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.

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192 comments

  1. Veronika
    I get the "keto rash" from fasting. Started a three day fast a couple of days ago. I knew I might get the rash as I've always had it before while fasting. And I got it, at the end of day 3. I've been to a dermatologist before, and he said that he's seen this many times before (i.e. the rash tied to keto/fasting). He prescribed me a drug that didn't work. Exiting ketosis always works though.
    Reply: #139
  2. Lisa
    I don't even know what ketosis is but I have developed an undiagnosable rash for the first time in my life. I was given steroid cream and a scrip for,predsinone which I didn't fill. Now in the middle of the night, I suddenly wondered if something about the Maffetone two week test for carb intolerance, which i'm a week into, could have something to do with it. I searched on paleo + rash and found this site.

    I have no idea if I'm in ketosis, but I call this the Charades diet--you can only eat animals, vegetables, and minerals. All these posts have really helped me think through the possible variables, so thank you all. I just took a couple of Benadryl and maybe tomorrow I'll stay away from eggs. I'm supposed to test carbs in 6 days, so maybe I can make it until then, if I believe that will mean the end of this rash.

  3. Anna
    I use salt water in my skin to get some relief
  4. Msconan
    Just experimented a bit with keto - and gradually saw the dreaded RASH. It is slowly clearing with topical coconut oil and a baby eczema cream (Skinfix). I've stumbled into info suggesting that Candida feeds on ketones. So the tie in with the anti-fungal properties of coconut oil (and tea tree oil) clearing the rash. I also was recently diagnosed with leaky gut (there's another tie-in to possible Candida) so had food sensitivity tested and started an elimination diet with no dairy, gluten - not a stretch from keto or Anti-candida, for that matter. Early in, so I can't report on final results, just thought I'd throw that out here. Not going to focus on staying in ketosis, for now, just healing.
  5. Debbie
    Doe anyone have a hive like rash. It comes on at night and is gone by mid morning. I tried eliminating different foods. Washed my bedding and anything else I could think of. Some nights are not as bad. I got up very early this morning with just a few hives. Within 10 minutes I was covered. A couple hours later they were all gone.
    Reply: #148
  6. Ninil
    Its have my rush at 3rd and getting worst and worst everyday. Began at both arm and spread to neck and leg.
    The worst part is my arm, the skin is going thicker.
  7. Eileen
    This explains the itching and the rash! I shall attempt to tough it out. At least one comment suggested an allergy, so I shall also try eliminating and alternating certain suspect foods, such as cheese.
  8. nancy
    I think what everyone is describing is miliaria. I had it on my chest after working outside/ sweating a lot and it is very very itchy and uncomfortable. Over the counter hydrocortisone helped and it did take about a month for it to clear up completely. washing the area twice daily with a dandruff shampoo for itchy scalps then cortisone cream cured the itch in about 48 hours. Not sure why it is associated with ketosis but here is an informative website: https://www.dermnetnz.org/topics/miliaria/
  9. L.J.
    I had it so bad i ended up in the emergency room. I thought i was having an allergic reaction to smething! I could find nothing about it being connected to ketosis at the time. I thought it was from the toxins released from Candida die off. It was horrible. I'm so happy to see it being talked about here and hope it helps others. Thank you for all the great information.
    Reply: #143
  10. Jo
    I also suffered from the keto rash several times. Mostly the chest area, but also the small of my back and at its worst, up my neck and behind my ears. Although I'm not sure about it, my theory is that it is caused by a combination of sweat ketones, sensitive skin (I get atopic dermatitis on my hands and neck sometimes) and an overload of the immune system due to dying gut bugs and general stress caused by the change in metabolism.
    However, I strongly recommend applying any balms or lotions with camphor as soon as the itching starts! Camphor is a local anaesthetic and keeps you from scratching yourself bloody (as I did). Most balms/lotions also contain something soothing, e.g. panthenol, so your skin finally gets a chance to heal. Scratching in general makes it worse as you damage your skin even further, so my go-to was stopping myself from scratching and then see what happens.
    After I took a shower I'd apply generous amounts of horse balm on the affected areas and let it dry for a bbit before dressing. You might smell a bit medicinal for a while, but it's worth it imho.
  11. Pamela
    Rubbing coconut oil onto the effected areas helps everytime
  12. Bugnout45
    I just couldn't sleep last night because my neck was so itchy. I didn't realize it until I got up and looked in the mirror and I saw a weird rash on the base of my neck. I washed it off and used a Benadryl spray on it. It helped and I was able to sleep. In the morning I showered with cooler than usual water and that helped. By this evening it is pretty much gone. This is so crazy! I'm hoping it means I'm getting into ketosis and that it doesn't get any worse..
  13. Robin
    I tried the keto diet for about 3 weeks or so. After keto flu, I felt better (as promised) for a few days, but then started having really watery diarrhea combined with sharp upper stomach pain. I read this might pass after a few days but after a couple weeks of working on electrolytes, tons of fluid and following recommendations for certain foods, etc., I felt I could not continue with the diet. I felt I was not digesting my food and I was getting terribly weak. Strange thing is, after stopping the diet, raising my carbs and generally getting my diet back to usual (for me) for a about a week, THEN I got the rash! I would think I am well out of ketosis, but the rash just started. I also still have diarrhea and low energy. I continue to lose weight as well, but thankfully the stomach pain has resolved. Any advise on how to get back to my "normal" or ideas on how long that will take are greatly appreciated.
  14. 1 comment removed
  15. Mustela
    Hi Robin and all - you have to consider the possibility that this rash is caused by toxins stored in the fat in your body. When you burn the fat through ketosis, the toxins go into your blood and make you itch. This can be particularly bad for people with latent infections like EBV or Lyme which can get reactivated when the virus and bacteria are released from the fat and liver where they were dormant. Also if you are gluten intolerant gluten is stored in your body and gets into your blood and makes you itch. It is like a Herx reaction (Google it). The best way to go is to slow down and try to detox slowly so you can cope.
  16. Connie Chaney
    I have had a rash on my upper back for nearly the entire time I have been on the Keto diet (9 months). It's severity comes and goes, but it is itchy, but not intolerable. As I am reaching my goal, I will soon try to add some additional carbs to see if it goes away, but I have decided to live with it, because I felt it was worth the outcome.
  17. Sam
    I don't get this unless I get hot; weather hot or exercise hot.
    Then its very bad, very itchy
    I take anithistamines and it reduces in a couple of days
    But I do a lot of exercise so this is really problematic
    I want to continue losing weight so reluctant to raise my carb levels - I'm at 20g or less at the moment
  18. Linda
    Wouldn't dry brushing prevent keto rash?
    Also if they had already contracted it , wouldn't it help GREATLY in eliminating it by stimulating the lymphatic fluids?
    If you notice ...the "general" infected area is packed full of lymph nodes ... as a person goes into ketosis and is rushed by all these toxins .. the lymphatic system is having a hard Tim keeping up and just needs help.
    Is this correct?
    Thoughts?
  19. Cathy Harper
    I believe it is caused by dying candida. When you are in ketosis, there is no food for the candida and it dies, causing the rash.
  20. jackie morrell
    I have had a keto rash for about 10 days, which is a shame because the LCHF diet has been a revolution. This is the first time in my adult life i have had lots of energy. I really don't want to come out of ketosis. I am trying to reduce the rash by taking activated charcoal and gallbladder supplements. There is some supporting evidence on you tube, as why gallbladder supplements might help, try Dr Berg posts. I have been taking the supplements for a couple of days and the itching on my torso has stopped, though my neck is still very itchy. I have ordered some essential oils and soothing cream, made from kefir. I'm hopefully this will help. Once I have tried it, I will report back
    Reply: #142
  21. Natasha
    It's my third week into Keto and over the last two days my ears, under breasts, back, ankles itching madly...ugh...Keto flu now this lol. Thank god Im seeing/feeling considerable health/body/emotional benefits from keto or I'd "scratch" it! ?
  22. Тамила/Россия
    I think that it is connected in principle with toxins. I will explain: 1 I pour out as soon as I begin to lose weight; 2 human fat accumulates toxins (the stock of the whole shit is stored in the human body in fat). How I struggle with this pain. => 1) The way out of ketosis helps. (And by the way, when immediately after knocking down ketosis, you sit back on keto then there is no rash) 2) hike to the sauna / sauna and I drink hot tea and smear with plain salt. 3) hot tea, hot soup + pepper. All to properly sweat. I'm saved from itching when it's bad, so => ​​in the bathroom I pour from the shower the places of the rash with hot water, as hot as you can tolerate. At night it saves if you cover the place of the rash with a damp cool towel and so sleep.
  23. Barb
    I am so disappointed that I have to be one of the unlucky ones with Keto Rash. Mine has NOTHING to do with sweat. There is no rhyme or reason when it appears. Over the past 3 weeks, I've gotten it on both legs from the knees down, the back of my neck and the underside of both arms. I was on Prednisone for 5 days, take Benedryl Allergy and use a cortisone cream. Nothing helps. I'm going to up my carbs (vegetables) from 20 to 50 and see if it helps. I DON'T want to stop Keto but I may have to.
  24. rajni
    I find Hemp oil useful for relief.

    Also rubbing Olive oil in the itchy area after shower helps avoid the problem.

  25. DW
    This is the best explanation I’ve read thus far. My rash has been driving me insane. I’ve been doing keto for 3 months and my rash is worse than ever and definitely exacerbated by heat and exercise. Nothing has worked - hydrocortisone, antifungal cream, coconut oil, etc. Now I’m afraid to workout. I did Paleo before keto and was happy. Oh and I look like I’ve been beaten from all the scratching and bruising. I’m upping my carbs starting today. Thank you.
  26. leigh-anne
    A few months after the birth of my son I started developing a rash. The Dr's said it was hives. I spent the next 2 years trying elimination diets, doing allergy testing, skin tests. .I could not fathom out what was causing my rash. It would come and go.
    After suffering 2 years it disappeared..I was free for a whole year..
    Then a few moths ago it reappeared. This time I realized that it seemed to appear when my carbs were low. I'd recently started the keto diet.
    So now if I don't eat at least 100g of carbs a day the rash will appear.
    It's so frustrating.
  27. Cassidy
    Seems I slip into ketosis so easily now, without even really trying. I usually f eel some fatigue, but that passes quickly. The rash and the itching on my neck and just drive me bonkers! I'll be half way through a cardio workout and my neck will start to burn and itch and it's even worse if my ear bud cords are grazing my sweaty neck. Sometimes I'm not sure if it's worth it, But inevitably I find myself back in the same spot. Journey on!
  28. Venita
    My keto rash is on my face; easpecially the jawline and forehead. Super itchy! I was my normal keto itchy (mine doesn't seem to go away) and in minutes, my face broke out like crazy! This speaks for doing keto well but wowser! Thanks for all the ideas and pointers. I'll give them a try.
  29. SAM
    04 Feb 2018

    My Keto rash started on my legs, below the knees, after about 3 wks on this WOE; now it is all over my body; I don't want to go out of ketosis, if I can help it; just want something for the itch!

  30. Jan
    I have been on and off low-carb for the past 10 years and the rash appears about 2-3 weeks into the diet every time I have been off low-carb for a while. Eating carbs helps of course, and when the rash occurs I do some carb-binging one night, 100 grams or so, followed by 6 days of low-carb, then carb-binging again and low carb again. The low-high-low-carb cycle doesn't kick me out of ketosis, but it's enough to alleviate the rash and itching. After a while it vanishes.
  31. Ivan
    I got it on my legs, 3 weeks into the diet just like a few other folks here before me mentioned. I m a bit relieved to know I m not the only one who got the itching/rash. I 'll keep in mind to go up on my carbs a bit next time it happens... it was bad, but mostly went away after a week or so, but occasionally the itching returns or hits a different area - now I'm about 8-9 weeks doing keto. Wondering if it will be an on/ off thing (for me )or if eventually the itch will go away permanently ..?
  32. Loly
    Can someone please help me! .. I got the keto rash on my chest and a little bit on my back. Afterwards, I've exited ketosis. However, I still get rash coming on my back. what shall I do?
  33. Peggy
    OMG, I have been to doctors and doctors, telling them that I have changed my diet and they have all poopooed me saying that has nothing to do with my rash that is on my feet, ankles, lower legs, elbows, forearms, neck, hairline and upper back. They took a skin scrap and told me I had Grover's disease. I checked it out and thought, that does not fit. So glad I found this. I might experiment with more carbs and see what happens
  34. simone
    I suffer with psoriasis, but its got worse over the course of the Keto diet. (Just found this page) I was wondering if mine is combined. The comments and description is fantastic and opens up heaps of questions and answers. So i might switch to the non dairy,non egg regime and see how I go with it all. Thanks for the info :-)
  35. Adam
    Thank God I found this! Over the last week I have had very little to almost no carb intake beside vegetables, Have eaten more cheese and avocado then I ever have in my life. A couple days after snacking on cheese and a whole avocado, I became intensely itchy and then it would turn into hives, the hives would spread to one part of my body and then the other, I first noticed it in the abdomen, then the shoulder blades, my neck, behind the ears and hairline, the itchyness would go a way for an hour or two and then it would hit another spot sometimes just a moderate itch and then sometimes it felt unbareable. I Immediately thought that I had formed a dairy or avocado allergy. I have even tried showering without the shampoo and body soap that I normally use because I could not find out a reason for the allergy. I spent the last two days researching, I discovered anyone with Eczema or other skin conditions can be susceptible to rash, I have a very mild case of Eczema. I found a list of foods that cause itchy ness and Avocado and spinach are on this list: /www.eczemalife.com/pages/top-12-eczema-itchy-foods-to-avoid, they are called salicylates. My carb intake from traditional, bread, rices etc has been extremely low.... The Keto rash explains it! I hope this is what I am experiencing!
  36. Thelma
    Went to the doctor for a lab review for hormones and told her about the weird underarm rash I got after a heavy night sweat. The rash in my armpit at first looked like I had cut off circulation with too tight of a sleep shirt. The skin was super red and welted in certain places. I checked the other armpit and it didn’t look like it was affected until the next day. I think I spread whatever it was to the other side when I examined the other armpit. VERY UNCORMFORTABLE! Itching, and burning. I ended up using a type of ultra diluted sodium chlorite (don’t judge my grandma’s go to for skin infections). I also used oregano oil. Eventually tried an anti-fungal cream, after washing with soap and water 2x per day, which moisturized the area. I went to the dermatologist and saw a PA who diagnosed it as dermatitis. (I didn’t agree) But my lady GYN said it was more likely Candida released through the lymph glands since the Keto diet causes detoxing. Depending on how toxic you are will determine the severity of symptoms. I am eating less milk products and more foods to increase alkalinity. It took a few weeks, but the rash has gone. I have never ever had any time of rash like that before. Our environment and food are so toxic!
  37. Monika
    I too am suffering from Keto rash. I heard Dr Christopher Shade speak on toxicity. He explained that it could be because the bile is not optimal. So you are not excreting the toxins as they should. So it tries to get rid of them through the skin.
    So I have added Bitters, Aloe bitters, Moringa as an anti histamine.
    I take some Charcoal tabs and add a small amount of bentonite clay in water 4 hrs after having your evening meal, to absorb the toxin while I sleep.
    It makes it bearable. Has not disappear though.
  38. Joe
    For me, all my symptoms fit the description above with 2 exceptions:

    a) There is no visible rash;
    b) It is worse in lower sweat areas such as my chest, in bilateral patches.

    I have been on the keto diet (strict) for 5 weeks.

  39. Norwegian
    I also get it when I'm fasting (for a longer period). I follow a low-carb vegan diet, going in and out of ketosis. It's almost a keto-meter: the rash gets worse and more itchy when I go deeper into ketosis.
  40. Elena
    I started keto in February. The rash appeared a week later when I started to put heavy cream in my coffee: it poped up on my underarms, the upper chest and between my breasts, but it was no itch. I stopped using cream, the rash got better, but didn’t go away.
    It stayed the same until a week ago (and I didn’t do or use anything new) - now I have it on my belly, on my breasts, and it is creeping on my neck, and it is itchy.
    I tried coconut oil and it helped with the itch.
    It would be very upsetting to go out of ketosis. I lot of people take Andreas Eenfeldt’s advice no. 4 and start eating a bit more carbs, but nobody is saying which ones.
    I would like to ask your advice:
    What would be the least “harmful” carbohydrates to eat to go out of ketosis, but still continue to be low-carb?
    Thank you very much
  41. Rachael
    I’ve done a LCHF lifestyle for about 13 years now (about 6 months on, 6 months off). About 6 months ago, I added intermittent fasting into the mix with great results! However, lately, I’ve had less and less of an appetite, so my “eating hours” on IF have changed drastically (like, I went from a 8-hour eating period to a 2-hour one accidentally). Within a few days of this, my chest turned bright red with a Keto rash. I’m trying to go back to the 8-hour eating window to see if that helps- anything rather than going back to eating carbs!!
  42. Laura
    Jackie, just reading thru these comments and wondered if you could tell us if your rash went away when you continued with the gallbladder supplements? If so, did you use bile salt supplements?
    Reply: #149
  43. Laura
    L.J....s is did you finally get rid of the rash if you don't mind my asking??
    L.A.
  44. Judy
    I am experiencing a mild Keto rash. Lots of red welts with lots of itching on my abdomen, surrounding the armpit but not inside, and my mid back area. I have increased my water intake and salt. Also, the first night of the two week challenge I had 1/2 cup cottage cheese and 1/2 cup strawberry yogurt. It helped a lot. But rash came back this morning. I wondered if it wasn't an imbalance of yeast in my system causing the problem. Also, this is my fourth try at the Keto diet. Last year I was successful for four months, July to November. I didn't notice the rash last time. I am determined to succeed this time.
  45. Paula
    I have been on the lchf diet for 12 weeks along with intermittent fasting of many combinations. Sometimes I fast for 24 to 48 hours and sometimes it's for 12 hours only. Every week I mix up my intermittent fasting. I have lost 27 lbs with 4" lost around my hips and 4 1/2 " lost on my waist. I want to continue to lose another 20 lbs however I have been experiencing the keto rash ever since I started. The rash has now gotten so bad that I pretty much have it everywhere except my face. It keeps me up at night and is almost unbearable . I have Googled everything I can on the keto rash and have tried every remedy I have seen. Nothing works. I'm afraid that I may have to increase my carbs in order to get rid of the rash. My question is how many carbs can I eat and still lose weight? I've been keeping my carb count less than 20 grams per day. I am a very active person who works out everyday. I have no idea how many carbs how much fat and how much protein I should be eating in order to continue losing weight. I have gone off of the diet a couple of times in the last 12 weeks because of vacations and got right back into the diet when I returned. Each time my rash went away but came right back. I have a lot of energy and feel great. But I'm afraid that if I have to add back carbs because of the rash I will feel sluggish and won't be able to exercise like I have them. Like I said before my goal is to lose another 20 lbs. Any advice?
  46. Paula
    I want to add that I know when I am in ketosis because I use the testing strips. My rash is definitely connected to ketosis. I also want to add that I have tried many different diets and I know that I am metabolically resistant. I have my A1C tested every 6 months and 8 weeks into the diet it had dropped one point. I am not a type 2 diabetic but my family is prone to it and my A1C had been slowly creeping up over the years
  47. Lori
    I had the keto rash for honestly about 6-8 weeks and it basically resolved on its own. I hated the rash but it was under my clothes so no one saw it. I did itch a lot and sometimes it was hard to sleep at night, but the weight loss and being able to come off of Type II Diabetes medicine, cholesterol medicine, and high blood pressure medicine made putting up with that worth while. I have also lost 40 pounds with eating keto and intermittent fasting. Once it went away it has not come back. I had it really bad too. I saw pictures of what some people had, but mine was all over my stomach, chest and sides. A lot of it seemed more pimply than rash like. One thing I did try though, was something Dr. Eric Berg suggested. I ordered some bile salts. His theory was that all of the fat in a person's diet may have a hard time breaking down with the normal bile produced by the gall bladder. I was so miserable that I went online and ordered a bile salt capsule to take with my meals. I ordered it from swansons vitamins. I cannot say whether that did the trick but I did get rid of the keto rash. It might just be that I am totally fat energy adapted or it could be the bile salts. In the beginning of going keto, my urine test strips were super dark maroon in color, but over time they gradually have gone to reading as a trace, but I read that happens once you are fat adapted because you don't have as many ketones spilling over into your urine. All I know is I continue to lose weight and my BP is down, my sugar is normal and I feel awesome. Hope this helps someone.
  48. Lori
    I think that I got the same thing but it was always after consuming coconut oil.
  49. Lori
    Laura, I just saw your comment. I started using bile salts and my keto rash went away and I had it really bad. Just FYI. Lori
  50. Paula
    Thank you so much. I am going to try the bile salts! Fingers Crossed!
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