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.


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.


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.

    Read more →
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All comments

  1. Peg Wadge
    Thank you. This is the best post I've read. You really hit the nail n the head. I'm suffering now with this rash and unbearable itching. Add to that, I have ms which also comes with itching. I feel like I can't win. You, however, have changed that. I am super and deserve a healthy body. Yes, it has limitations but healthier than it was yesterday. I can and will persevere. Thank you, Michelle.
  2. Kimberly
    I’ve been at home freaking out thinking I have scabbies or some other crazy skin problem, and now I’m thinking HOLY CRAP!!! It’s because of my low carb diet. All on my upper back, shoulder, chest between and under breast and around tummy. It’s tiny little dots barely a rash that itches but ITCHES when I’m sweating. Uggh if this is actually what it is then this rash I guess is really nothing and very worth it.
  3. Natasha
    I started the diet on a Monday. The following Sunday I did a very heavy yoga workout, and Monday (exactly 7 days after starting the diet, I had lost 6 pounds and was constipated) noticed the rash under my bra line and on the side of my torso. The next day it spread further across my back. It was never itchy, but had a mottled appearance. I immediately ate carbs and stopped the ketosis process. After doing a lot of research, I think that we overload our liver so much (over-producing ketones and can't produce enough bile to break down all of the fat), that the rash is an inflammatory response. Basically your liver is saying WTF!!?!?!?! Don't take a liver detox protocol as that will be too hard on it. Instead, take something to support it. I found a high quality supplement which provides critical liver support and includes milk thistle and other items. Also, I started taking a fibre supplement. The rash hasn't gotten worse since I stopped ketosis, and is slowly healing. I'm being really gentle with my body, and do not plan on inducing any crazy sweating until another week or so as when things have really normalized. I'm not convinced that these rashes are worth the diet and feel that there should be more emphasis on educating people about this as a potential risk. The doc may recommend antiobiotics and cortisone creams, but that is a bandaid solution and not treating the underlying cause. (I am not a medical professional, these are just my opinions.)
    Reply: #204
  4. Naz
    Keto for me was just the worst. I stopped the diet in the end of January and am struggling with rash since then. I spent loads of money buying remedies and teas and so much stuff. Finally I decided to talk to doctor. She prescribed cremes, anti-allergies, anti-fungal etc. Nothing is curing it.
    I agree with Natasha. People should stop giving advice in something even doctors are not aware of.
    I really regret doing Keto diet. The pounds I lost I’ll certainly put in again in the process to stop this crazy rash. Really sad😢
  5. Helen
    Calamine lotion is all that works for me. I have to up my carbs when it's really bad. I get it awful under breasts and so itchy wearing my bra. My armpits also suffer. I wash as much as I can but when at work the only thing is to reapply calamine lotion, I have to dab it on and leave as thick a layer as possible, let it dry and carry on with my day.
  6. Becky H.
    I am sorry to hear that people have had to stop the diet because of this rash.
    I have gotten this every time I went into ketosis, until I figured out what was causing it.
    From researching, I have learned that bile is absorbed from the end of the small intestine and recycled in the liver to use again. The problem comes when this happens too much.
    Since bile is also used to carry some types of bodily wastes out of the body, if it keeps getting recycled, then the wastes just get concentrated.
    Soluble fiber binds to bile and takes it out of the body. Then the liver makes new bile.

    Once I started taking soluble fiber, the rash stopped. I haven't had problems since. I use psyllium husk. But other forms are aloe vera, carrageenan, xantham gum, chicory root, etc... and it occurs in some veggies too.
    I hope this helps someone.

    Reply: #222
  7. 1 comment removed
  8. Bronwyn
    My keto rash shows up on my scalp too! It's starts with a tiny itch and then feels like bee stings, then blisters and weeps. I'm desperate to find a solution. Just started taking ox bile today. Praying it works. I don't want to give up low carb and ketosis.

    I never had this problem when I did Atkins in my 20s. I'm in my mid 40s now. This is so incredibly frustrating.

  9. Shrly
    I've been on keto for nearly 6 months and experienced excellent weight loss. For the itching I use Lacto Calamine liberally. And in a day or two , gone!! On the neck its a little tougher . Thats because while the rash is on, it has a patch that emabarassingly looks like love bites.
    I first dab Lacto Calamine and sun block cream over it and then a very slight foundation. Good to go. All this worth it for an otherwise healthy, happy, fat- free life.
  10. Shlomit
    Whatever people said I had the same. At first I didn’t know what is that. Poison oak, stress...I went to the doctor and both him and the norse practitioner didn’t know what it is. I was so upset for them being doctors and don’t know. Until I read this article and was so relieved. Same symptoms. Applying Viniger on the rash helped a bit, but only eating carbs solved the problem completely. I didn’t mean to go Ketosis, but I am gluten free and very particular about the food, so I found myself not eating carbs, and still it will happen sometimes without intention getting into Ketosis. So I have to make sure I eat carbs... cause the rash is unbearable.
    Reply: #211
  11. Coraline
    Same exact issue... I didn't even notice I had stopped eating carbs, or had ever even heard of this Keto diet, but like you I changed my eating habits and have been eating mostly raw veggies/foods, and foods that are naturally colored (especially for my GI issues), which had so for totally helped my GI flare ups.. until I woke up with this horrid rash all along my upper chest/shoulders and lower neck, and even my scalp! I'm going to carb load right now lol .. I just hope this helps!
  12. D Dean
    Well..... increasing my carbs. The bumpy, itchy rash has not abated at all. It’s like alligator skin now, on my chest, back and neck.... I’ve tried ACV, calamine lotion, coconut oil, expensive all natural creams, liposomal glutathione capsules, bile salts...... it’s now about 2 months of the itchy rash..... ANY suggestions at this point???
    Reply: #213
  13. Kristin Parker Team Diet Doctor

    Well..... increasing my carbs. The bumpy, itchy rash has not abated at all. It’s like alligator skin now, on my chest, back and neck.... I’ve tried ACV, calamine lotion, coconut oil, expensive all natural creams, liposomal glutathione capsules, bile salts...... it’s now about 2 months of the itchy rash..... ANY suggestions at this point???

    That sounds much more severe than keto rash, you may wish to speak to your doctor.

  14. D Dean
    The thing is, it started a little after starting the keto diet. It is in exactly the same places as your picture shows. It’s not on any other place.
  15. Rosa
    Hi guys, 4:00 am awake because of the annoying itch . I am doing the keto diet. I was so excited, I lots 8 pound in 20 days. I was feeling that my body was asking me for fruits, something fresh. Any way, the rash started very small at the back of my neck, but is moving down, super itchy, specially during the night, went skin is touching the bed. Super itchy. I also got palpitations!!! Any way the worse is I can't sleep a D that it is not good for your heath . I am buying the psillium husk as someone suggested before. God help me
  16. Gabriela
    Well, now I know what it's all about. My rash is on my calves, my forearms and between my fingers. I've lost almost 4 kilos during this first week of my challenge and feel great. I'll try to handle the rash the Best I can, although living in Panamá Will high temperatures all the time makes it more difficult.
  17. Karen
    I start itching on my inner forearms every evening and then see the arrival of the hive like rash all over my arms. It doesn't stay, it leaves within an hour. I have been experiencing this only since starting this keto diet. Anyone else just getting the hive like rash on arms?
    Reply: #218
  18. Kristin Parker Team Diet Doctor

    I start itching on my inner forearms every evening and then see the arrival of the hive like rash all over my arms. It doesn't stay, it leaves within an hour. I have been experiencing this only since starting this keto diet. Anyone else just getting the hive like rash on arms?

    Keto rash is normally on the trunk of the body. You may wish to see your doctor to rule anything else out.

  19. Rebecca
    After starting the keto diet I upped my workout routine and I had a terrible rash on my hair line on my neck. It was definitely correlated to where i sweat the most. What really helped me was to immediately use cleaning wipes on my neck after my workout to remove sweat.
  20. James
    What helped me, as I got the rash after 1 week into keto.

    1. Cold shower to lessen the inflammation
    2. Zinc cream
    3. Aloe Vera

    Trying CBD oil in conjunction with the above, now that I got more oil. If the rash appears again I'll see if the CBD helps. Will report back once I know more.

  21. James
    Oh, and I instantly went out of ketosis not let it escalate. Will gradually reduce carbs and let the body adjust rather than going straight down to sub 20.
  22. Michael C.
    Thank you for this comment. I have been struggling for 8 weeks with keto rash and don't want to stop keto. I started psyllium husk right after reading this and 2 days later is already helping. I also saw this video which goes further: The video by Dr. Berg indicates that supplementing with purified bile may further help. I have ordered some and have fingers crossed. So itchy.
    Reply: #224
  23. Leyla
    Thank you Michelle, very encouraging!
    Did you experience the rash and then it went away?
    How long dit it take?
  24. Michael C.
    FYI - over the past 8 weeks with this rash I've been to the doctor a handful of times and tried benadryl, topical steroids, oral steroids (prednisone), and the rash just kept going. Calamine lotion gives short term relief from itching. Doctor had me stop using cortizone cream as it was making it worse. I stopped doing vigorous workouts and it got a little better. I am hopeful that psyllium husk (soluble fiber) and/or purified bile salts will help. If not I plan to try cyclical keto with 1 carb load day every 2 weeks.
    Reply: #225
  25. Leyla
    Thank you Michael,

    In addition to what you mentioned, I have read about other possible things to try.

    • In a video by Thomas DeLauer, He suggests ( )
    -Drink ginger and green tea
    -Stabilize gut bacteria with probiotics and prebiotics (which? I don't know)
    -Consume artichoke, asparagus, souerkraut and/or kimchi
    -Drink kombucha

    • Dr. Eric Berg recommendation ( )
    -Take Bennonite clayTake
    -Ox Bile as a supplement each day.

    Nobody seems to know what might help with this. It looks like people have to experiment and find what will work.

    I have been on the ketogenic diet for nine days along with working up to a 16/8 intermittent fast. I am experiencing a very welcome increase in energy, some weight loss, and improved respiratory function.

    The transition has been going smoothly until yesterday, when I noticed a few small and itchy bumps on my forearms (not mosquito bites), somewhat like the reaction a have when I eat fish, which I have not consumed at all. So far it is not unbearable, but I do not want it to escalate.

    Given that I am experiencing such great effects with the diet, I would not want to increase my consumption of carbs and stop getting into ketosis.

    In any case, I wish the best luck to you, Michael. Please write an update about things go for you when you have tried the new items.

    Reply: #227
  26. Bonnie
    This is my 2nd round with Keto because I had to get off after injuring my leg and couldn't do the grocery shopping. I have experienced the rash and itching again now that I'm back on it for a few weeks but itching starts in my feet. About 6pm every day my feet become uncontrollably itchy, by mid evening I developed the rash on my chest and back and I am itchy from head to toe! Have been going crazy thinking of what it could be as I have numerous allergies so I of course have been dosing with benedryl, calamine, cortisone cream, lotions, and cold showers. All of this is only temporary relief and I went to my PCP and they couldn't for it out either. They gave me a 'script for a higher dose benedryl (loratodine) that seems to allow me to get some sleep and relief but does not completely go away. My sister in law has jumped on the keto wagon since I did so well the first time and dropped 50 lbs in 7 months. She was the one who saw this site and thought of me when I complained of this mysterious rash and itching again and that made the light go on! It has only happened one other time when I first started this diet and went away after a week and a half so I knew it was because of the diet and nothing allergy related. I am taking the loratodine and also added a few more carbs in my day instead of dropping to 0 net carbs and let my body adjust as I lower it. So glad she saw this and many others are experiencing the same thing so I'm not alone and feeling like I have something medically wrong with me that Drs just can't figure out!
  27. Michael C
    Thanks for your input Leyla,
    After much reading and trying many things here is my summary of things that I tried and how helpful they were:
    -Stopping workouts (heat and sweat) were helpful and slowly the rash would begin to go away but not really an option as I need exercise to be healthy. Appears that increasing carbs would also stop the rash but again I did not want to do this as this WOE has been very beneficial to my health.

    1) Black Seed Oil - very helpful (and fairly inexpensive) in making rash go away (not sure if due to antibacterial, antifungal or other properties) (applying 2-3 times per day to affected areas topically with rash visibly improving within 2-3 days)
    2) Aloe Vera - helpful with skin healing and itch relief after rash begins getting better
    3) Psyllium Husk fibre - uncertain but theory is it helps move used bile and toxins out
    4) Bile Salts - uncertain but seemed helpful (
    5) Milk Thistle - uncertain but theoretically provides liver support
    6) Coconut oil - helped with dry skin as rash dissipated
    7) Greens Supplement - uncertain but using
    8) Wheatgrass - uncertain but using
    9) Cod Liver Oil - uncertain but using
    10) Showering with Vet's Best Allergy Itch Relief Dog Shampoo - helpful with itch relief
    11) Zinc cream - helpful with with itch relief
    12) ACV Protocol (as described at: - moderately helpful but berries have too many carbs for me and ACV a nuisance to apply to skin

    Prior to this I had tried antihistamines, hydrocortisone cream, antifungal creams, topical steroids (betaderm) and oral steroids (prednisone) but none were effective and the rash kept getting worse.

    Basically once I started using the Black Seed oil I was already using the bile salts and the rash began to disappear even with high intensity exercise, which previously would always make the rash get worse.

    Good luck to all dealing with this issue.

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