Zemanta Related Posts ThumbnailI’m currently in the midst of an experiment for fat loss and body recomposition using a variation of a cyclic ketogenic diet called the Carb Nite Solution, which essentially has me in ketosis for the entire week with a single day where I am required to do an aggressive carb re-load within a window of 6-8 hrs.

I wanted to provide an update on the effects of this diet on prurigo pigmentosa, which is the rash that many of us have discovered appears when we are in a state of ketosis.

During the 1st week of my experiment I noticed that a few of the spots that signaled the rash started to appear as my blood ketone level crossed over into the nutritional ketosis range (> 0.5 mmol).  Slowly more and more red dots would appear on my chest and back the longer I remained in ketosis.  Within the few days immediately following my carb re-feed, the rash disappeared immediately.  I decided to take some pictures in order to document this effect.  You can click directly on them for full resolution versions.

I’ve also included my blood ketone records here for reference


10/13 – The morning of my week 1 Carb Nite.  As you can see there are a few of the typical red dots of the rash in my upper back and mid chest.  At this point it wasn’t itchy at all.  Unfortunately by this was the day I had run out of ketone strips so I didn’t have a blood ketone measurement.  However my blood ketone measurement from the day before was 0.9 mmol, well within the range for ketosis.

 10/14 – The evening immediately following my week 1 Carb Nite.  You can see the rash is already starting to fade.  Things look a little different because I used a flash for this one.  You can also see some scratches along my back from my BJJ training!  Again I wish I hadn’t run out of ketone strips, but considering what I ate the during my Carb Nite, there was absolutely no way I was in ketosis.

PP 10.14 BackPP 10.14 Front

10/15 – Two days after my week 1 Carb Nite and you can see the rash has almost completely disappeared.  There are only a few dark spots remaining.  Still no ketone strips. today.

PP 10.15 BackPP 10.15 Front

By the following day, even the dark spots were gone.  No trace of prurigo pigmentosa at all!  At this point I stopped taking pictures regularly.

However, I noticed that as my experiment progressed a pattern emerged.  Approximately 4-5 days after my carb re-feed, around when my blood ketones jumped into the ketotic range the rash would reappear.  Faintly at first as in the pictures above, but the following day, it would become worse.  More red dots and darker red dots than the previous week.  Then 2-3 days after my Carb Nite, the rash would disappear completely.  I’d have 1-2 days of clean skin, and then as I re-entered ketosis, the rash would come back.  Again, faintly at first, and then more aggressively.

This pattern has been pretty consistent throughout my entire cyclic ketogenic experiment.  Here are a few random snap shots:

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10/24 – This was taken 5 days after my week 2 Carb Nite with my blood ketones measuring 1.3 mmol. Due to the lighting, it doesn’t show that well but the rash has spread to my mid and lower back.

11/1 – This was taken 7 days after my week 3 Carb Nite.  My blood ketones measured 0.6 mmol.  You can see that there are more red dots and they appear darker than previously.

 PP 11.1 BackPP 11.1 Front

At this point I’m thinking about playing around with two options:

1. Keep things as is and continue my cyclic ketogenic experiment for weight loss and body recomposition and see where this takes me.  I wonder exactly how bad the rash will get the longer this continues?  There’s only one way to find out…

2. Try a course of antibiotics (Doxycycline or Minocycline), which are reported to treat the rash effectively.  The only question I’m not entirely sure of is if the treatment is temporary, ie will the rash return?  Or will it permanently make the rash go away so that I can stay in ketosis and be rash-free for good?

The results of these options may also yield insights into the potential causes of this rash.

What do you think I should do?

36 thoughts on “Prurigo Pigmentosa: The Keto Rash Revisited with a Photo Journal”

  1. Pingback: The Ketosis Associated Rash - Prurigo Pigmentosa | Mark's Daily Apple Health and Fitness Forum page

    1. Interesting that you bring this up. I actually had it slated as my next book to read.

      What’d you like best about it?

  2. Mostly the no Bro-science, it’s based on real studies with no bias.

    But the keto diet is pretty simple, the problem is the stuff people try to add that’s incorrect and mostly bro-science.

    Actually I would recomend this book over the one your using now “The Art and Science of Low Carbohydrate Performance”

    1. Thanks. I’ll let you know what I think after I pick it up.

      Out of curiosity, why’d you say that the guy is an a-hole. I’ve seen the around on some message boards, but it seemed mostly in terms of customer service and response to questions…

  3. I just say that because I see that some think he is a little anti-social and can be a little rude at times and the people who complain think he should bend over backwards for them, I think anyways.

    I guess I say this just as a warning, because it seems most people today are a little too sensitive.

    I notice these things but I’m fine with it, I’m not bothered.

  4. Pingback: Carb Nite Solution results after 10 weeks | The BJJ Caveman

  5. Any update on the prurigo pigmentosa / what you’ve been doing to treat/mitigate it? I’ve recently developed a similar rash after making a concerted effort to re-enter nutritional ketosis.

    I’d love to hear that you successfully treated it with the antibiotics, and could subsequently resume ketosis without the rash!

    1. Haven’t had a chance to try the antibiotics yet.

      Currently I’ve been messing around with trying to do ketosis while taking resistant starches.

      Bad news is, rash still came back… just today! Will have to do a post on this too….

      Thanks for following up.

      1. Following up here…

        My rash arrived immediately after a 2-day fat fast. I just had blood ketone strip; it measured 0.8mmol first thing in the morning about 2-3 days after the fat fast, when the rash was starting to concern me.

        I variously tried benadryl at night, allegra 1x/day, and hydrocortisone cream. I tried a big bowl of berries to no effect one night, but that was about all the carbs I wanted to wager on experimenting with adding carbs. The rash ebbed and got more inflamed on a day-to-day basis with no pattern I could figure out.

        2 weeks of regular keto later when it hadn’t gone away, I went to the doc with some of the studies/info you’ve collected (thanks!).

        I had the rash only on my stomach, lower chest, and upper groin areas: mainly and most inflamed in the center of my stomach around and above my navel, but also wrapping around my sides some.

        He wasn’t totally convinced about the PP (especially since I’m not asian), but prescribed doxycycline, gave me a stronger steroid cream, and recommended trying zyrtec as an attempted “3-way attack” to knock out anything it might be.

        I started with just the doxy for a few days (mostly to see what would happen). The center rash around my navel went away almost immediately, and was completely gone within 3 days, though the rash on my sides stubbornly persisted, and (my wife insisted) “looked worse”. I started the steroid cream about 3-4 days into the doxy treatment and switched from allegra to zyrtec a few days later.

        On days 9-10 of the 10 day doxy course, just as I was starting to despair, the rash on my sides faded and went away too.

        ~10 days after ending the antibiotics, the rash hasn’t come back. I’ve been in standard/strict keto the whole time. Ketostix (acquired after the antibiotics were done) show in the 15-40 (light to moderate) range.

        I took a “strong” probiotic supplement beginning when I started the doxy, and have continued it. The antibiotics made me feel bloated for about 2 weeks, but my digestion seems to be back to normal now. I’m happy I went with the antibiotics, rather than dealing with this with no known end.

        1. Wow, thanks so much for the followup. Glad it worked so well for you.

          If you don’t mind, can you chime in with a post to update us on how things are after 1 month and then 2 months?

          If it is bacterial in nature, it may take a while for it to come back and recur. It’d be great to know for certain that using the antibiotics will make it go away for good while on ketosis.

          Thanks again!

        2. Hey Nick,

          I know I am responding to your comment a year later, but are you able to give an update. If the rash returned and how long after treatment?


          1. Treated myself with Antibiotics December 2014, and up till now, March 2015, rash has been completely gone!

  6. The first time I went on keto I got this for months. Mine was jut on the front of my chest. It only stopped when I slightly upped my carb count(still staying on keto) on workout days which seemed to get rid of it.

    I just started deep keto again, and the rash has come back in two weeks. I’ll probably have to up my carbs before/after workouts to get rid of it.

  7. I had the rash for about 3 weeks and finally got a prescription for Minocycline and could feel a huge difference after 3 days. My prescription is for 4 weeks and the rash now (after 1.5 weeks of Minocycline) is pretty much gone except for the pigmentation. Just wondering if I should stop the antibiotics and save the rest for if it comes back or to finish the course, how long did everyone else stay on the antibiotics?

    1. It’s interesting that many of the papers I’ve read don’t really go into how long and what dose of medications they used to treat the rash. I still have a few papers to go through, so hopefully the answer will be in those!

      I’d be interested to see how things go with you! Let us know what you decide to do, and whether or not the rash comes back!

  8. I decided to take a break on the Minocycline at 2 weeks so I have taken exactly half my prescription. My last dose was on Thursday and so far so good although I also did a carb refeed on Wednesday (2 big mangoes + other things) and I don’t think I am back in Keto fully yet. So we will see how it goes with time. It’s good to know that I have the 2 weeks worth of drugs when I need it, I was miserable when the rash was in full bloom 🙁

    1. Great! So at least we know that in your case 2 weeks of antibiotics will make the rash go away.

      Now the question will be how long this effect lasts! If you can go back into keto and stay there for at least 2-3 weeks without the rash coming back, then that really supports the idea that antibiotics are the ultimate cure for it!

      Please keep us updated!

    2. swedish dude

      The interesting/unkown part is if the rash goes away when you take the antibiotics while still in ketosis and after the treatment.

      What I would really like to know is if the rash diasppears for good after treatment.


      Ive tried the grapeseeds, I did not notice any diffrence, the rash returned in it normal fashion. Only treatment so far is the carbs.

      My personal oppinion is that this is not a fungal issue.


      1. At least 1 or 2 people in the comments section of my original PP post have reported up to 3 month rash remission following antibiotics.

        1. Very disappointed that my rash came right back after 1 week without the antibiotics, and I did a carb refeed the day before stopping and it took me at least 4 days to get back into keto properly. So needless to say, I only has a week off antibiotics. I had it in 2 areas (1 large and 1 small) and only the rash only came back to the small area. It also took a lot longer for the antibiotics to do its trick (over a week, and I would say it’s still a tiny little bit itchy even now). I am going to run out of Minocycline in a few days, will try taking some time off again (have doctor’s appointment on the 23rd so will get another prescription then if it’s back).

          1. Wow, sorry to hear that it came back. That’s very disappointing. Are you going to try doxycycline?

          1. One of the commenters named John wrote:

            “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.”

  9. SD – Yes, I am still in Ketosis and I took my last Mino yesterday so we will see what happens this time. It was still a bit itchy yesterday where it came back, I hope I can last till the 23d. My doc prescribed Mino rather than Doxy because I only have to take 1 a day and I agreed, maybe I will suggest Doxy this time (a different doctor though so hopefully she will be as open-minded with my internet research as the last one).

    I will try to update here with what happens.

  10. An update – I took my last Mino on May 7 and the rash has not returned this time, I wonder if I needed to take it continuously for 1 month to kill of whatever bacteria is causing the rash or it was the fact that I am now not in as deep ketosis as before, I am mostly between 1 & 2 while as before I was more in the 2 & 3 range, not by choice but just my desire for some foods got the better of me.

    I also got a prescription for 3 x 1 month worth of Mino but will only get it when I need to so I should be ok for a while 😀

      1. This rash is (according to a naturopath) yeast infection. When we go low carb it will kill the yeast in the body and this is the result. Taking acidophilus (noFOS – which is a sugar) and drinking water along with using a cream like NatureCare AF- anti fungal cream will take care of it. It should clear up in a month as long as you keep it dry and use an antifungal cream. I’ve had it too around my bra band. This may be why folks get the dreaded Keto flu which is the effects of yeast dying off in the body. Hope this helps

  11. I’m wondering if you are still having these rashes Kay or did the antibiotics help to solve your problems permanently?

    I’m currently dealing with this rash aswell(looks very much like other cases of prurigo pigmenosa) since about 2 months ago when I started reducing carbs and like most other report it’s been worse when strictly low carb and gone during periods of more carbs. The prescribed cortison and antihistamines haven’t really helped except maybe relieving the itching somewhat if not only placebo.

    Would very much like to know if antibiotics could work as a permanent solution for this in order to keep eating low carb and have all the other great effects that it have given me.

    Greetings from sweden

  12. Pingback: Prurigo Pigmentosa - The Ketosis Rash Nobody Warned Me About - The BJJ Caveman

  13. Hi I know this is already two years old. I just started on the ketogenic diet. I must say that I will never go back to any other diet. I’m losing weight rapidly but the new found advantage that’s surprisingly overshadowing the weight loss is the mental clarity. I feel it particularly several minutes after eating a high fat meal. I am also dealing wit rash. I’m one of those that may be inclined to think this is fat cells releasing toxin because the rash happens in the areas where fat accumulates. the outer-lower chest (man boobs), the stomach, below the arm pits. for me those are all areas where my fat has resided. I’ve been googling this and the concensus is that there are too many variables to tell or associated with any one thing. However in my case I’m going to treat it as though I’m certain it’s keto related. Ive been trying rubbing lemon on my rash, rubbing organic coconut oil on the rash, increasing the amount of carbs to roughly 50g, adding organic apple cider vinegar and lemon to my drinking water and consuming at least 64 oz of water per day. my rash is fading. some areas still itch and unfortunately it is also the middle of summer time and I am almost always at least a little sweaty. To sum it up. Not sure which of these elements are causing the rash to subside but I will continue to implement all of them and I’m hopeful that the rash goes away.

    1. Best of luck. Thank you for sharing your experience. If you figure something out that works, please let us know!

  14. Thanks for sharing guys. I’ve been stressing out for the past week of getting the rash. Noticed after rapid weight loss I had two patches of rashes on the side of my neck. Thought nothing of it and started putting topical cream on it. It slowly started fading away and I was relieved, but 4 days after a bright red patch of rash started forming in the center of my chest and started growing to my left moob. I tried applying ointment once again but it didn’t work. I have been reading constantly about the keto rash, yeast die off, and everything to see what natural way I can combat this. I started eating carbs again yesterday and will report my findings. I do notice that ever since I’ve been on this low to no carb diet, I feel more heat radiating inside my body. The same kind of feeling you get when you take hydroxycut. Sad. Was hoping to show off my nice new slimmer body but now I got this ugly rash to show for it. Oh the irony.

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