One of my readers, Doctor Timothe, was kind enough to write a very thoughtful response and analysis of my first post on prurigo pigmentosa, and while I was in the middle of typing a response in the comments section, I thought it’d probably be more helpful to write it as a full post.
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 ?
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…
– Dr. Timothe
Thank you for such a thorough response! Here are some of my initial thoughts:
1. It’s great to see that you have not experienced this rash. It’s not a very common rash and not much is known about it still at this point. I was able to do a comprehensive literature search going back to 1978 in pubmed and found only 300-400 cases ever described, in all of the literature. So it’s probably safe to say that most people aren’t going to get this (looks like I’m one of the unlucky ones).
2. Pictures – Unfortunately I didn’t take more pictures of my own body as this was happening. Once I was diagnosed by the dermatologist, I kind of let things go. I thought, ‘Pytiriasis Rosea is a well described entity in the literature, and this guy probably knows what he’s talking about so I’ll just do what he recommends.”
In retrospect I should have taken more pictures to document this phenomenon. I didn’t want to go too overboard using pictures from the literature because I didn’t want to raise any copyright issues. Most of the journals I read required an account to access, and since I’m affiliated with an academic institution I have access to them. Here’s a link to other pictures of this rash from the internets. Mine looked liked a milder form of some of these.
3. Inflammatory nature of ketosis foods – This wouldn’t quite explain the pathogenesis in all the patients that developed the rash in diabetic induced ketosis/ketoacidosis, in which the rash resolved with simple administration of insulin. My diet consisted of coconut oil, grass-fed butter, bacon, cruciferous vegetables, organic omega 3 eggs, beef, tomatoes, avocados, chicken, and dark chocolate to name a few. I can’t imagine these things to be inflammatory.
4. Vitamin/mineral deficiency – Not sure. I don’t think this is the case because I was able to make the rash go away almost immediately after reintroduction of carbs. My understanding is vitamin deficiency (such as scurvy) actually take a while to develop. I actually thought about scurvy since I know it can present with a rash… so I took some vitamin C during this time, which didn’t really help. Not sure about other minerals since I’ve never really measured mineral levels in my body…
5. No other symptoms such as GI issues… just the rash.. which was only mildly itchy. Hot water seemed to exacerbate the itchiness.
6. Heavy metals – I’m dubious to the idea as to water concentration ‘unmasking’ the presence of heavy metal toxicity. When I do a rigorous work out, BJJ/Crossfit/Basketball, I go pretty intensely and can be very bad about rehydrating. This would in theory leave me to be hypovolemic and water depleted, which should unmask any underlying heavy metal toxicity I have, but this rash has never occurred before in any of those situations. Since I’ve never measured my levels of heavy metals, it’s something I’ll consider doing during my next blood test.
7. Martial Arts Hygiene – I have to admit, ring worm was one of the first thoughts that crossed my mind. I had it once a few years ago, and ever since I’ve become meticulous with my hygiene. When I train in BJJ, I always wear a long sleeve rash guard and compression leggings under my GI, no matter how hot it is. The only parts of my body that are exposed are my head and neck, my hands, and my feet. None of these places were affected by the rash.. only my trunk which is covered by the rash guard and GI, with no skin to skin contact. I also wash my gear after every training session. The instructor of my BJJ academy makes sure to clean the mats at least 3 times a day. I felt better after the dermatologist specifically said he didn’t think it was ring-worm… which is a disease that they see and treat all the time. All of these factors made me pretty confident that it wasn’t ring worm.
8. It’s not to say that any of these aren’t possibilities. The point is that not enough is known about prurigo pigmentosa and it’s causes. I just wanted people to be aware of this and provide an easy to read resource. There are definitely other rashes that look like this which can also confuse the issue. If you have a rash, it’s still probably a good idea to get it checked out by your doctor.