The Keto Rash after a Strict Ketogenic Diet

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NOTE: A version of this was originally published on bjjcaveman.com (here) on August 28, 2014

This one had a very promising title and was in Pediatric Dermatology on December 30, 2013.

Prurigo Pigmentosa after a Strict Ketogenic Diet

This was a single case report about a 17 year old white boy who presented with this rash on his chest, upper back, and abdomen for 2 weeks.  He also had pain in his knees, wrists, elbows and ankles.

Because of his joint pains, he was initially diagnosed with dermatomyositis and was treated with IV corticosteroids (methylprednisolone).  This resolved his joint pains however the rash persisted.

This doesn’t surprise me since as we’ve seen in my past few posts, steroids aren’t really that effective in treating this rash.

The fact that this patient presented with the joint pains caused me to raise my eyebrows a bit because that isn’t the typical presentation of the keto-rash (in the end they attributed the joint pains to a simultaneous viral infection).

He was monitored for a few months, and apparently not treated with anything, while the rash “waxed and waned in severity.”

At some point they discovered that he was eating almost zero carbs, hence the ketogenic diet, and was quickly given carbs to eat.  He was also started on Doxycycline 100 mg twice daily for two months.

The rash went away and did not recur for the period of follow up of 15 months, during which he was eating carbs.

As with the article in about the keto rash in the Middle East, we can’t say for certain if the rash is gone for good or if it will come back the moment he resumes a ketogenic diet.

I would really like to see a case where they treat someone with just the antibiotics without altering their diet to determine if the antibiotics alone can keep the rash at bay for good.

With the research that we have thus far, the best we can say is that Antibiotics + Carbs is the solution for keeping the rash away long term.

In my experience, and in those that have commented previously, carbs by themselves will keep the rash away… but only if we keep eating them.  The moment we remove carbs from the equation and get back into ketosis, the rash will re-appear.

Incidentally, they never discuss why this kid was eating a ketogenic diet… and they never document whether or not he was actually in ketosis using either blood ketones or urine dip sticks!

It also seems like this kid was on a longer course of antibiotics (2 months) compared to the 1 month course of the 4 subjects in the Middle East study.

This is what the kid looked like after his course of treatment:

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