out if caprylic acid a few days ago but it did not stop the rash. Ended up here trying to find answers to this rash nonsense. My rash is getting better, so I don’t think it’s the same problem. I have not increased my carbs. Anyway, just wanted to share my experience with caprylic acid and zeolite clay.

  57. […] Prurigo Pigmentosa – The Ketosis Rash Nobody Warned Me About […]

  58. Kris says:

    Hi Bjj,

    I have been battling with Prurigo pigmentosa for years, but only when I have limited sugar/carbs in my eating habits. Once i introduce the carbs my itchy rash slowly heals then fades away.
    I have gone thru my own experimenting with, food allergies eggs, bread, red peppers, sweeteners. I have seen two Doctors one diagnosis was shingles, it was not. I also, suffered through thinking it was Candida die-off rash and continued my diet for months to kill off the candida until it became completely intolerable and inflamed. I have tried Apple cider vinegar, oil of oregano treatments orally and externally, as well as Topical corticosteroids, and anti fungal creams to no avail.

    So this leads me to my point. I have an amazing new Doctor who has listened to me and has allowed me to self diagnose. He has given me a macrolide antibiotic in the form of clarithromycin 1000mg. Two pills taken with food at breakfast and dinner. 4 250 mg per day. Our plan is to continue limiting carbs while being medicated to see what the results will yield.

    My fabulous doctor will also continue treatment plans should this not be effective.

    Bjj. Thank you so very much for your webpage it has been a fantastic resource, as well does provide some comfort knowing i am not a crazy freak of nature….lol.

    I promise i will post results.

    • BJJ Caveman says:

      Thank you! It’s wonderful that you found someone who is so open-minded and willing to work with you! Please keep us posted as I know a lot of other folks would be interested in your findings also!

  59. Lisa says:

    I just started eating Keto and within a few days got a rash starting in my armpit. I guess mine is a little different since it was primarily on my face after that. Around my nose. Basically it hit every crease i had on my body. Back of the neck and genital areas. Not great places to be itching. I was keeping my carb intake extremely low though. 6-10grams per day. Maybe that’s why i had such an extreme reaction. I also suffer from psoriasis patches here and there occasionally. That i was always treated with a steroid cream and it goes away. I did not attempt putting that cream on this. (i couldn’t find it) it took me 3 days of eating huge amounts of carbs to get kicked out of ketosis. After 4 days the rash on my face is going away. My neck not so much but i think this actually also kicked up my psoriasis and i’m having a flareup. Gotta find that cream! I do think i may have some candida issues. they seem to go hand and hand with other issues i have. I’m currently on grape seed extract. I seriously freaked when this spread all over my face. I’m going to try and get my stomach flora in shape with probiotics. Then try to ease back into ketosis. maybe starting off with such a low number is what did me in.
    Funny thing with the rash, i was losing 1-2lbs a day but as soon as the rash popped up i stopped losing weight. Nothing for over a week. at 6-10 carbs a day that seems pretty damned impossible.

  60. Colleen says:

    Hi All…..
    Am glad I found this page….. I have started on the Atkins Induction Diet about 1 week ago and have lost weight already and am so far finding it easy to stick to.

    My plan was to stay on this for a couple of months until I have lost a fair bit of weight and then slowly add in carbs like brown rice, high fibre pasta etc etc.

    However like you all on here, a rash has appeared. Mine is not on my trunk….yet, but I’ll have a look later, but is in the creases of my elbows and has just started around one knee…

    I know it definitely has something to do with this diet as it is the only thing that has changed in my life and I haven’t added any new foods, just deducted carbs.

    I don’t want to get of this diet as I need to lose weight and I am certain I can stick to this.

    I also could probably put up with the rash and find something to put on it if it itches HOWEVER I am more concerned that we are getting this rash because something about the diet is dangerous to our body…..I am hoping the rash comes because the diet is good for the body……what do you think???

    I am 48 with two youngish kids so don’t want to do anything that may be affecting my kidneys, liver etc…

    I have been reading here about candida and I suspect I have a major candida overgrowth and really its a bummer if it is.

    You would think with the amount of people that have been on Atkins, low carb diets and Paleo diets that nutrionists or scientists or doctors would know about this….

    I am going to keep watching your blog to see what comes up…and yes I am just going to stay on the diet..

    • Lisa says:

      I’m doing the same thing. I had it mostly on my face. I stopped for almost two weeks to get it all to clear up. I then tried it without dairy but after a week to the day I had it on the back of my neck again. I felt it right after I ate eggs. I’m going to try eliminating eggs and seeing if it clears up. I don’t think mines candida. I did the spit cup test and it was fine. Try some of the things people suggested above. If it’s not eggs for me I’ll just try raising how many carbs i eat. Maybe we just have a higher tolerance to carbs and 10-20 is just too low.

    • Kim says:

      Colleen, you have exactly the right idea about Atkins – finding your carb tolerance. My rash was controlled by adding just a slice or two of whole grain, low carb bread back into my diet. Nature’s Own is my favorite, either the 100% Whole Wheat or Whole Grain, at 9-10 net carbs per slice. It makes a nice vehicle for peanut butter, grilled cheese, or other low carb sandwiches you might enjoy. Good luck! I’m six months into Atkins and have lost all the weight I desire (20 lbs). I love new WOE and don’t feel very good after a major cheat (I keep my “cheats” small and infrequent.) I’m going for a checkup soon with labs and am curious about my lipids and so forth, so that will determine if I stay on it for life.

      • Lisa says:

        Oddly enough it looks like eggs was it for me. I stopped eating my daily breakfast scramble and my rash is clearing up after 2 days. I still use egg white though in cooking. I need my protein bread but it hasn’t seemed to effect the rash. I never increased my carbs. I guess everyone just has to experiment.

  61. […] Prurigo Pigmentosa – The Ketosis Rash Nobody Warned Me About […]

  62. BJJ Caveman says:

    Please check out my newest project, for the latest updates on the keto rash!

  63. […] have been a few commenters in my initial post that reported using antibiotics, but unfortunately we haven’t had much […]

  64. […] Prurigo Pigmentosa – The Ketosis Rash Nobody Warned Me About […]

  65. […] also had a few commenters chime in that they’ve tried topical grape seed extract or oral grapefruit seed extract […]

  66. Michelle says:

    I have this right in the middle of my lower chest! I think it started about a week into the ketogenic diet, and now I’m a month in with more spots. They’re not itchy or uncomfortable, though. It just looks like acne scars. I imagine I can just keep going until I hit my goal weight (which is 40 lbs from now) and then I’ll slowly reintroduce carbs to my diet during a period of 2-3 months and maybe wait 6 months before getting the scarring removed (if there is any at the end of it all)
    Good plan? Yay or nay?

    • BJJ Caveman says:

      In my experience, there isn’t really any scarring once you reintroduce the carbs… just some residual hyperpigmentation which fades after a few weeks.

      I can tell you from my own experience that if you go the full 2-3 months in keto with letting this rash go nuts… it will get a little nasty. New rash on top of old rash, some with some fluid leakage and scabbing… the BJJ Cavewife was really grossed out… even though I was losing weight.

      While I haven’t published it yet, I’m currently doing a version of keto, and I started taking antibiotics.. Doxycycline, and the rash is completely gone! I’m going to complete the course of antibiotics and see what happens. The question now is if the rash is gone for good… or if it will eventually come back when I’m in ketosis.

      check out my other site,

      But at this point, If you think keto is the best way for you to attain the goals you want, and the rash isn’t abating, then I’d go with the antibiotics. This will allow you to go keto without the rash!

      Let me know how things go.

      • John says:

        I had no reoccurrence of the rash after taking Doxycycline for 11 days without any change in my diet 9 months ago (see above and be aware of rare but possible severe side effects affecting mood). In order to avoid antibiotic-associated diarrhea I took Saccharomyces boulardii together with the antibiotic.

        I now do intermittent fasting daily throughout the work-week without any problems. My longest fast was 36 hours.

        Maybe Doxycycline wipes out certain types of gut bacteria that can proliferate extremely well under the conditions of ketosis, but not otherwise and produce a substance that causes the rash. Some people may have them, others don’t. That could potentially explain why the effects seem to be lasting after only one course of antibiotics and why most people aren’t affected. Just guessing though…

    • Robert M says:


      I have earlier commented on this.

      I lost about 35-40 pounds (18 kilo) on a LCHF diet. I Ate like this for about 3,5 years before i started experimenting with intermittent fasting (16 h without food) and i got the rash.

      I had almost 0 carb intake (mayo instead of heavy cream) and that pushed me into a really deep ketosis and hence the rash appeared =).

      Once i stopped fasting and introduced some more carbs for a short while the rash disappeared.

      WHat i wanna say is that it’s possible losing a lot of weight on just a LCHF (low carb, not NO carb) and be rid of the rash.

      LCHF eating also gets your fatburning going and resets the body for burning fat (ketones) and can be a preferred way if the rash seems a bit annoying 😉 is a good place to learn more about LCHF and weightloss etc.

      Good luck!

  67. Mike says:

    I have gotten this rash everytime I did low carb!!! I went to a dermatologist she had no idea, gave me prescriptions that didn’t work and even did a biopsy leaving me with a scar. The rash never went away till I stopped cutting carbs.

    I figured it was ketosis bc it was the only thing i was doing differently. The first time I looked it up a few years ago. There was nothing on ketosis and this rash. Years later only a few people online saying they had the same thing but no answers. It wasn’t till today I found your blog confirming my suspicion. Thank you!

    It is sad though that the diet that works so well for me for weight loss and lifestyle is ruined by this rash. It depressing.

    • Robert Mellqvist says:


      Sorry about your problem. Although for me it helped adding some more good carbs and still being able to be in a more moderate form of ketosis, still the benefits with weight-loss and great endurance.

      Good luck!

    • BJJ Caveman says:

      I’m glad you were able to find this resource and have found it helpful.

      If you are sure it is keto rash and can confirm that it comes and goes with your carb intake, I would encourage you to try a round of doxycycline.

      If your doctor is hesitant about it, consider referring him to and having him look through some of the studies that are available.

      I’m having tremendous success with the doxycycline right now. I’m on day 9 of the course and the rash is completely gone… And I’m still in ketosis.

    • BJJ Caveman says:

      Mike, not sure if I was clear enough in my prior post… but I just wanted to emphasize that if you decide to go the route of using antibiotics, it will allow you to treat the rash while at the same time remaining in ketosis… which I gather is important to you.

      The question for now is how long will this effect last… that’s what we’re all trying to figure out, but there’s at least a few reports from commenters here that the effect is lasting.

  68. Doretha says:

    Thanks , I have recently been looking for information about this subject for a long time and yours is the best I have came upon so far. But, what in regards to the conclusion? Are you sure about the supply?

  69. Laurel says:

    Hi! I’ve been dealing with my own case of PP for the third time of going kept. This time, I changed my google search terms and found your site. Thank you! I am 2 weeks into a doxycycline course and my rash has cleared significantly. I am not sure how long I’ll continue the antibiotic for. In reading the comments here, it looks like you trialed doxycline back in October with some immediate results. Any follow up? Have you had lasting results? How long of a course did you take?

    Thanks so much!

    • BJJ Caveman says:

      I took it for 10 days, and have been completely rash free since!

      • sherman says:

        sorry, but I cannot remember caveman. after you took antibiotics and became rash free, do you include bad carbs in your current diet at all – whites: potatoes, rice, flour, sugar; etc? or do you eat a very healthy diet all the time?

        thanks for keeping this going and helping others! 🙂

        • BJJ Caveman says:

          Yes. I do have occasional bad carbs and good carbs once or twice a week.

          I eat healthy 5-6 days of the week, and semi-healthy the other two days. My Carb Nites/Cheat days are nowhere near as epic as they used to be!

      • kate says:

        Just to be clear, you took doxycycline for 10 days and have remained rash free since while still being in ketosis?

        • BJJ Caveman says:

          At the time I wrote the post, the answer was an absolute YES.

          Now… the answer is more ‘kinda sorta’

          I’ve been eating lowish carbs but not keto lately to sort out my cholesterol issues

          but I HAVE noticed that on days I workout hard… I see one or two faint red spots pop up on my chest.

          I haven’t checked to see what my ketones are or if I’ve gone into ketosis, but it makes me suspect that the rash is making a reappearance.

          I might test this out in the future by going hardcore keto for a week or so to see if the rash manages to come back for sure, but I want to get all my cholesterol issues sorted out first.

    • BJJ Caveman says:

      Would you be interested in writing a guest post for my site to share your experience with others?

      • Laurel says:

        Sure! I would be happy to! I think I want to wait and see that the rash really doesn’t come back after a bit of time off antibiotics, while still maintaining a ketogenic diet. As a brief update though, I did a lot of literature review and decided to do 2 weeks of doxycycline at 100 mg twice/day and then decreased to 100 mg daily, which I plan to continue an additional 2 weeks. It might be a longer course than necessary and I am concerned about my gut flora, but after hard workouts I was noticing a mild itchiness at the initial site where my rash started. I am taking lots of probiotics and eating fermented foods and so far, GI-wise I seem to be doing fine. The rash is totally gone, with just the tiniest bit of pigmentation left. Will update in the future when my story is more comprehensive!

        • BJJ Caveman says:

          Great! I’ll followup with you in a couple weeks!

          • Ann says:

            I wonder if this rash is actually related to excessive histamine release, rather than any particular diet per-se…For those who notice an improvement in itching after downing a bunch of water, water just happens to be a natural antihistamine. There’s a lot of info related to histamine on The Low Carb Chef’s, (Yasmina’s) website. She went through a TON of problems relating to histamine, and she’s very knowledgeable about it. I think her site may help someone. Blessings.

          • BJJ Caveman says:

            Hmmm, if histamine were the case, do you think that taking an antihistamine like benadryl would have an effect? I haven’t read anything about this. Might be interesting to investigate!

          • John says:

            If it’s really PP anthistamines and topical steroids do not have an effect. That’s what I experienced and what’s written in the literature.

          • BJJ Caveman says:


  70. […] stored toxins. So besides a few blemishes on my cheek, I continue to experience my keto rash, Prurigo Pigmentosa. It’s not as dense as it was during my low carb, high fat (LCHF) days. It seems to lighten up […]

  71. Roman S. says:

    I’m so glad I’ve found this. After experimenting with ketgenic diets , I have come to a conclusion that is why I’m getting a rash. It happens exactly by the end of the third day of water fasting. So, I’m not crazy. My rash IS caused by ketosis and I’m not the only one However, something whose happens to me as well.
    If I stay with elevated ketones for more than a few days after the rash stats, and then resume eating carbs, the rash goes away. After it comes the skin peeling! It’s as if I was burned under the sun. It continues peeling off for up to two weeks! There are flakes of skin all over my house. It’s disgusting. The skin doesn’t perk of if I resume eating carbs the next day after rash develops, though.
    It’s almost as if I’m being burned by this allergic reaction to ketones.
    But after some DNA testing, it turns out that low-carb diet is not for me. It’s nearly 3 as hard for me to lose weight on low-carb. And that is why I might get into ketosis so damn fast and get this reaction. For my body, low-fat diet is the way to go, and had been working superbly!

    • BJJ Caveman says:

      Sorry to hear that you’ve been having such trouble with ketosis. This rash isn’t one of those things people are warned about and so can catch a lot of people, myself included, completely off guard.

      What was the DNA testing you did that showed low carb is not for you?

  72. Roman S. says:

    I forgot to add that my rash starts in my elbow creases and she’s of the torso. Eventually, if I stay with elevated ketoes for a few days after the rash begins, it will spread everywhere, except face and everything below the knee. Even my palms get little water-filled bumps on them.

  73. Lucy says:

    After a lot of research, I now have good reason to believe the cause of the ketosis rash (Prurigo pigmentosais) is H-pylori.

    For those who have PP but have tested negative for H-pylori, the H-pylori test commonly brings back a false negative as H-pylori can lay dormant at times and go undetected.

    H-pylori feeds on ketones, so you’re basically feeding the H-pylori bacteria when in ketosis.

    This is a natural protocol I’m going to try…
    – Oregano oil (natural antibiotic)
    – Artemisinin (Chinese herb known to get rid of H-pylori)

    I’ll give it a go and post an update in the future,
    Kind regards and have a lovely day 🙂

  74. Lucy says:

    I have this exact same rash appear whenever I start a water fast.

    Could there be a link to heavy metals?

    Has anyone else who gets this rash had/have amalgam (mercury) tooth fillings?

    Has anyone been able to permanently cure themselves so they don’t get the rash while in ketosis?

    I’m thinking toxins(heavy metals) might be a possible cause, as well as vitamin deficiency’s (I know I’m low in B6)

    Also, is carpel tunnel linked at all? Also, once after a master cleanse when I started eating, I had terrible upper abdominal pain waking me up in the night for about 5 nights, then eventually it went away… I wonder if there’s a link…

    Any reply’s would be helpful,
    thanks and have a lovely day 🙂

    • BJJ Caveman says:


      It looks like this comment got lost in the shuffle (I was in the process of transferring my website hosting service), so I made sure to repost it.

      Some people believe there’s a link to heavy metals being released from fat with lipolysis, however I haven’t found and research to back this up.

      In terms of curing it permanently, the most success I’ve come across in the literature and anecdotally are with antibiotics.

      I haven’t seen any links with carpal tunnel anywhere.

  75. weber says:

    Sorry my poor English, I am very happy to get information from here, I tried to enter keto but got rash again and again, may be that is Candida infection, I remember FORSYTHIA has Candida inhibition effect,

    So I tried some kind of this
    when rash came, I took it for few days for rash disappear, , A month later, rash never came again while I enter keto.

  76. […] It’s almost a week into the Whole30 thing and I’m still chugging up the hill going I think I can, I think I can (actually it’s something closer to I think I…what? since I’m SUPER SPACEY right now) and when I got out of the shower this morning I noticed that I have a rash. Now you’re saying lady, you ALWAYS have rashes, and about this you are not wrong, but this is a NEW rash, a DIFFERENT rash, and thusly of course I consulted Doctor Google, who told me it’s a side effect of not having carbs. […]

  77. Sara says:

    That could be caused by too much protein intake, constipation or food allergies, since a lot of times cutting out carbs means having to try new foods.

  78. Bertrand says:

    I know what causes rash skin when on keto diet.
    It’s the lack of carbs!

    This problem proves Traditional Chinese Medicine right!
    TCM says that none of the five basic flavours should be set aside. Sweet (=carbs) is one of them, it is in fact the major one.

    Sweet is related to the spleen whose job is to transform food and transport nutrients to the body parts and hydrates the body.

    If this process is stopped,
    – you get demineralized.
    – you get dried skin, hair, eyes, mouth (for lack of water).
    – you get tooth cavities (for lack of calcium (no matter how much broccoli you eat)).

    Exactly what happened to me when I was on keto.

    I think keto can be followed by fat people, but lean people (as the Chinese are) should not stick to rice (and other grains).

    Kind regards,
    Bertrand from France.

  79. Neil from Australia says:

    I have only discovered your excellent web pages and information today. I have been following a LCHF/Ketogenic lifestyle since end of March 2016 with very positive results – significant weight loss, and marked stamina improvement (I do a lot of hiking).

    I also experienced an unexplained rash on my chest & upper abdomen. I did not (till now) think of a relationship to the level of ketones in my system. I use a Ketonix breath analyser to monitor variations/trends.

    I used coconut oil rubbed into the affected skin areas over a period of about three days. The rash disappeared and has not returned. I have no further data on this as I did not relate it to the ketosis at the time. I have used coconut oil for a number of years for any skin issue – applied directly to the skin, or consumed as part of my diet. I have noticed one other reference to use of coconut oil in this interesting stream of comments and anecdotes.

    You have done a great job with these web pages – and I still haven’t read all you have here 🙂

  80. Frank says:

    As a dermatologist, obesity medicine specialist and ketogenic for 10 years (also an elite ironman athlete)… Highly doubt your rash was from keto. Can take a lot longer than a few weeks to get rid of ( often 6-10 months actually)- try Uv light ( sun)- takes it away more quickly.
    This rash is very common and most people don’t even know they have it. There is no good evidence linking it with diet. Most common cause – viral illness though the etiology is still not completely known.
    In my clinical experience (with hundreds of low carb skin patients) most skin conditions improve on keto as it generally is profoundly anti inflammatory. Acne, rosacea, psoriasis consistently improve. Early in keto uric acid and ketones compete for renal excretion and can potentially cause itch and potentially increase risk for nephrolithiasis and gout. This however is a phenomenon that lasts only a few weeks.

    • BJJ Caveman says:


      Thank you so much for stopping by and commenting here. I tried going the UV route before and didn’t notice any improvement.

      In terms of your assertion that there is no relationship between the rash and diet, which is the same assertion the dermatologist I visited made, I think you might find my second site interesting:

      I’ve collected a series of anecdotal as well as evidenced based peer reviewed data regarding the rash, and there seems to be convincing evidence that a relationship with diet exists.

      I would love to get your thoughts.

  81. Rhonda says:

    Keto Rash—Trying to solve this ‘KETO RASH’ and came across this article—Too much biotin (eggs, nuts, cheese, dairy….) can rob your gut of B5 which could potentially cause a deficiency and thus, cause a skin rash. Thoughts?

    • BJJ Caveman says:

      It’s an interesting thought and not something I’ve come across before. I don’t know of any relationship between biotin and keto though. If I were biotin deficient and rash free prior to doing low carb, why would going low carb all of a sudden bring about the rash in a few days? I don’t expect my biotin levels would have changed much in the interim.

  82. Jinane Atchane says:

    Would you please mention a sample day of your ketosis diet that was the cause of this condition?

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