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:
- Toxin Binders
- Activated charcoal
- Calcium d-glucarate