Treatment

Treatments supported by literature and known to be effective:

  • Antibiotics – The length of treatment is varied in the literature from 2 weeks to 2 months, with 1 month appearing to be the average.
    • Doxycycline100 mg twice a day (or 200 mg once a day) for 1 month
      • Doxycycline is emerging as the preferred antibiotic because of its better side effect profile
    • Minocycline 50 mg twice a day (or 100-200 mg once a day) for 1 month
    • Clarithromycin 250 mg twice a day for one week
    • Antibiotics that have fallen out of favor
    • Some papers suggest that the reason these medications are effective is because of the anti-inflammatory effects of antibiotics rather than their anti-microbial properties
    • It’s also unclear how long the effects of the antibiotics last.  While most papers indicate that antibiotics treat the rash permanently, these papers also couple the treatment with a change in diet (ie stopping the fast or attempted weight loss, or adding carbs to stop a ketogenic diet), so I don’ think you can say for certain.
      • Here is one paper showing the return of the rash despite antibiotic therapy once patients resumed their dieting attempts.
  • Stop Fasting – This has been repeatedly shown to work in patients that present with this rash after they start fasting.
  • Increase carbohydrate intake – This has also repeatedly been shown to work in patients that develop this rash when in ketosis, whether as a result of another disease, or by choice (as with a ketogenic diet).
    • This is the treatment course I’ve chosen.  I can make this rash appear within a few days of eating a ketogenic diet, and then I can make this rash disappear by increasing my carbs.
    • I even documented this with a photo journal correlated with blood glucose and blood ketone testing here.
    • Some commenters have found success by slowly titrating their carb intake up in order to find that narrow window of carbs that will allow them to keep the rash away while staying in ketosis and allowing them to benefit from all of its positive effects.
  • Do Nothing – At least one paper has reported cases of the rash spontaneously resolving after a couple weeks.  I have my doubts about this, since they didn’t consider patients who were eating low carb who then subsequently added carbs back into their diet as a treatment, and may have included them in the ‘do nothing’ category.  Also this was not my experience, since I had the rash for almost 8 weeks until I added carbs back in my diet.

Treatments mentioned in the literature with questionable efficacy:

Treatments tried by commenters:

Treatments recommended by Dave Asprey:

  • Toxin Binders
    • Activated charcoal
    • Calcium d-glucarate
    • Glutathione
    • Chlorella
  • Antifungals
    • Grapefruit seed extract
  • Miscellaneous
    • Berberine
    • Garlic

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89 Comments

  1. Judy

    Thank you for this site. This is the best information I’ve ever seen, as someone who has suffered with this recently. It’s strange for me because I first did keto for over 6 months, I lost 50 pounds and had no rash. Then I took a break and now every time I return to keto I get this rash.

    Anyway, my question is, do you know how much is a “large dose” of fish oil? I’d like to give it a try, as I’ve been wanting to take it anyway for other supplemental reasons.

    Reply
    1. bjjcaveman@gmail.com (Post author)

      Regarding the fish oil, I’ve read anywhere from 1 gm to 4 gm… some people even go up to 8 gm!

      I’d be careful though because prolonged intake of high dose fish oils can lead to some complications… such as bleeding!

      Reply
  2. Dustin

    Thanks so much! I’m going to try the grapeseed. I’ve suffered from this on and off (only after about 4-5-weeks of ketosis.) I even had a doctor wrongly diagnose it as a yeast infection.

    You can understand my reluctance to simply eat more carbs as the ketogenic diet has aloud me to loose 70lbs and keep 50 of it off for 7 years.

    Reply
    1. bjjcaveman@gmail.com (Post author)

      Thanks for the comment! Let us know how the grapeseed works out for you!

      Reply
      1. Aisha

        Really good website. I have tried to lose weight going into ketosis many times. ( around 20 carbs per day) and ALWAYS come out with a rash on my face about 3 days after entering ketosis. It gets itchy, hot, scares badly and always comes out on the exact same places on my face. WEIRD! But the rash looks just like Prurigo Pigmentosa. I’ve tried Topical corticosteroids, anti fungals, anti histamines, oils and NONE work. But like expected, the rash starts to fade when the carbs are introduced back into my diet.

        I’m hoping taking antibiotics during the phase of the keto diet will keep the rash at bay. My only problem is getting hold of such antibiotics! I live in the UK and normally the only way to get such anti biotics is to already have an infection and go to a doctor. Any suggestions?

        Reply
        1. bjjcaveman@gmail.com (Post author)

          My only suggestion is to get an appointment with a general practitioner and provide print outs from my website, especially being sure to print out the papers I reference.

          Then also show him that you’ve been in documented ketosis, either with ketone strips or blood ketones.

          I don’t see how they would still deny you the antibiotics in the face of such hard evidence.

          Reply
        2. valarie mceuen

          Where did your rash appear on your face? I have several spots now too -on the left and the right of my chin, both temples and a spot right by my upper lip.

          Reply
          1. Jack L.

            I’m entering week 3 of the keto diet. I woke up and had two c shape rashes on both sides of my chin about a quarter of inch length. Very weird.

        3. Asuru

          I live in UK as well. Were you able to get the antibiotics and if so, how did you do it?

          Reply
  3. Josh

    I’ve had a mixed bag with this. The first time I adopted a ultra low carb diet with intermittent refeeds I developed this rash for about the first 2-3 weeks and then it faded and I never had another bout of it for the remain 10-12 weeks I conducted that experiment.

    The next time I went ultra low carb I got it right away and couldn’t shake it without reintroducing carbs to the point I couldn’t maintain keto. My diet leading up to that was pretty jacked and carb heavy so I’m wondering if that had anything to do with it.

    I’m trying again, this time coming off a much more moderate diet that would probably be considered low carb by some. It will be interesting to see if and for how long I am afflicted.

    In any case, I was not aware that antiboitics had any effect and will give those a try if I get a rash lasting longer than two weeks this time out.

    Reply
    1. bjjcaveman@gmail.com (Post author)

      Great! Thanks for sharing. Let us know how things work!

      Reply
  4. Adis

    I am currently on keto and it has been about 4 – 5 weeks since I have started it and this rash appeared on my back literally over night. I woke up one morning itching like there was no tomorrow. I have reintroduced carbs into my diet but how long until I see change?

    Reply
    1. bjjcaveman@gmail.com (Post author)

      I noticed a change after 2-3 days.

      Keep us posted as to how things turn out!

      Reply
      1. Joel

        Adis, I also had the rash appear on the middle of my back over night with no warning. It was on the 5th day of restricting my carb intake. I have had the rash now for about 2 weeks with no significant changes. Only thing I have done is try and eliminate different foods to make sure I wasn’t allergic to anything (so far no success on that front).

        Reply
        1. Joel

          Just an update on mine.. The rash started to diminish after 48 hours of upping my net carb intake to ~50 per day. It’s now been over a week since making the modifications to my diet and the rash has lost all of it’s itchiness and redness. The color is now a light brown as if my skin is stained, but even that seems to be dissipating.

          Reply
          1. bjjcaveman@gmail.com (Post author)

            Thanks for sharing! It looks like all you needed was just to add some carbs.

            Now that you know that, you can try to experiment with finding that narrow window of carbs, where it’s low enough so you can derive some of the benefits of going low carb, while still high enough to prevent the ketorash from coming back!

  5. Phil

    I am getting the keto rash and can also confirm that once I increase carbs it goes away. This is my second time entering deep ketosis and the rash is back with a vengeance. Is there ANY WAY other than antibiotics that has taken care of this yet while staying in deep ketosis? Has ANYBODY had luck with waiting it out? I will probably only go about a month but this is highly frustrating.

    Phil

    Reply
    1. bjjcaveman@gmail.com (Post author)

      I haven’t come across anybody that has had luck with waiting it out. I’ve even read about people having this rash for years on end… so waiting it out doesn’t seem like a good option.

      The only definitive ways I know of are

      1. Antibiotics – You can do this while maintaining ketosis.

      2. Increasing carbs – Some readers have found success bringing their carbs high enough to be out of the rash.. but low enough to still experience some of the benefits.

      Reply
    2. ella haliminski

      I may have an answer to partially treat your rash. I found that part of the reason for the rash is ketones excreted through sweat having an irritating effect on the skin. Try to wash your back (or affected area) twice a day with water and a gentle soap (I used a sonic brush to better remove debris and dead skin), and at the very least wash it with a wet cloth whenever you sweat. This will reduce itchyness and irritation. I also used a specifically prepared acidic formula to “burn” my back once a day, giving myself a light peel. This kept my rash at bay, but in the end antibiotics took care of it in under a week. Only the brown marks left now.

      Reply
  6. Hans

    I can just say Cortisone. Cortisone-creame just removes the rash in 1-2 Days. Ofc this is not a treatment of the actual cause. That seems to only be to let the body get used to it or eathing more carbs. But when it comes to get the rash to be removed Cortisone-Cream just totaly nailed it.
    Went from beeing the itchiest thing ever to just som discolouring on the skin in 2 Days for me.

    Reply
  7. Anita

    I have had an itchy rash on my upper back ever since I started a very low carb diet a number of years ago. I went on the diet as a way to treat Candida overgrowth so at first thought it was a yeast rash but it doesn’t follow the same pattern as my other Candida symptoms. I have found many other benefits to a low carb diet as well as having read so much good information about the dangers of grains. I think I will try to raise carbs a bit but have a difficult time doing that without making the Candida problem worse. Glad to find your site – thanks for the time and effort you’re putting into it.

    Reply
    1. bjjcaveman@gmail.com (Post author)

      Glad this helped you out! Best of luck!

      Reply
  8. Ross

    Just found your site after having struggled with what appeared to be a shaving rash that appeared about six months ago. Also had developed some recurring bumps on my scalp a few months prior to that. Never had them before. I’ve always shaved with regular soap and had no problems whatsoever, then developed this irritation which became chronic. It’s waxed and waned bu never gone away. It’s progressed to a feeling of general itchiness from my neck up.

    Now my problem with putting it down to ketosis is that I’ve been low-carb (20-30gms net carbs day) for about 18 months before these problems developed. I did wonder if it could be diet related but since I was so far into it (having lost about 40kgs/90lbs) at that point I just couldn’t make the connection. All other health indicators were pretty stable.

    So the question for me is do people develop this rash after having been in ketosis for some time, or is it a reasonably quick-developing thing?

    Reply
    1. bjjcaveman@gmail.com (Post author)

      From what I’ve read, it can be both. In my case it took at least a few months to develop. After it developed, whenever I carbbed up it would go away pretty quickly, and whenever I’d go Keto again, it’d come back within days… sometimes even the night of!

      Reply
  9. Jill

    I too have a pimply ( like a heat rash) over my face. Very itchy. Been on this woe for 6 weeks. Have been on a probiotic forever until the past 3 days. Was wondering if going off this could somehow contribute in some way

    Reply
    1. bjjcaveman@gmail.com (Post author)

      I’m not sure. Nothing in the literature has suggested this, but you never know.

      Reply
  10. Beth

    I wonder if green tea extract might help. I’m going to try. I’ve been off carbs two days and taking spirulina and I don’t think I’ve improved, or at least I haven’t fast enough. I read here that the antibiotics that are working for people “inhibit migration of neutrophils” and I googled and found this article saying green tea, specifically the EGCG in it, might do that: http://www.jimmunol.org/content/170/8/4335.long
    Again, thank you so much for this site!! The doctors don’t know about this “rare” condition that turns out isn’t so rare in our diet crazed culture.

    Reply
    1. bjjcaveman@gmail.com (Post author)

      Give it a shot with the green tea and let us know how it goes!

      Reply
  11. Beth

    After four days on carbs and the green tea extract and spirulina the rash has died down, not completely gone but the end is in sight.

    Reply
    1. bjjcaveman@gmail.com (Post author)

      Great news!

      Reply
  12. paleoinc

    Definitely garlic, GSE orally and topically applied with Mometasone Cream.

    Reply
  13. A reader from Japan

    Thank you for this site. Best wishes for you.

    Reply
    1. bjjcaveman@gmail.com (Post author)

      You’re welcome!

      Reply
  14. Mikey MIleos

    Hello!

    Cool website. Quick question, do the antibiotics work long term? Like, if I get a keto rash, do I have to take them while I have the rash or can I take them before for a month and see the same results?

    The reason I ask is that sometimes I do extended water fasting, and pretty much every time I have, I have had to stop due to the keto rash.

    The first time I lasted about 3 weeks. Since then I can’t go more than 10 to 12 days before it becomes unbearable.

    I wouldn’t want to be taking antibiotics during a water fast, which is why I ask about it. I guess it would be called a cure not a treatment if it worked long term, but yea, I’ll ask anyways.

    Thanks!

    Reply
    1. bjjcaveman@gmail.com (Post author)

      All the research seems to indicate that antibiotics last permamently.

      I can tell you that in my experience, it treated the rash for at least a year, but I’ve noticed that in the past few months, after hard days of training I see a few spots of the rash coming back…. so in my case, I don’t think the effect was permanent. I’m not even eating a keto diet, I’m eating lowish carbs in the 100-150 gm range, and I suspect that when I train hard I cross over into keto and that’s when those spots come out.

      Reply
  15. Aisha

    Hi there. I can’t quite say if they work long term because I’m not brave enough to find out. Last time I did a water fast I just took the antibiotics during the duration of my fast. But still felt great after fast, so I don’t think they really had any negative effects on my body.

    Reply
    1. Mikey MIleos

      Thanks! I try not to take anything during a water fast but if it works, it might be worth a shot.

      Reply
  16. Joseguadalupe

    By all means eat a good variety of foods, the more nrtaual is generally thought to be better for you. Feel free to lower your intake of soda pop and other sugary foods, but carbohydrates are necessary energy. Carbs are the energy you use to run, for instance.Grains, which are often thought of as carbs, also contain amino acids, which are the building blocks of proteins. Proteins are what allow every cell of your body to function, and are especially important for building muscle. To intake a full complement of amino acids, eat grains (especially whole grains)- found in bread, pasta etc- and Legumes, such as beans. Meats also contain a full complement of amino acids.many low carb diets don’t consider whole grains carbs since they have a large amount of fiber in them, which helps your digestive system keep itself healthy, but they would still help provide energy for running. Weightlifting would help you become more defined than cardio exercises such as running, biking etc, which raise your metabolism and help you stay trim. Weightlifting would add muscle bulk and define your muscular structure as well as strengthen other muscle groups. Food choices honestly won’t define. Food provides opportunity for your body to become something; opportunity to live, grow, become. You still have a choice to make: store that opportunity in fat, or use that opportunity to build muscle and strengthen your heart and lungs. The choice is whether or not to exercise, and what kind of exercise you do.

    Reply
  17. Killigirl

    I was under the impression that a ketogenic diet is an anti inflammatory diet. Carbs and sugars cause inflammation

    Reply
  18. De Anna

    I broke out with a rash on my neck when I first entered Ketosis, but it came and went and I put up with it without doing anything. Strangely, when it returned, it was in the exact same strange pattern and place. Then, overnight it spread up my chin, along my jawline and around my ears, streaked across one cheek, up the side of my nose, and also took over the tip of my nose. It was Red, hot, bumpy, angry, and horribly itchy. It looked bad too. I would have given anything to have had it on my trunk, as others have described. No OTC treatment gave me any relief. Cortisone cream burned, and Benedryl did nothing.

    I went down the summary list (above) and decided I would use antibiotics as a LAST option, as I have already taken so many antibiotics in my life for other reasons. I just couldn’t bring myself to putting lemon juice on my face. I was not willing to end Ketosis just to get the rash to clear up. I did, however, stop intermittent fasting.

    A friend suggested it was a “toxic release reaction” and that I try Infrared light therapy. Now, this falls into the quacky category for me, but I was desperate to try anything short of oral antibiotics as the rash was literally in my face and couldn’t be ignored. I kept full force in my keto diet, applied Neosporin Ointment, as it is an antibiotic, provided a sense of moisture for my face that began to chap, and was the only thing I could find that didn’t make my skin feel worse. And I also did that quacky Infrared therapy. I just happen to know someone who operates a “Life Vessel”, a large box that you lay in, relax, go into delta mode, and soak up infrared light while listening spa sounds. I didn’t believe it would do anything, but I just surrendered and climbed into the box. I did four 1-hour sessions on consecutive days, and I also purchased an Infrared bulb from Amazon. (The bulb was $12. The Life Vessel sessions were $99 each.) By the 3rd session, the rash calmed down, and 3 days later it cleared up.

    So was it the magic box? The triple antibiotic ointment? Or it could have also been the fact that I took quadruple my usual dose of probiotics, IGG (to boost immunity) and also L-glutamine. Or else it just went away on it’s own. I’m not a controlled study…I’m just glad it’s gone.

    I am just now starting a “Fat Fast” and have no signs of the rash yet. Fingers Crossed.

    Thanks for the information you supplied. I feel it helped me make choices.

    Reply
    1. Gladys

      De Anna, wondering if you could update if this was a permanent solution for you? Even if I just need to use the infrared bulb when ever it appears, seems easy enough, if it let me stay in Ketosis.

      Reply
  19. Max

    Hello BJJ Caveman. Thank you for posting this anecdotal but rigorous analysis! I love seeing people write about their personal experiments and discover something interesting in their own lives. Great work.

    I too found that I get a small case of this rash on my hand (only, thankfully) when in ketosis. I have a history of eczema and ringworm so I thought it was an old enemy, but it disappeared as soon as I started hitting the carbs again, then it was back with the diet. The treatment that worked for me was prescription strength steroid cream: Triamcinolone Acetonide Ointment USP, 0.025%. I would have to use it once a day for a few days before the rash abated, and then it would slowly come back as I took a break from the cream since you’re not supposed to use it for long, consecutive periods. It’s not an elegant solution, but it’s cheap and in my unofficial opinion easier on the body than antibiotics.

    Cheers!

    Reply
    1. bjjcaveman@gmail.com (Post author)

      Excellent! Thanks for sharing this!

      Reply
  20. Asuru

    How deep in ketosis do you need to have this rash, I think I have it immediately after 2-3 day sensible eating and exercising. I am in moderate ketosis, not in deep ketosis. And i have some PP in my stomach area, but lots of very itchy bumps on my scalp. I will try antibiotics if I can find someone to prescribe them to me.

    Reply
    1. bjjcaveman@gmail.com (Post author)

      You don’t need to be deep in ketosis at all! I was like you. Even being in light ketosis would get the rash going.

      Please keep us posted as to how your experience with antibiotics work out for you.

      Reply
      1. Asuru

        I want to thank you for this site first of all. Yes, mine too was keto rash although it appears on my scalp. It comes and goes definitely with me being in ketosis. I struggled with this for more than 4 years, and every time I get a different diagnosis. It was so unbearable and so random that there were times I was very depressed and didn’t know what to do anymore. I was diagnosed with seborrheic dermatitis more than once, but nothing they prescribed was working. I was using zyrtec. I think it was not even zyrtec which was working, rather zyrtec making me very hungry and me going out of ketosis because of cravings was the solution, but I didnt know that. Now, I can control it, and whenever I feel them coming back, I up my carb intake a little. I tried to explain this to my lasy dermotologist with the hope that this may be useful for other patient too, but she didn’t care and told me to continue to take zyrtec ;). This page was a life-saver for me, so thank you very much again.

        Reply
        1. bjjcaveman@gmail.com (Post author)

          You are very welcome. It’s responses like yours that motivate me to keep this site up! I’m glad it helped you!

          Reply
  21. Iliya

    I started the keto diet in January 2014, after I hit the 117 kg mark and I decided that it is finally time that I should make a change. My weight problems in my opinion were coming due to my inability to fight sugar and carb cravings, which most of the days was leaving me at probably more than 300 grams of carb intake. For the following two months on the keto diet, I have experienced weight loss of around 22kg, dropping down to 95kg by following a very strict carb intake regime at practically zero. During the two months in which I have been on the keto diet I did not have absolutely any physical activity.

    My experience with the keto rash started 2 weeks after I was on the lc/hf diet. At first I have started getting itches and small signs of rash under my left arm pit and above the arm pit on the inner side of the hand respectively about 2. At the time I was unsure what is causing it and I tried to treat in different ways. I implemented vitamins as a supplement, moisture and derm creams, oils and different things. Unfortunately for the next month and a half of the diet, while intensively keeping the rash area clean and treating it, nothing seemed to effect it. The rash kept getting worse with each day, with me receiving fresh limps on top of the already old and healed ones. Even that the rash was changing and evolving at those two spots, it did NOT spread to any other spots. For the 2 months in which I had the rash it was on a daily basis itching and hot(probably due to the scratching).

    After slightly over 2 months on the keto diet and still with a rash I started intaking carbs and broke out of ketosis. I met a dermatologist one week after I stopped the keto diet, at which point there was absolutely no evidence of any active rash rather than the intense pigmentation of the skin that was left behind at the spot where I had the irritation, which made the doctor uncertain of putting a diagnosis of what exactly it was. I asked him if ithere could be a relation between the rash and the lowcarb/high fat diet I was doing and the answer was decisive no, which at this point leads me to the conclusion that doctors really do not have a lot of knowledge about the relation of this type of rashes and the keto diet. Back then I had a suspicion about the relation between the keto diet and the rash without me actually doing research, because I haven’t come to the idea to actually google the term “keto rash”. The intense pigmentation of the skin left by the rash dissapeared around one month and a half after I started intaking carbs and the rash resolving.

    I have not had experience with similar type of skin condition until now (May 2016). In the middle of April I was comfortably sitting at 93kg and intensively training around 4-5 times a week doing crossfit for about 2 months, but I wanted to cut 4-5 kilos of extra fat that I have. As my will is very weak towards carb cravings and I tend to overeat on them I decided to give the keto diet a shot again as it keeps me sated and completely kills my cravings. I started my keto regime in the middle of April and for two weeks I have consumed <20 carbs per day, around 130-150g of protein and ~300g of fat. At this point in ketosis I can start to see the rash coming back at exactly the same spots as it was before, approximately after the exact same time after I started the keto diet as before, in the exact same pattern. I can only imagine the rash evolving in the same way as before, which if happens will convince me even more that the rash and the keto are going hand by hand, which I was suspecting back then.

    I will continue the keto diet strictly for another week and if I see that the rash follows the same pattern as before I will include 50 grams of carbs per day in my diet to check if at this rate there will be an improvement.

    This is a nasty side effect of the keto diet and a sad one. I will be very interested if there is an adequate solution or at least explanation of this. I am totally against using antibiotics for this as my experience has proven that I can easily fix it by introducing carbs and I am trying to avoid medicine as much as possible. I am by no mean expert in this, but I wanted to share my experience.

    Reply
    1. bjjcaveman@gmail.com (Post author)

      Thank you so much for sharing your experience.

      If you don’t mind, I will also share this as a separate blog post.

      Reply
  22. Leem

    I started about 4 weeks ago, got the rash in my chest, between my boobs. Happened the first time I tried it about a year ago but stopped because if it. Anyhow, i tried adding spirulina to my diet and treating it with apple cider vinegar and coconut oil (thought it was going away but didn’t, seemed to get better then worse)

    Remembered that I had 500mg of Cibdex CBD oil in my supplement pantry (had not take in a long time since it tastes like hell). Figure it was worth a try since CBD is supposed to be an anti-inflammatory. Woke up the next day and a lot of the redness had decreased. I believe today is my third day on it and only have a few red pimple like spots left and flat dark marks. It’s working for me so thought it was worth mentioning in case anyone else wants to try it out. Take it orally and also apply some to rash at night.

    Reply
  23. Nichole

    This is information I wish I could’ve gotten my hands on 3 years ago! Great work! I had the same experience with misdiagnosis. My first time in ketosis, I developed this rash and I was in deep ketosis. It started in the middle of my chest and over 6 weeks spread up my neck, under my chin, down my back and it was unbearably itchy. I didn’t connect the two until now. This is my fifth round of ketosis, I get this rash every time and it’s the first time it dawned on me that it could be the cause of the rash. My dermatologist brushed off my diet as well and I’m not as savvy, so I just never thought about it again. I was finally prescribed two things that work for me. If there’s anyone out there that doesn’t want to damage the integrity of their diet but also can’t deal with the rash, I’ll share.
    I take the first mentioned antibiotic in this post and also a very expensive (depending on your insurance) effective, topical cream. It’s prescription only, neo-synalar [neomycin sulfate 0.5% (0.35% neomycin base), flucinolone acetonide 0.025%]. You can’t use it for extended periods of time but if you get the rash early on, it stops it from spreading.
    This is really great info, thank you for taking the time to put all of this data in one place.

    Reply
    1. Asuru

      Hi Nichole,
      Were in you in ketosis and did you stayed in ketosis while you are taking the antibiotics?
      I am trying to understand their longterm effects

      Thanks

      Reply
  24. Hanneke

    Great information. I have wicked keto rash too. I am not extremely low carb anymore but eat about 80-100 grams a day. (mostly upped my root vegetables and a little more fruit). I still have keto rash but not as bad. It’s not really visible and I can live with it.
    Low carb/keto does help me with menopausal symptoms, it helps a lot.
    Thanks,

    Reply
  25. bb

    Prurigo Pigmentosa
    I just confirmed I have Prurigo Pigmentosa. I am suffered from it for many years.I am allergic to Minocycline. I took Diflucan (Fluconazole)for my virginal yeast infection. Some how this medication help me treat my rash several times. But my rash come back few months later. my doctor refuse to prescribe it for Prurigo Pigmentosa because right now have no evidence to support and it can cause liver damage if long term use.

    Reply
    1. Kathy

      I have Prurigo Pigmentosa for many years. Rash over my boob, my back very badly espiecally in summer, when i feel tired, exercise.
      I just try grapefruit seed extract and i work. I mix 10 drops with a cup of orange juice and drink it. It treat my skin rash in 2 days. I cant believe it too. I keep drink it two times a day everyday now. Its been a week my rash still no sign of come back. Hope it keep me away from my rash. My life saver. I am going to let my doctor know because i am so fear to take any antibiotic.

      Reply
      1. Kathy

        Ok let me update my case. Its been a month my rash did not come back at all. Grapefruit seed extract really work. =)

        Reply
        1. Kathy

          Updated Sadly long term use of grapefruit seed less effective on the rash
          Will try antibiotic

          Reply
  26. miche16

    Hi there

    I had the rash when I first embarked on a water fast. The doctor was stunned and said that it may be related to something in my gut because my tongue was also white which is an indication of fungal/yeast overgrowth. I dont know if anyone else has noticed that at all. I am convinced that there are bacteria/fungas that are stored in the fats around the stomach which ‘rebel’ when that fat is being broken down. I have previously lost weight by going veggie declaring that I would rather give up meat than carbs! now I am Keto plus doing intermittent fasting because I have had a persistent layer of fat on my stomach. I think people who have had a very carb heavy diet are more susceptible.

    Now the rash is not so itchy but rather like a burning sensation even when my body temperature changes it get more painful. So how am I combatting it? Topically I have applied organic coconut oil with Black seed oil and emu oil. Black Seed oil is a very powerful anti fungal and anti microbial. I used this last time to get rid of the white tongue and rash rather than the medication the doctor gave me.I break my fast by drinking warm water with 4 tablespoons of coconut oil and 3 teaspoons of black seed oil. Its been 2 days and the rash has not spread and it has calmed down dramatically in sensitivity.. I have not eaten carbs at all to change it. Today I drank half a cup of Kefir as this is the best probiotic around and to help to eradicate whatever is thats inside. I hope this helps someone. I really strongly recommend black seed oil. I have am also taking protease enzymes Papain and Bromelain in 600mg capsules- 1800mg in total on an empty stomach before I sleep. This is because these enzymes will eat anything that is not meant to be in my body.

    Reply
  27. Matthew Newport

    Thanks for this site! I’ve suffered with bouts of this rash on and off for 6 or 7 years now. I’ve had trouble figuring out what was causing it but looking back on it, the first attack as when I first tried the Paleo diet and was trying to keep my carbs very low (this was before I’d heard of keto).

    Doctors weren’t much help – I was originally told it was probably due to not washing my workout gear regularly enough. I was prescribed a topical steroid cream which did nothing other than cause me to grow hair in unwanted places where it was applied.

    I’ve had a number of theories over the years as to what caused it: a reaction to working out too hard, a food allergy (various foods seemed like possible culprits at times) or a reaction to heat. None of those seemed to consistently predict it though. My latest bout was after restarting keto though and now I think that is the most likely cause. I’ve increased my carbs somewhat and it seems to be easing.

    As far as relieving the symptoms go, the most effective treatment I’ve found is Reactine. Taking Reactine for a few days has generally helped clear it up for me in the past. I’ve also found Aveeno Active Naturals Anti Itch Cream gives some relief from the itching. Cold showers and direct application of cold to the rash also provides some relief.

    I’d love to find a solution that doesn’t require me to drop out of ketosis. I’m going to keep experimenting now I have a plausible theory for the cause and see if I can find a carb level that lets me stay in ketosis without the rash.

    Reply
  28. Julie

    I found this site a few days ago because I have the keto rash really bad and was looking for something to help get rid of it. After reading all the comments, and not wanting to go on antibiotics, I remembered that when my dog got rashes, the vet suggested Gold Bond medicated Body Powder (Green Bottle) and the rash cleared up within a day or two. So I decided to try it and it worked awesome. It is day 3 and the rash is almost gone. The powder relieved the itching instantly. I know talc powder is linked to ovarian cancer if applied in the genital area, and I don’t think it’s good to breathe in, so be careful when applying. I apply underneath my clothes and it helps keep the powder from going airborn. I also researched talc powder on the cancer website and there wasn’t a link to cancer if applied on the torso or back.

    Reply
  29. Dru

    This rash appeared on day 7 of my Keto diet. Again. This time I wasn’t working out. It does seem to appear from wherever I sweat the most. Right now that’s around my bra line. It’s still hot in Texas. I scratched at first coz I totally forgot about Keto rash. Didn’t know I was in Keto already. Once you scratch, all u want to do is scratch more. I put on bio oil and in a few minutes the need to scratch disappeared! The rash is still there but it’s a only day one. I’ll try grape seed extract and activated charcoal. My sister is convinced it’s toxins being excreted in the sweat. We’ll see..

    Reply
  30. Asli Umur

    I have found this article, saying that after antibiotics treatment there were no recurrences. May be it’ll help also to find the etiology.

    I am yet to try the antibiotics, I am waiting for the winter to come. I had it again, when on hollidya due to possible ketosis with trekking and eating less and had to wat lots of carbs for it to be resolved. So carbs definitely works, but I want to go back to ketogenic diet somehow.

    http://escholarship.org/uc/item/6rv324m4

    Reply
  31. Jess

    I did ketosis/ intermittent fasting for years with no trouble. I stopped due to peer pressure and only returned to ketosis / intermittent fasting within the last 10 months. Within the last month I have developed this rash on my hands and feet. It started as tiny eczema like blisters that soon turned into huge puss filled itching burning blisters. I did what i could to clean them and drain the puss using a combo of witchhazel and rosemary extract. Dried it up really well but still had the itch and burn and the blisters and red kept returning. The dermatologist was useless, told me it was basic athletes foot because all he saw was the dried out flaky skin after I had treated my feet. He gave me antifungal cream that was useless. My primary dr gave me prednisone and anti-biotics. the antibotics were useless. the prednisone worked for about a week and then it came back again this time with hives/urticara all over my body. I’ve spent a few days researching histamine diet and basically came to the conclusion that many histamine symptoms are caused by toxic mold exposure. I live in a very moldy environment that is pretty much a loosing battle. Have repaired and replaced many things in the residence and it keeps coming back. I’ve tried benadryl and it did nothing except make me dizzy. I’ve been using alkaline water for 2 days now for its affect at removing toxins in the body. I mixed in a small amount of tart cherry juice for its anti-inflammatory effects.(better than ibuprofen for anti-inflammatory effect and I’m allergic to Ibuprofen) Its the only thing getting rid of the burn and no blisters today. I’ve also added in a new probiotic that has bifido Longum, Bifido Plantarum and lactobacilis infantis recommended by a website on histamine diet because they help heal the mucous lining in the small intestine. I have celiac disease and intestinal damage that I’ve treated for about 10 years now with gluten free diet but I still get the random exposure to it which keeps the damage from completely healing. SO my take on the whole problem is that the mold exposure is attacking my system, and causing the inflammation, which is exacerbated by the celiac disease/ leaky gut syndrome which allows toxins into my blood stream. doing the antibiotics actually weakened the beneficial microflora and this new probiotic should help restore that balance and help heal some of the damage. I am not going off ketosis, just going a bit higher on carbs (20gm per meal instead of 20gm/day) until I get this beat. I’m also experimenting on anti-inflammatory Chinese herbals that are having some effect but I still haven’t dialed in the effective combo. I will try to update this info if anything changes.

    Reply
  32. Chris14

    Thank you for this site. Very informative! I’m dealing with a bad breakout of the keto rash right now. This is my second worst breakout and my 4th total breakout in the past couple years. I was finally able to link it to my diet after this last occurrence. I was able to make the rash almost disappear within a week of a high carb intake. I’ve been misdiagnosed by my last 2 dermatologists when this all started. One thought it was impetigo staph infection on the skin and another said it was grovers disease. My worst breakout (1 year ago or so) started in the middle of my chest and quickly spreaded from my chest to by belly, back and neck. I did oatmeal baths, vinegar baths, salt baths along with alcohol and peroxide to clean the area. No luck. The only thing that worked was eatting tons of carbs. I’m now taking doxy 100mg twice a day and just started treatment yesterday night. I will post my condition update on the forums page. Thanks again for all this information!

    Reply
    1. Chris14

      So after 4 days of being on doxy, the rash on my chest is breaking up and much lighter in color. It is also “flat” rather then the raised swollen areas as it was before. It was still itchy at times.

      The bad news is the rash started breaking out in isolated areas on my back 1 day after taking doxy. Within 4 days of doxy the rash got worse and started to spread and make “groups” of even bigger splotches of outbreaks. I would say about 25-30% of my back has some sort of colony or outbreak of the rash. The itching was so unbearable I made yesterday my early “cheat” day. I started eating everything in sight and probably consumed upwards of 300+carbs. That was yesterday and todays results? Astonishing, the rash is much lighter then yesterday and my back does not itch at all. So I’m going to put my body back into ketosis today and see what happens. I’m continuing the medication and hoping the intake of carbs yesterday helps doxy keep the swelling down on my back and hopefully it makes progress over the next few weeks.

      PS: The rash feels like constant prickly needles agitating on rash breakouts. Once i scratch them it feels awesome but the after effect feels like the worst sunburn with a strong sting, almost like a wasp sting. My previous outbeaks and current spread so quickly 75% of my chest and even stomach were covered and my back was about 50% covered. Even under my stomach area had outbreaks.

      Reply
      1. Chris14

        So no changes to my diet other then 1 cheat day I had like 3 weeks ago or so. The rash is almost completely gone other then a light orangeish pigment on some places. No itching nothing. Successfully treated with the doxy i was prescribed. I’m about 15 lbs lower then what I was when the rash seemed to be at its worst. doxy 100MG twice a day as this page states. It took about 1 week for treatment to really start kicking in and within 3 weeks im pretty much cured. I will stop taking doxy after my month of dosage is gone and hopefully it wont return.

        Reply
        1. Jboy

          Thanks for the details and info.
          I have the rash on my torso. Only today put that and ketosis together.
          Oddly enough a friend left some doxy pills here after his last visit and I started taking it today.
          I only hope I can get more, I will see a dermatologist, but where I live this can not only take time but the likelihood of getting a prescription for doxy is low.

          Reply
  33. N

    I’ve got this rash on my chest and neck after 1 month starting a keto diet. After that I did a hiking marathon of 21 kilometers after which the rash really started to show its power. For the first time, I also got slightly yellowish tongue. I have rosacea (subtype 1) and ketogenic diet proved to be nothing but ANTI-inflammatory. I started this diet because of reactive hypoglycemia so it completely sucks to go back to controlling blood sugar. If you ask me, there is some kind of die-off or bacterial overgrowth (due to the diminishing values of sugar-loving strains that act as a competition, prividing a safe measure). I guess I don’t really have to point out that our gut also controls our immune system… Oh, btw, I’ve also taken small amounts of black cumin seed oil which didn’t help and I occasionally wake up in the middle of the night wet and sweaty. I’m going to try grapeseed oil. I will definitely let you know if something will work. My hypothesis is that this rash could be eliminated by introducing suitable probiotic bacteria (and prebiotics). Eventhough my digestion hasn’t been better. There must be some kind of opportunistic bacteria going on (or maybe not, but my yellowish tongue which corellates perfectly with the rash tends to disagree). Finally, there is new post on NCBI: Folliculitis in prurigo pigmentosa: a proposed pathogenesis based on clinical and pathological observation.

    Reply
    1. N

      Curcumin supplements for inflammation might work. Hm..

      Reply
    2. N

      If it is in fact inflammation, we should find out which of the biomarkers get increased (but keto is mostly anti-inflammatory) and try to inhibit it (read some posts on selfhacked).

      Reply
    3. Helen

      I got rash around back of my neck (scalp) and chest area after 1 month into a keto diet. I went to see a doctor today about this and she didn’t know what was going on. A dermatologist stopped by to see my rash and she doesn’t think it’s related to keto. I mentioned Prurigo Pigmentosa after visting this site. She was crueless. Frustrating that keto rash is not well known in the US medical field. I ended up leaving the dr’s office with topical cream, Alclometasone Dipropionate cream. Based on Dr’s note, more lab works needs to be done so she rubbed my rash with a swab for lab report.

      Meanwhile, I hope this rash doesn’t spread. Yeah, it’s itchy! What is the remedy? Why are we having this rash? No one seems to know exactly.

      Reply
    4. Denise

      Be very careful with antibiotics. They are last resort. I know Derms say these don’t cause resistance issues but don’t believe it. Antibiotics will mess you up. Also be careful of grapeseed oil, very high omega 6. The best cure is eating ‘normally’ meaning healthy but including grains and carbs. Go for high quality organic home cooked meals. Also Check out Matt Stone who offers a different perspective on diets. Good luck all!

      Reply
  34. Kris

    This has been very interesting to read; thank you for creating this. I am a female and eight weeks into Keto. In reading some of the remedies I am wondering if the rash has anything at all to do with the type of fat consumed on the eating plan, as well as the hormonal changes each month in the body I had a rash several years ago that has developed in the same place; on my forearms, and a very small one on my stomach and in my left arm pit. When I researched at that time (eating then WAY too many carbs) I read that too much fat could cause the type of break out I was experiencing. I cut the fat back and it diminished. Since that time I had changed the type of fats I eat, but now being on Keto I consume more saturated than I used to. Wondering if there is a connection, and some literature I am reading stresses the importance of consuming Omega 3 fat sources in equal quantity to Omega 6. Anyone have any thoughts on this? I know I have to keep the macros for fat on target, but am looking at types of fats I eat now. Thanks!

    Reply
  35. Susan

    I have been dealing with this horrendous and incredibly itchy rash on and off for about 6 years and have seen countless doctors about it. I’ve desperately tried every single thing listed under treatments (and some), but to no avail.

    It wasn’t until I came across this site that I found a solution that actually worked! I started minocycline 100mg daily 7 days ago, and today the active rash is completely gone (although I saw a dramatic reduction after only 3 days). My rash is extremely severe so obviously it leaves behind hyperpigmentation that takes around 4-6 months to fade, but for the most part I can say it’s gone!

    I’d like to mention though that my rash directly correlates with weight-loss and not necessarily keto. I’ve found that increasing carbs kicks me out of keto, yes, but it also puts a halt to the fat loss too. I’ve tried a plethora of diets but the rash only seems to appear when the number on the scale falls.

    Anyway I’m eternally grateful for this site and for finding a solution to this rash. The bane of my existence. Finally gone.

    I’ll check back in a month and let you know if it comes back after I stop taking the antibiotics. Cheers!

    Reply
    1. bjjcaveman@gmail.com (Post author)

      Thanks so much for sharing!

      Reply
    2. Susan

      It’s been a month, so I thought I’d check back in.

      Unfortunately the rash is back and this time it came back with a vengeance! The antibiotics seemed to work but it WAS around the same time I hit a plateau in weight-loss, so I’m thinking that might be why I had some success. I stopped taking the minocycline after 15 days or so since I felt I wouldn’t need them anymore, but now that it’s back I might just have to keep taking them. Shame, I thought I finally found a solution.

      Reply
      1. Asuru

        Mine exactly the sam, although mine looks like seborrheic dermatitis. It’s related to weight loss which produce ketone bodies of course.

        Reply
  36. Nicole

    I’ve had great luck with this rash. I don’t add carbs back in. It’s either a histamine reaction to toxins as a side effect of weight loss or a yeast die off.

    My doctor said that the weight loss is more important than treating a rash and recommended the following as antibiotics tend to make yeast way worse for me.

    Use the brown listerine as a topical, then after its dry, spray the area with the powdered tinactin spray and it stops itching immediately, the rash fades over the next week. I continue this twice daily for 10 days after the rash is completely gone. I especially do this after working out and showering. If it comes back I start again. It never gets weepy, it isn’t uncomfortable, and I know first hand that the spots do fade over time.

    Treat it like a fungal skin infection, you’ll feel much better.

    Reply
  37. Asuru

    What about citric acid comnumption?
    I think I kicked myself out of ketosis with diet coke, and I stopped a rush coming (which I definitely can feel on my scalp, I even had 2 very tiny lesions). Not sure though, still experimenting.

    Reply
  38. DuceRona

    Thank you SO much for this site. It saved me a lot of time and energy trying to figure out what was wrong and how to treat it. Like most people here the rash kicked in within 3 weeks of starting the diet – moving from right armpit to left, then my back and then groin area. After finding this site I added in carbs and it stopped within 12 hours – just the pigmentation left. I waited 3 weeks and tried again – two weeks in and boom – right back.

    I skipped all the treatments that had been tried and failed here – didn’t want antibiotics – and tried new stuff. I found something that REALLY worked well for me – Essential Oil of Lavender. Applied neat. It did not stop it moving from location to location but once it appeared it provided instant relief from swelling and itching and started ‘healing’ almost straight away. 5 days in and my arm pits are clear and other areas (that appeared later) are starting to recover. May not be for everyone but totally works for me. Also loved Physiogel daily moisture therapy shower cream – expensive but it cleans the area and you don’t need water to wash it away – so can take to work (I cleaned the area 4 times a day assuming it was sweat related – but I live in a tropical country!)

    Many many thanks for all the help and guidance.

    Reply
  39. xu

    Thank you for this site… It’s just good knowing there is a community out there and I am not alone.

    Reply
  40. Pat

    I am on the Ideal Protein Protocol which is a protocol that is low carb and puts your body into ketosis. I have been following this protocol for three weeks and have lost 10 pounds and 16 inches. However I have developed the keto rash. My coach told me it happens to very few people but she has seen some cases of this. She said that toxins bind to fat and when the fat is breaking down it is releasing toxins. She also said it is a sign that I have a lot of inflammation as well. She suggested mixing one teaspoon of baking soda with water and drink it. Just a small amount of water so you don’t have so much to drink, and chug it. If the itching does not stop repeat in 15 minutes increments until the itching stops. Once it has calmed the itching repeat every three hours to change the ph of your system. I tried it and repeated after 15 minutes and the itching stopped. Three hours later the itching started again so I repeated the process and went to bed. I slept through the night but in the morning the rash flared up again so I started the baking soda water drink again. I don’t know how long I will need to continue the process but it is natural and does provide relief. I also used Aveeno skin relief 24 hour moisturizing lotion which has dimethicone in it and is fragrance free. Before I spoke with my coach I did not associate the rash with the weight loss and I used Benadryl at bedtime to help with the itching so I could get some sleep and it helped. I never realized I was storing toxins with the terrible things I ate. My rash is over my entire body except for my face. I have never seen anything like this or itched so much. I did it to myself and I will have to live through it since I truly want to be healthy.

    Reply
  41. Vasco

    Being a biomedical researcher and experiencing the keto rash myself when i started the paleo/keto diet, I found it very intriguing at first.

    Indeed, and like to most of you, my keto rash appeared after the 3rd or 4th week of the diet. I was in panicked I have to say. I completely recovered from it after ingesting more carbs (was below 30g a day) but this prompt me to research of what happened to my body. I’m now for almost a full year in the keto diet, and since then i never experienced the keto rash anymore; mostly because i kinda think i understood what happened to my body.

    When you start the keto diet (high fat/low carb), the body does not go right away to ketosis (as all of you noticed it already; and this a good thing as you will see). This is because the body at the beginning starts burning mostly fatty acids directly with some very low level of ketones (which are produced in the liver from fatty acids). This is actually a good thing, because your muscles and some other organs (e.g. like the kidney) are able to burning fatty acids (alongside with the low levels of ketones produced) for energy.

    you DON’T require to be in ketosis to burn fat, you can do it extremely well during this early stage (which is the same to what happens to a normal person in a normal carb diet while fasting [e.g. after sleeping, the carbohydrates reserve is depleted so you start burning fatty acids instead]). *note: An average lean-person, as by rule of thumb, has a carb reserve of 2000 kcal, while has 30.000 kcal of fat (reason why the keto person can stand long periods “fasting”).

    During the early “keto diet” or fasting period, your brain is still using glucose as a an energetic fuel (unfortunately is not able to burn fatty acids), which is uptaken from the carb intake (even if low on the keto diet). As an alternative, the body can produce glucose in the liver from a process known as “gluconeogenesis” where it will use the glycogen storages (i.e. carbs) to produce the necessary glucose amount to fuel the brain.

    Why I said this is a good thing? Because the liver in turn, is not extremely loaded producing ketone bodies (b-hydroxybutyrate or acetoacetate), and can operate its normal functions: FILTERING all the products/toxins our body does not require. *note: there is another ketone formed in the body, acetone, which is produced from acetoacetate. However, because acetone is not significantly metabolized, and can be toxic to the body, it is expired in the breath (reason why some people experience bad breath on the keto diets).

    Ok, now going to the rash itself. The ketosis mode occurs when the body is in a complete “starving” mode, meaning that after a long period of adaptation to the keto diet, the carb intake is so low with very low carb storage (glycogen) that the body starts now in an “high demand” of ketone production with the brain not using anymore glucose as a fuel source. INSTEAD, ketones are used by the brain.
    The keto rash comes after this part: since the liver is overloaded producing ketones (to mostly sustain the brain, while some levels of ketones go to the muscle [still highly burning fatty acids] and other biological processes) it is not able to efficiently detoxify the body from other susbtances. Then, your body tries to do the inevitable: it starts to expel them out of the body via the skin that starts to get irritated. One thing that I suggest all of you in the keto diet, experiencing the keto rash, is take a nice sauna or steam bath! Yes, sauna or steam bath! This is because you will help your normal process of detoxification.

    Another temptation in the keto diet newby is the happiness of eating fat and more fat. This is indeed good, but as is catches as well. Fat stores a lot of toxins, so does some vegetables if not fresh (from pulverization of chemicals and so forth). So you can imagine low quality vegetables and fatty-meats/fishes will send right away to your body this toxins. Your liver is not able to cope with this very well as you can imagine.

    Another thing is the copious amounts of nuts a keto person eats. Not a bad thing, yes, but nuts also carry a lot of toxins, in specific almonds. Almonds contain some amount of amygdalin, which is a cyanoglycoside. As you can guess by the name, it is then broken down in the body to hydrogen cyanide (yes, a toxic substance). Small amounts of hydrogen cyanide are inactivated in the liver principally by rhodanase, which converts it to thiocyanate. Hydrogen cyanide is present in the air, in soil and water as cyanide salts, and in foods as cyanoglycosides. Most of the cyanide in the air usually comes from automobile exhaust. Another foods which contain amygdalin are pits from stone fruits (e.g., apricots, peaches, plums, cherries), sorghum, cassava, soybeans, spinach, lima beans, sweet potatoes, maize, millet, sugar cane, and bamboo shoots.

    So for those in the keto diet, my suggestion is to not panic with an extra carb here or there, just eat normal. You don’t need to be in full ketosis to burn fat, you burn fat directly as well. Also as a curious note of on how your body processes fat: as soon as you put fat into your body, it is digested and uptaken by the liver. The majority of the fat then goes from the lower intestine into your lymphatic system where fat is used in the normal biological processes, like replacing the fats from your cellular membranes, brain and bones (and so forth). If you are on a keto diet, I honestly believe the best for you it is not because you loose weight, but largely because you become extremely healthy in return. Since our composition is mostly fat, adding new extra sources of good fat, replaces the old fat in our system. Just after this period, the fatty acids are then used for energy or converted to ketones. And indeed, you don’t make tryacylglycerides from fat, you need carbs to do it, reason why “You don’t become fat by eating fat”. It is from carbohidrates that you make fat.

    Ok, another note and why the keto coffee can be extremely beneficial and energetic for you keto people. Fats (and fibers) take a lot of time to digest in the body, reason why when you start the keto diet you feel fatigued, since the energy from fat takes some time to “hit” you right away. Nevertheless, there is some type of fat, the saturated fat from coconut oil and butter, that is faster digested in the lower intestine and does not go to the lymphatic system! It is promptly used as an energetic fuel source and hence, will never be stored. (even in a normal carb diet, this type of fat will be easily burnt as energy).

    Hope this helps you all, cya

    Vasco

    Reply
  42. Vasco

    Typo correction on my previous post on the section “when you put fat into your body, it is digested and uptakrn by the liver” i wrongly wrote here “liver”. This is not what I meant as you can check from what I wrote after. I meant instead is “fat is digested and broken down into fatty acids and absorbed in the lower intestine”.

    As a personal note, I don’t track anymore (as I did in the beginning) the exact macro ratios of fat, over protein over carbs. I just try to eat normal and my body efficiently burns fat. I also work out, and been trying to not be in métodos. I also stopped checking my ketone levels with keto urine strips. Eat normal; the good thing of being on a keto diet is the fact that you get healthy; as a side note, the Mediterranean diet (which is high on fat) showed study after study that it is extremely healthy. The keto diet we can assume it is an even better venue for health. But no need to be extreme.

    As some side note (and I apologize that this is outside the keto rash topic, but I think useful for everyone on a keto diet)

    Far more important is the quality of the fat you put in inside; the best fats are saturated and monosaturated. This is because they are extremely strong against damage with saturated being far stronger (saturated fats are easy to see, since they are commonly solid at room temperature). This means that damage like “heating” will not destroy it easily while cooking. Saturated fat is found for instance in pork belly, sausages, bacon (fatty meats and fish), coconut oil, butter (real butter), dark chocolate, etc.

    Monosaturated fat is also extremely healthy but is more easy to get damaged while “heating” in the pan. This includes for instance olive oil. I suggest cooking at low temperature while using it. The same applies to fatty meats, bacon, eggs (contain a mixture of saturated and monosaturated). While they do have a lot of saturated fats, they have also monosaturated fat. So monosaturatrd fat when damaged will get rancid! So avoid the extreme crispy bacon and burnt sausages, because the fat has been destroyed and transformed into transfat. THIS ONE YOU NEED TO AVOID! Reason why, plant and vegetable oils are not recommended whatsoever, because they have the weakest type of fat: polyunsaturated fats (in high amounts)! This type of fat is so weak that will easily get damage and rancid. For instance margarine, vegetable oil for frying. Avoid these; specially margarine, which in nature is liquid at room temperature and via a process called “hydrogenation” they turn this fat into saturated, reason why it becomes solid. Margarine natural colour is gray, so the industry adds chemicals to make it the appealing yellow of natural butter.

    Another last note, omega 3 supplements are extremely good for you, as you have read before, and surprisingly they are polyunsaturated fats. But they are essential to your body because your body cannot produce them unfortunately; so you need to supply it with your diet but never heat it up! Because otherwise you complete destroy. The majority of fats you need, your body produces it from saturated fats (for instance, saturated fat can be converted to monosaturated fats essential to your body). Unfortunately our body cannot produce and synthetise omega 3 (polyunsaturated fat), reason being called an essential fatty acid.

    Well, sorry for the long texts but I hope they can be useful to everyone with intent to be healthy.

    Cya,
    Vasco

    Reply
  43. Lamya

    I had the keto rash and mine got pretty severe. I had them all over my lower back, my upper right arm and my chest. I went to the dermatologist, got a biopsy done and he gave me the required medication and they disappeared soon enough. But I still have some hyper pigmentation scarring and it’s been about 3 months. I would like to know if there is anything I could do to make these scars go away.

    Reply
    1. Hanna

      What medication did your doctor prescribe? I just had a biopsy done and I’m waiting for the results. Would be interested to know what your doctor gave you.

      Reply
  44. Mark

    Just found this site and wanted to pass along my 2 cents in case it might help others.

    I developed keto rash the last few years, even though i’ve been doing Intermittent fasting for 10 years, and this I believe provides a big piece of evidence for the cause, which, Vasco above suggested. The second clue, is I only get it badly during the summer here in Phoenix, litle the rest of the year.

    I have tried to narrow down issues – and in my case, its definitely not related to ‘low carb’ or diet, its purely to do with AMOUNT/SPEED of FAT LOSS during the fast period – i.e. the more I exercise during that period, the worse the rash/itch.

    So, for me, there are two ’causes’ – speed/amount of fat loss, heat/sweating.
    I read elsewhere that ketones contain acetone, which can come out in sweat in the area’s the rash typically appears. I think that is PART of the problem, because, mine is worse the more I sweat. But, I don’t believe its the ’cause’, because its more sweating worsens the rash/itching, but its starts due to something else.

    Now, without boring you all, I have lifelong chronic health, eventually diagnosed as various autoimmune. Because I trained in science, i’ve spend 10+ years self experimenting to try to solve that one, and turns out autoimmune another misleading diagnosis, in my cause, I have narrowed it down to
    – seriously messed up gut biome ( I was given 10 courses of anti biotics in 2 years around 11-12 due to tonsil problems, my health issues started soon after)
    – problems at cellular level with toxin removal (the science is early but proven on this, leads to so called ‘chemical sensitivity’ – I literally reacted to everything)

    So, what is likely to help, is improving gut biome ( tons on internet for that), and also improving your detox pathways such as glutathione – that has fixed most of my chemical sensitivity for example which was life destroying. It’s a big topic how to that, do some research but basically, you need to improve liver, increase glutathione , and ideally, bind toxins in the gut using clay or charcoal, maybe chlorella.

    Now, even with all that ( and I do alot more ), I still get this rash currently. I am finally down to about 10% body fat, so, I think its very likely this fat is heavily toxin holding ( I am 50 y/o) ..and really, the only solution to SLOW the fat loss to avoid it, the slower I lose, the less I get this rash.

    Also, once I have the rash, I also get ‘contact dermatitis’ i.e. my skin is just sensitive, so be careful of chemicals on clothes, or whatever is touching the rash/itch area’s, it can make it much worse!

    Prednisone clears mine up quickly, but that might be because of my autoimmune=super over active immune system, which worses all reactions, and steriods lowers immune response, so might not help others.

    Reply
  45. N Hare

    I weigh 73kg, I have very low body fat, and my muscle definition, particularly on my abs, is really showing. I must be in ketosis and I believe I have ketosis rash, particularly on my arms and legs. The itchiness for me is at night. Last night I had a hot bath with Epsom salts at 2am and then again at 4am. That eventually settled the itching.
    I sweat very easily and actually find that exercising / sweating helps and dampens the itching. In fact, I would say not exercising makes my rash worse.

    I am taking 4 x purified bile salt capsules per day, eat healthy etc. BUT I still have this ketosis rash after 5 months or so. It’s doing me in!

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