Research

Case Report of the Keto Rash in the journal: Pediatric Dermatology

The Pediatric Dermatology journal published a case report of the keto rash, prurigo pigmentosa, in their March-April 2015 issue:

Prurigo pigmentosa after a strict ketogenic diet.

 

This was a report of a 17 year old kid who developed a rash and joint pains.  They thought he had something called dermatomyositis which involves inflammation of the skin and muscle, and treated him with intravenous steroids.  This only helped his joint pains, but his rash remained.

Steroids Did Not Help

The ineffectiveness of steroids is typical of keto rash.… Read More

A Reader Shares His Keto Rash Biopsy Results

Keto rash biopsy 1Keto rash biopsy 2Keto rash biopsy 3All identifying information was redacted.

I’ve always been curious as to what a biopsy of keto rash would show and was pretty excited when this reader emailed his report to me.

I asked him a couple of questions and this is how he responded:

You are welcome to share whatever! Where was your site 5 years ago when this started!? It’s a godsend for any of us that suffer from the condition. And yes, it leaves after a couple of days carb intake.

I will email you again after I start the oral anti fungal, which will probably be after I see if what I”m doing now works.

Read More

Ketone bodies cause inflammation? I call BS

In a few of the papers I’ve read, some authors have expressed the notion that ketone bodies can actually cause inflammation, and this may be an explanation for why the keto rash occurs.

Most recently I read this in the study looking at prurigo pigmentosa in 50 koreans:

Ketone bodies cause inflammation BS1

 

Like I mentioned before, this idea really piqued my curiosity so I headed on over to the references and saw:

Ketone bodies cause inflammation BS2

Fantastic!  I now had a resource I could turn to.  I went ahead and found this paper published in Diabetes & Metabolism in 2005 on Pubmed and discovered that luckily it was a free article. … Read More

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).… Read More

Prurigo Pigmentosa vs Confluent and Reticulated Papillomatosis

Prurigo Pigmentosa and CARP

This is just a letter to the editor in the Journal of the American Academy of Dermatology reporting a single case published in 2013.

Is prurigo pigmentosa an inflammatory version of confluent and reticulated papillomatosis?

The case was of a 24 year old white male with a 2 week history of itchy rash on his back, chest, and abdomen.

He was first treated with both oral and topical corticosteroids to no effect.  A skin biopsy was performed and he was diagnosed with prurigo pigmentosa.

Unfortunately they do not go into potential causes of the rash in this patient (ie fasting, dieting, weight loss, etc.), but since this is a letter to the editor, it’s not subject to the same scientific rigor as regular journal articles.… Read More

The Keto Rash in 2 American Women

Keto Rash in 2 American Women

Keto Rash in 2 American Women2Here are two American women that developed the keto rash.

Prurigo Pigmentosa: Report of two cases in the United States and review of the literature

Published in the Dermatology Online Journal December 2011

I actually really feel terrible for the first patient because she had this rash off and on for 2 years and underwent multiple skin biopsies… which led to her being misdiagnosed with herpes simplex virus for which she was treated unsuccessfully with anti-viral medications (oral acyclovir, valcyclovir, and topical acyclovir) as well as topical corticosteroids with no improvement.… Read More

The Keto Rash in 50 Koreans – The Most Comprehensive Study Yet!

PP 50 koreans 2This is a great paper with one of the largest series of keto rash cases assembled to date.  They also do a wonderful job going into the history of the rash, and is probably the most comprehensive paper available.  Let’s dive in!

Prurigo pigmentosa: Clinicopathological study and analysis of 50 cases in Korea

Published in 2012, in the Journal of Dermatology

They report that this rash was first described in Japan, in 1971 (can’t wait to look at this paper), with more than 300 cases reported at the time of this papers publication.… Read More

The Keto Rash and H. Pylori

PP-H-PyloriNOTE: A version of this was originally published on bjjcaveman.com (here) on September 5, 2014.

This was another paper that caught my attention because of the title which identified a specific organism in the skin biopsy of the prurigo pigmentosa rash.

Identification of Helicobacter pylori in Skin Biopsy of Prurigo Pigmentosa

This was published in the American Journal of Dermatopathology on June of 2012.

This was a 23 year old Chinese man with a history of rash for 3 years.

They performed a skin biopsy from which they were able to isolate the Helicobacter pylori organism. … Read More

The Keto Rash and Lyme Disease

PP-BorreliaNOTE: A version of this was originally published on bjjcaveman.com (here) on August 31, 2014

I was very excited by the title of this article, especially since it offered potential insight as to a specific infectious etiology to this rash!

Molecular detection and genetic identification of Borrelia garinii and Borrelia afzelii from patients presenting with a rare skin manifestation of prurigo pigmentosa in Taiwan

This was published in the International Journal of Infectious Diseases, August 2013.  This is a free article, so please feel free to read the whole thing yourself from the link provided.… Read More

The Keto Rash after a Strict Ketogenic Diet

PP-ketogenic-diet

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). … Read More