Here is an e-mail from Dem in Greece:
I am sending to you my case of “keto rash” in case you find it interesting for your very helpful website.
Wanting to lose some weight after my holidays I decided to follow to the letter the Dukan Diet protocol because I know from the past that it works but I had never because followed it strictly.
So I started with the Dukan Attack Phase eating for 4 some days ultra-low carbs. On the fourth day I noticed the rash on my skin. Alarmed by it because I hadn’t read anything about it before I did a Google search and voila! I found your website.
Thanks for putting all the effort to make it because it really helped me to understand what was going on. Although my rash was not prurigo pigmentosa (from what I can see in the photos in your side (it looked more like mosquito bites and was mainly in my arms and legs in parts that come in contact with the desk and the chair where I sit) I immediately stopped the Dukan protocol and decided for the next couple days to go on the opposite side i.e. to an ultra-high carbs diet to see if the rash will go away.
So for the next two days I went to eating almost only carbs and in very high quantities:
Brown sugar cubes (!), potato chips, pasta and the like.
And lo and behold, from the second day the rash started to diminish and with it the horrible itching (without using any lotion, antibiotics or anything else). By the fourth day of high-carb the rash was gone by 90% and the itching stopped
So in summary:
It took 4 days of ultra-low carbs to bring forth the “keto rash” and 4 days of ultra-high carbs to take it away.
In my mind there is no question that it is the ketogenic diet that causes the rash (and although I don’t have any proof I believe that it is not a detoxification effect but an inflammatory condition that makes the auto-immune system to attack the organism.
Philip what is your theory about the keto-rash after all the studying you have done on the subject?
I’ve heard of the Dukan diet before but had to give myself a refresher. It’s essentially a protein heavy diet with non-starchy vegetables added in at later phases.
Now one thing I want to clarify is that just because the rash doesn’t present itself exactly like what all the pictures here show doesn’t mean it’s NOT prurigo pigmentosa. Rashes can have varying presentations. If the rash comes and goes with carb intake, then it’s pretty much confirmed to be prurigo pigmentosa.
It’s also important to clarify that not all rashes are prurigo pigmentosa.
As to my theories as to the causes of keto rash? These are all the potential causes. I tend to favor a bacterial/micro-organism cause. I’m not sure where though… organisms on the skin? Organisms in the gut? At this point who knows.
The fact that antibiotics are an effective therapy really make this a likely scenario for me.