Keto rash – why some people itch on low carb, and what to do about it

Keto Rash

Typical locations of a keto rash

This is not a common problem on low carb or keto, but for the few people experiencing it, it can be really annoying: Itching.

This itching – sometimes called the “keto rash1 – can be troublesome, sometimes even interrupting sleep. The itching and rash are almost always symmetrical on both sides of the body. It most often develops over the chest, back, armpits and sometimes in the neck (see image above).

What is the reason for this problem, and how can it be cured?

There are many posts about this online, and many different theories. The time has come to make it simple, Diet Doctor style. Here’s everything you need to know.

 
 

The cause of the keto rash

SweatWhile there are dozens of theories about this problem, each more weird and unlikely than the next, we believe there’s a very simple answer. This is based on many people’s experiences,2 and the limited scientific studies available.3

Here are the clues, and the conclusion:

  • The itching usually starts soon after people get into ketosis. It stops within a day or so if people eat more carbs and exit ketosis.
  • It can often get worse in hot weather, or after exercising.
  • The usual distribution of the itch and rash matches areas where sweat can accumulate.
  • When in ketosis sweat can contain the ketone body acetone.
  • Acetone can be irritating at high concentrations.

I think there is good reason to believe that the itching that some people experience in ketosis is caused by ketones in sweat, perhaps as this dries on the body.

 

 

How to cure the keto rash

There are several things you can do to cure keto rash:

  1. Clothing: Wear comfortable clothing for the climate, so that you don’t sweat more than necessary. Use air conditioning when appropriate.
  2. Shower: After exercising it might help to take a shower – after you’re finished sweating.
  3. Change exercise plans: If the itching is really troubling you might want to skip exercise for a few days, or do something like brief weight training that does not produce perspiration.
  4. Exit ketosis: If the the steps above are not effective enough, exiting ketosis will reliably cure the issue within a day or two. This can be done by eating about 50 grams of carbs or more every day. To still get most of the benefits of a keto diet – at least for weight loss and type 2 diabetes reversal – you can do a more liberal low-carb diet (50-100 grams of carbs per day) and add intermittent fasting.
  5. Other treatments: There are many other treatments suggested online; like antibiotics taken for weeks or months and/or special creams. These will likely offer temporary relief at best.4 We definitely advise not to use oral antibiotics, as the side effects and risks are much worse than the doubtful and temporary benefits. Steroids, anti-fungal creams and anti-histamines appear not to be effective at all. There’s a safe, simple and free solution if you need it – number four, above. Use that instead.

 

 

What’s next?

If you get rid of the keto rash by exiting ketosis, can you ever use ketosis again? The answer is likely yes.

If you felt great in ketosis and had a lot of benefits, you may want to try again. The keto rash may stay away. Some people appear to get it only once, or only early in ketosis, when first starting out on a low-carb diet (given time, the body may excrete fewer ketones in the sweat). Remember, most people in ketosis don’t get the rash at all.

Keep the advice above in mind. And if all else fails, just eat a bit more carbs and the problem will go away.

Comments

Have you experienced keto rash? Do you want to share what helped and what did not? Feel free to leave a comment below!

 

 

  1. Another name that is sometimes used for this condition is “Prurigo pigmentosa“.

    The name means that it itches (“prurigo”), and that long-term, after many weeks, it can result in increased pigmentation (“pigmentosa”) in the affected skin area, looking like darker patches.

    This increased pigmentation, should it occur, fades very slowly after the rash is cured.

  2. Here are a few places to read about people’s experiences with keto rash:

  3. Here are a few relevant studies:

  4. This study references the experience of treating the keto rash (prurigo pigmentosa) with antibiotics. It did have an effect – possibly due to anti-inflammatory properties – but once the treatment was stopped the rash reappeared.

    J Dermatol. 2012: Prurigo pigmentosa: clinicopathological study and analysis of 50 cases in Korea.

285 comments

Top comment

  1. Justin
    Good to finally see *something* written about this. I remember being unable to find anything when it happened to me in 2014. Read a lot about skin conditions, tried various antifungal creams, coconut and tea tea oil. Eventually had to admit the obvious source, my recent change to a ketogenic diet. I had the itch under my armpits and abdomen. It was intense. Not "troublesome". And it receded almost as soon as I began eating carbs. I only managed 7-8 weeks in a ketogenic state before I couldn't take the itching any more.

    It was too bad as I really enjoyed the ketogenic diet, felt less drowsy, and much better GI function (less gas, cramps, diahrea). Also was forced to eat more vegetables and nutritionally rich foods.

    Interesting idea that it could be related to acetone/ketone presence in sweat. I had figured it was related to the affect low blood sugar has on the adrenal gland, and how long term elevated cortisol might disrupt the immune system. The rash being some adverse inflammation as it's very similar to hives.

    I would love to see some proper research done on this. Heck, I would love to be the one doing it.

    Excellent article. Thank you.

    Replies: #255, #294
    Read more →
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All comments

  1. Corinne Nokel
    Hi,
    I have experienced the keto rash various times and yep, Aloe gel right from the plant helps soothe the itch ... I figure that our fat cells are the depository for toxins and starting ketosis - opening up the body fat cells at a larger scale and often after decades - releases toxins, which requires, that we take some form of binders for heavy metals etc. during the beginning. I started taking gluthathion and chlorella to support detox and things are getting better. Bentonite clay or zeolite are good, too.
    Enjoying feeling utterly well and cleansed on the inside... Happy Journey to a new level of well-being!
    Corinne

    P.S.: Dr. Mercola and Dr. Gundry talk about this phenomena a lot: Heavy metals can circulate in the bloodstream for more than a year if ignored, after weightloss. There is also a study on sea animals as well that relied and lived on ther body fat for a period of time and had drastically elevated levels of toxins and heavy metals in their bloodstream.

    Replies: #263, #264
  2. Rhonda Mojica
    Hi, I have done this low carb diet 5 times now and every time the first place I get itchy is my inner arm. Its a spot I must sweat a lot in. I love how I feel on Ketosis but this rash that has now spread to the other spot shown on this site, is really uncomfortable and annoying at work. I also have a welt on my forehead that I’m hoping disappears soon. 😳
  3. Marva
    Thanks to the advice on trying the fiber, psyllium husk, xanthum gum etc.. I have those on hand and use them occasionally in baking keto goods. I've had this keto rash before when in Ketosis and it was much worse, more like fungal rash, very weepy and mostly in my arm pits. Using antifungal creams did help a lot but it didn't go away until I started using bile salts. This time around it covers most of my body. Legs, arms neck and face. I'm so grateful to not have it on my back where I would find it hard to get relief with itching, haha! However it is insatiably itchy, it is not weepy and painful. Like many on here I have had such great results with the ketogenic way of eating, it's not an option for me to add carbs. The benefits far outweigh the irritating itching which I know will go away in time. Other than the rash I feel the best I've ever felt anytime in my life. I'm hoping the extra fiber and maybe some bile salts ( need to purchase) is going to help to speed this along out of my system. A big thanks to those who have shared their advice and remedies that have helped. I will post back in a few weeks and let everyone know if I found relief with extra fiber.
  4. 1 comment removed
  5. Ellen
    Wow your story sounds just like mine. Today is feb 21, 2020 and started keto jan1, 2020. About 8 weeks. The itch started about 1 week in and hasn’t stopped since. Today it was so bad that i have decided keto isn’t for me. I am going to increase my carbs and just do it slow. Never ever again will i indulge in carbs as i did but ten carbs a day isn’t good for my body. Hence the itch. And it’s such an intense itch it’s insatiable. I have scars all over from it and you’re right. They are hives. I wish there was more information on it. I’ve tried everything. Only thing that helped a bit was Benadryl cream. If you have received more information on this, i would love to hear it.
  6. Helen Batting
    Keto sweat is much less acidic than normal sweat, which upsets the ph balance of your skin and allows the wrong bacteria to grow. I live in South Africa which is sometimes hotter than comfortable for me and I often got keto rash, especially if I exercised. I have cured my rash (and that of my daughter and a cyclist friend) by using vinegar! Normal spirit vinegar is fine, you are making your skin acidic, not nourishing it. I just wipe it on after a shower while still wet. I do my head, chest , back and upper arms. I rinse my exercise bras in a vinegar solution. I have been in ketosis for years, and never needed to go off it, by doing this. My daughter scratched hers and developed ugly sores but they cleared up in less than a week.
    Reply: #283
  7. Armando Castillo
    Hello Michel C. I too have the keto rash. What brand/product of bile salt do u use? As well as the black seed oil.

    Thanks!!

    Reply: #259
  8. PatCalhoun
    How much and how do you use the psyllium husk and bile salts for those who said they helped?!
  9. Michael C
    @ Armando, Here is the one I used:
    Kiva Black Seed Oil - Organic,... https://www.amazon.ca/dp/B016NHTTBO?ref=ppx_pop_mob_ap_share

    However I think there are many brands and not too critical which one. It’s fairly common. Can also buy at Whole Foods.

  10. 2 comments removed
  11. therorichs
    I only got keto rash after about 10 weeks and the rash is heaviest on my shins, with only minor itching and very light rash on my torso, so I'm fairly atypical. I have had it now for 3 months. At times, esp when fasting, it gets very inflamed and vcauses oedema in my feet. I have tried many things including fresh aloe vera, black seed oil (topical and oral), tea tree oil, rose hip oil, apple cider vinegar (oral & topical), 200g berries daily - all to no avail. I eventually got so fed up I went to a doctor, who prescribed cortisone cream. This provided relief for almost 2 weeks, but the rash is now back. As I don't want to take antibiotics, I am now having 3 carb-heavy meals a day to see if it makes the rash better, as well as taking bentonite clay orally. and applying it topically. I hope something works. 1 week on carbs is making me crave being keto again.
  12. l.chouinard007
    Hi Corinne
    Do you have the links by any chance to these doctors on the heavy metal as well as the study? Thank you for sharing.
  13. l.chouinard007
    I have tried alcool in spray..seems to help a bit..calms down the rashes in armpits and below my breasts as well.
  14. shari l bryer
    I itch but I don't seem to have an actual rash
  15. Vik
    Is the issue with Keto in regards to dairy - lactose, or is it something else in dairy foods?
    Reply: #267
  16. Kristin Parker Team Diet Doctor

    Is the issue with Keto in regards to dairy - lactose, or is it something else in dairy foods?

    Yes, generally speaking. A lot of dairy has too much lactose, but cheese and heavy cream can be enjoyed in moderation.

  17. mfalcon
    So glad i found out what this is!!!!! Mine is terribly itchy and usually flares up once i lie down. It can take 2 hours to fall asleep because of the itching. I have to try the vinegar if i still have some in the house....during covid 19 I am on lock down, so I shouldn't go to the store right now. I read the decrease in carbs can cause decrease in iron which in turn, causes itching.
  18. Dianne
    I repeated my question, just found all these suggestions and answers, sorry for my repeat inquiry
    Dianne
  19. Greg
    I'll definitely back up anything that's said about black seed oil. The active ingredient, Thymoquinone, is a natural phytochemical. It's also been shown to actively interrupt the inflammation cycle, perfect for the rash. I've used it every time I get an inkling of rash appearing.
    I'd highly recommend SciZenna. The oil itself is great, but it's smelly and it sticks to your clothing. They've put it into a cream that also helps with the itching.
    Reply: #277
  20. MICKAELA
    QUERCETIN - it really helps. It's a supplement which reduces inflammation and histamine reaction. I went to see a doctor because I didn't know why I was suddenly really itchy..went on for months and of course they just said it was Urticaria.. I then went to a dermatologist who wanted to put me on a 9month course of 3 x antibiotics a day. No thanks...... then after reading and reading but not knowing what was causing it, I came across Quercetin. I thought (and still think) it was related to overzealous Mast Cells being out of whack and cut out lectins etc etc. It flares up now and then and I take the quercetin.
    I'm also going to try the vinegar spritz :)
    Replies: #276, #278
  21. Marx
    I experienced the problem not only on a Keto diet, but due to the fasting (19:5). I originally thought it was allergy, now i think it is the keto rush. It appears on my eye and chest. Usually Elocom helps, but now I consider just supplements like vitamins, and see what will happen.
  22. Ki
    It’s my 3rd day on keto and O got this rash on the side of my breast
    It happened before but on the 18th day.I don’t think I’m on ketosis yet so why is it happening so early.
    Anyway I’m planning on eating 5 days keto then have a cheat day so this rash go away.is this gonna be bad or it’s okay?
    Reply: #274
  23. Crystal Pullen Team Diet Doctor

    It’s my 3rd day on keto and O got this rash on the side of my breast
    It happened before but on the 18th day.I don’t think I’m on ketosis yet so why is it happening so early.
    Anyway I’m planning on eating 5 days keto then have a cheat day so this rash go away.is this gonna be bad or it’s okay?

    We recommend consistently eating a keto or low carb diet. Incorporating a cheat day may delay your progress and prolong cravings. Rather than adding in a cheat day, you may find it best to moderate your level of carbs to liberal or moderate low carb rather than keto.

  24. Amy
    I have had itchiness on my face that’s continuing to get worse!! It’s driving me crazy! Other than 4-5 days into keto NAT drink, I have not done anything different and I’m not putting anything on my face.
  25. Katsiaryna
    I am on keto 9 days. I have tried year before, but I got keto rash and just quit dieting. But in this year, I am determined more than ever. I learned a lot from my previous an experience and I thought that I avoided all problems which I got year before, but again this nasty thing happened to me again. But I am not quitting dieting because it gives me so much — brain fog gone, my mind is clear. So, I viewed all advises from the website how to solve problem — nothing worked for me except the quercetin does.
    Rush is gone in 2 days! Now I feel much better, and I have a lot of energy to stay on track. Thanks!
  26. Audra
    Where do you get the black seed oil?
    Reply: #279
  27. Roy
    Quercetin might also be why I no longer seem to get this keto rash. I take 250 mg daily. I also recently discovered I had a vitamin D deficiency (16.4 ng/ml), which I did not expect at all. So the last 5 months I've also been supplementing vitamin D3, 4000 IU a day. And I take a 25 mg zinc supplement daily.
  28. Jan
    Black Seed Oil (black cumin seed) is usually available at any health food grocery store like Sprouts or Clarks Nutrition and, of course, online. Get a non-GMO product.
  29. 1 comment removed
  30. Jan
    Roy: You may want to ramp up your supplementation of Vitamin D3 as your lab value is extremely low. During these Covid-19 times, Vitamin D is critical!! You want an optimal level of 60-70ng/mL, per Dr. William Davis of Undoctored fame. When I discovered mine was only 25ng/mL, Dr. Davis and others in Undoctored Inner Circle educated me and I took 10,000IU for about 2-3 months to bring it up to 75. Now I maintain with 5000IU daily throwing in an extra 5000IU twice a week. I also found I have a genetic marker that makes it more difficult for me to metabolize Vit D. Perhaps you do too. Great on the zinc at this time!! That's so important as well. Make sure you get a "clean" brand of Vitamin D without gums, fillers, gluten, GMOs, etc.
    Reply: #282
  31. Roy
    Thanks Jan. I also have a genetic risk for Vitamin D deficiency (reduced binding and conversion). I had started with 8000 IU the first 2 months, and am currently waiting for a Vitamin D test result, but there are long delays, so I'll increase my dosage to 7000 IU till I get the results.
    Reply: #286
  32. Jackie Kienlen
    Thank you Helen, so by using vinegar will it eventually rid a person from the rash or do you just have to apply vinegar daily?
  33. Rita
    I've had the itching from March and when it started my private part, tongue, fingers head was on fire. Now after I take a bath, I have to spend a good 15min scratching. My body has so much scares, I can't take it anymore. I literally live on allergex each day
    Reply: #285
  34. Kristin Parker Team Diet Doctor

    I've had the itching from March and when it started my private part, tongue, fingers head was on fire. Now after I take a bath, I have to spend a good 15min scratching. My body has so much scares, I can't take it anymore. I literally live on allergex each day

    That does not sound like a normal case of keto rash. Please check in with your doctor to rule out other potential causes.

  35. Roy
    Now that I went from a vitamin D level of 16 ng/ml to 33 ng/ml, which is still too low, I no longer get the rash as quickly. It seems that when my ketone levels stay under 6 mmol/L, I don't develop a rash anymore. But if I reduce carb intake further, my ketone levels quickly go up towards ketoacidos +16 mmol/L levels and then I quickly develop the rash still. I read that vitamin D deficiency and insufficiency is common in people that are newly diagnosed with diabetes, especially those with ketoacidosis.
    Do others who also got the rash have a low vitamin D level as well?
  36. Mcc
    Very interesting feedback here. I started keto a month ago and 2 weeks in the rash appeared. It’s very hot here & I exercise regularly so the sweat is surely aggravating it. I am also Vit D deficient & find it interesting that there may be a connection. Will go back to my higher dose supplements. Thinking of trying the quercitin as well. I feel like this is a great lifestyle for me but the itching is brutal. Benadryl and cortisone cream take the edge off but barely. Am desperate to sort it out without exiting Ketosis.
    Replies: #288, #291
  37. Crystal Pullen Team Diet Doctor

    Very interesting feedback here. I started keto a month ago and 2 weeks in the rash appeared. It’s very hot here & I exercise regularly so the sweat is surely aggravating it. I am also Vit D deficient & find it interesting that there may be a connection. Will go back to my higher dose supplements. Thinking of trying the quercitin as well. I feel like this is a great lifestyle for me but the itching is brutal. Benadryl and cortisone cream take the edge off but barely. Am desperate to sort it out without exiting Ketosis.

    Our medical team is not aware of any evidence connecting Vitamin D deficiency with the keto rash.

  38. Mika
    I tried keto about a year ago and got a rash on my lower back, started after about a week, and my doctor though it was shingles! I stopped the keto and it disappeared. I have tried it before but it always comes back. I do fasting sometimes and every time the rash is back, always on the third day. Ive given up keto cause of this (and terrible toilet visits just after eating). Glad to know its not just me, good luck on your keto journeys!!
  39. Tatiana
    I’ve tried Keto 3 times, every time I get the horrible rash. I can’t seem to find anything that helps other than reintroducing carbs which leads me to have cravings and ultimately stop being Keto. It sucks bc I like the way I feel on Keto but it is not sustainable for me, unless I find something to help get rid of the rash.
  40. roykaats

    I am also Vit D deficient

    Interesting, have you done a DNA test as well maybe? As then you could lookup if you have a genetic risk for vitamin D deficiency as well, like Jan and I reported above. You can usually browse your raw DNA data and look for the following polymorphisms that I have, that increase the risk for vitamin D deficiency, and require me to take much higher doses of vitamin D3 supplements:
    - rs7041(T;T): The variant form (T) results in a GC Vitamin D binding protein that binds less efficiently to vitamin D.
    - rs2282679(C;C): Like the one above, this variant form also results in less efficient binding.
    - rs2060793(A;A): This variant form can lower the conversion of D3 into 25-hydroxyvitamin D.
    Your DNA-test provider might use a different orientation, in which case these could be shown as: rs7041(A;A), rs2282679(G;G), rs2060793(T;T).

  41. Candice Trott
    Hi
    This is the third time trying keto, because of the rash. First on my side, itchy and red huge big bruise like. Went to my doctor, she had no clue and thought it was Shingles. The pain And the itching Got so bad I had to quit, I noticed when I scratched my skin Around the area Red streaks would show up Looking like blood in my skin. The scratch marks would stay for weeks I thought I was damaging my kidneys So I quit.
    The second time it started in my Armpit along my upper inner arm and across my chest It was so painful once again I quit. I couldn't find anything On the subject and didn't know there was such a thing as Keto Rash.
    This time it's 3 weeks in and And I have the rash all over my lower back It is so itchy.I
    It looks like I have a sunburn And a rash on top.
    I started to take Allegra it gives me some relief for few hours, and then take another at night to sleep. I put black seed oil On top of the rash It gives me relief for several hours.
    I also take Digestive enzymes, Which has the bile salts in it. Also took Activated charcoal
    But it doesn't look any better I've been doing this for the last 3 days.
    I'm trying to hang on, I'm not Quitting this time I need to lose 40lb
    I know my body is toxic I had all my amalgam fillings taken out by a bad dentist. That didn't give me a Dental dam. It wasn't until the numbness wore off, i found little metal pieces in my mouth. I started have Huge big blotches from head to toe, which lasted for months.
    So my question is when is enough, am I damaging my liver or kidneys?
    What is the best treatment to remove the toxins?
    I also have low blood pressure and a times feel weak and dizzy. With all the salt an Magnesium I've been taken, It does not help, As it lowers blood pressure, but I need it for Cramps in my legs I've been taking magnesium for years.
    Reply: #293
  42. Kristin Parker Team Diet Doctor

    So my question is when is enough, am I damaging my liver or kidneys?
    What is the best treatment to remove the toxins?
    I also have low blood pressure and a times feel weak and dizzy. With all the salt an Magnesium I've been taken, It does not help, As it lowers blood pressure, but I need it for Cramps in my legs I've been taking magnesium for years.

    I am sorry you are having such a tough time with keto, and in general. For the keto rash, if it is that much interfering with your quality of life, you may find you're happier with a more moderate carb intake to get rid of the rash. Please make sure and keep in touch with your doctor regarding your question about your fillings and your blood pressure.

  43. Sofia
    My keto rash started a good few months in, first at the back of my neck and then in between my breasts in a straight line. Two places I’ve never had a rash before. It’s small red spots that turn into a dark brown pigment. I’m going to keep the areas super clean especially after I exercise. Does anyone else have any recommendations to make it go away as I love this diet, thank you
    Reply: #295
  44. Kristin Parker Team Diet Doctor

    My keto rash started a good few months in, first at the back of my neck and then in between my breasts in a straight line. Two places I’ve never had a rash before. It’s small red spots that turn into a dark brown pigment. I’m going to keep the areas super clean especially after I exercise. Does anyone else have any recommendations to make it go away as I love this diet, thank you

    If it didn't show up for a few months, it may not be keto related. You may wish to check in with your doctor.

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