Keto Rash in 49 Koreans

Keto Rash in 49 KoreansNow this may sound familiar, especially since I just wrote a post on another study where they analyzed the keto rash in 50 koreans, and I myself had to do a double take because this was published in the same year as the other study… but after reading the paper itself, I can reassure that it is a completely separate study.  While the country is the same, the authors are different, the journal is different, and the patients are different (although there may be some overlap, I’ll explain why).

Prurigo pigmentosa in Korea: clinicopathological study

published in 2012 in the International Journal of Dermatology

The authors studied 6 patients diagnosed in their hospital from 2003 and 2009, and also reviewed the charts from 43 other patients diagnosed in Korea between 1988 and 2008.

The other study with the 50 Koreans looked at cases diagnosed in 3 main hospitals (Asan Medical Center, Hanyang University Medical Center, and Boramae Medical Center) located in Korea between 2003 and 2011.

So you can see, there may have been some overlap in the cases that were reviewed from 2003-2008.  Now that we’ve gotten this out of the way, we can dig in further…


  • 36/49 were female (the other study also had 36 females!)
  • Age range of 11-64 years with a mean age of diagnosis at 22.7 years.

Associated Conditions

  • Rash occurred and recurred more commonly in the spring and summer, when it was hot
  • 6 patients reported weight loss following a strict diet
  • 4 patients reported associations with wet conditions like sweating, exercise, or wearing wet clothes
  • 4 patients developed the rash after swimming
  • 2 patients reported an association with wearing new clothes
  • 1 patient was associated with ketosis (unfortunately they don’t describe how they knew he was in ketosis)
  • 1 patient was pregnant
  • 1 patient reported an association with alcohol


  • Dapsone or Minocylcine or Dapsone + Minocycline in 37 patients all of whom had rapid resolution of the rash
  • Doxycycline in 1 patient with successful treatment
  • Topical corticosteroids or IV Corticosteroids in 7 patients given in combination with the antibiotics
  • 3 cases resolved without the patients having to do anything

My Thoughts


All in all, this study was very similar to the 50 Korean study although these authors did not report recurrence of the rash following antibiotic treatment.

It’s also interesting to see that there were also 3 patients in this study in which the rash completely disappeared on it’s own, without them having to do anything.  Could these have been the same 3 patients reported in the other study?  Especially given the potential overlap in the patient population?

In the discussion section of this paper they do bring up some interesting points.

Minocycline hydrochloried (100-200 mg daily), which is a semi-synthetic tetracycline antibiotic known to have anti-inflammatory properties as well as the ability to inhibit neutrophil chemotaxis…

This statement gives some further insight into the anti-inflammatory effects antibiotics can have.  Neutrophils are a special sort of white blood cell.  Chemotaxis is just the word describing how cells crawl around the body.  So what they’re saying is that antibiotics can be anti-inflammatory because they prevent these white blood cells from moving to where they want to go (ie the source of inflammation).

A second point in the discussion that caught my attention was that they referred to a few other cases in which the cause of prurigo pigmentosa was thought to be caused by allergic exposure to chemicals like: trichlorophenol, para-amino compounds, and chrome.  I’ll definitely have to look into these further.


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