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What is Keto Rash?

What is Keto Rash?

by David Anderson -

The keto flu, fruity-and-strong-smelling breath, and even hair loss are some symptoms that may occur when beginning a low-carb, high-fat diet and we've found ways to cope with them all at Konscious Keto.

There is one more symptom though, that some experience when starting the diet that you may not know about yet, called keto rash.

The changing of a dietary protocol can trigger many physiological responses and one that some experience in the absence of carbs and refined sugar can appear as a red web-like inflammation, usually about the neck.

Keto rash is a bit of a lesser-known effect of adopting a ketogenic diet, and it is for this reason that we want to share more regarding the condition, possible causes, and tips to help prevent its symptoms altogether.

What is Keto Rash?

Along with fatigue and brain fog, among the symptoms commonly experienced when adjusting to the keto diet, some may develop a distinct rash known as prurigo pigmentosa (a.k.a., keto rash).

Fortunately, similar to the keto flu, the keto rash is temporary and merely a side effect of rapid weight loss and becoming fat-adapted—for most—often characterized by a red, itchy rash around the trunk and neck.

Studies have shown that the keto rash, evidenced by red spots, a web-like appearance, and remnant dark spots, occurs disproportionately in Asian women but all nationalities are subject to this inflamed state.

Symptoms of Keto Rash 

A keto rash is a form of dermatitis and may be evidenced by:

  • An itchy, red rash that primarily appears on the abdomen, chest, neck and upper back
  • Red spots, known as papules, that take on a web-like appearance
  • A residual dark brown pattern left on the skin once said spots/rash disappears

What Causes Keto Rash?

Research is still emerging regarding the causes of keto rash; however, some preliminary observations leans toward a possible connection between living low-carb and the noted outbreak.  

Furthermore, there are thought to be some associated conditions that increase the probability of experiencing the rash. These include:

  • Still’s disease
  • Sjögren’s syndrome
  • H. pylori infection

More research is required to detail the correlation between ketosis and the acute rash some experience when getting acquainted with the diet—if any.

However, there appears to be a strong connection between the red, spotty rash and initiating metabolic ketosis.

To get a broader picture of possible rash causation though, it's vital to remember that sunlight and extreme heat, sweating, friction, skin trauma, and allergens, in addition to dietary choices, can all trigger a rash, as well.

How to Treat Keto Rash

Developing a rash when beginning a ketogenic diet can be the result of a food allergy, the body adjusting to running on ketones, or possibly an indication of nutrient deficiencies that require addressing.

Fortunately, if the rash is due to the association of starting a keto diet, there are some easy ways to reduce or prevent the keto rash, and we're going to share those tips below.

Eat More Nutrient-Dense Foods

A rash is mostly a sign of a disturbance or inflammation in the body.

This may be associated with vitamin C, A, or B-12 deficiencies, more than the reduction of carbs and sugar in your diet, when eliminating many high-carb fruits and veggies, if not careful.

Some mistakingly eat only fat and protein to the exclusion of all fruits and vegetables on a ketogenic diet, and this can lead to many vitamin and mineral deficiencies that impact every system of the body.

So, it’s wise to focus on micronutrients and macronutrients equally.

Fill your meal plan with a significant amount of leafy greens and other low-glycemic vegetables like kale and chard, along with antioxidant-rich berries, and even exogenous supplements when needed, to ensure complete nutrition.

Increase Your Carbs (From Veggies)

Broccoli, cauliflower, and asparagus, along with dark leafy greens, are all excellent veggie options on a ketogenic diet.

Plus, eating an abundance of colorful fruits and vegetables is a fantastic way to prevent nutrient deficiencies and support optimal health.

The following is a shortlist of our favorite low-glycemic veggies to eat when keeping carbs low:

  • Spinach
  • Kale
  • Swiss chard
  • Asparagus
  • Cauliflower and broccoli
  • Brussels sprouts
  • Green beans
  • Sea vegetables like dulse and kelp

Lower Inflammation

The good news is that ketosis is naturally anti-oxidative and helps to reduce inflammation in the body, thanks to the plan's mandate to remove refined sugars and carbohydrates.

However, the foods and beverages we consume can either enhance or detract from our bodies' ability to eliminate disease-causing free radicals, even when eating low carb—choose wisely.

Eating a diet rich in omega-3 fatty acids, vitamin D, as well as prebiotics and probiotics can all aid in reducing oxidative stress.

Check for an Underlying Condition

Sometimes the emergence of a rash may be related to another health issue and not necessarily caused by what's on the menu.

Communicate your desire to switch up your meal plan with your doctor and make sure changing your meal plan won't pose a problem per a pre-existing condition.

Follow up with your physician if a rash emerges shortly after cutting the carbs and lingers or gets worse over time.

Eliminate Food Allergies

Again, the emergence of a rash soon after starting a low-carb, high-fat diet may have nothing to do with your initiation to ketosis; you may be trying new foods and discovering new allergies.

Consider stripping the diet down and removing any newly-introduced foods to identify the likely culprit. Also, your physician can run targeted tests to determine various food allergies that may be at the root of what you suspect to be symptoms of the keto rash.


Similar to the keto flu, lifestyle and dietary changes can significantly help to prevent or reduce the onset of the keto rash.

Here's a takeaway that should help keep your skin clear as you ease into nutritional ketosis on a low-carb, high-fat diet:

Ease gently into the ketogenic lifestyle.

Slowly reduce your intake of carbs and sugars until you meet the threshold, to achieve ketosis.

You'll soon begin to see your clothes fitting loser, along with surging energy levels. Stepping away from processed foods and refined sugars in steps can prevent unwanted side effects like the keto flu and keto rash since this approach is gentler on the system.

Supplement with a multivitamin.

It can be challenging to get the perfect blend of micronutrients when transitioning to a ketogenic diet. We get it, the 'bacon and butter' extended honeymoon phase can affect even the best of us—with the biggest cost being malnutrition.

Consider adding a quality supplement to your daily regimen to ensure you're consuming a comprehensive and tailored blend of vitamins and nutrients suited to your specific needs.

Consult with a doctor.

Again, the rash you may be experiencing after starting a ketogenic diet may be the result of food allergies or some other undiagnosed medical issue, not the initiation of ketosis.

Reach out to your doctor to discuss your personal needs before making any significant dietary change.

Be sure to also follow up with appropriate professionals if you feel your rash is lingering, or maybe related to something other than the therapeutic elevated ketones present in the body on a low-carb, high-fat dietary protocol.


  1. Dupuis, N., & Auvin, S. (2016). Anti-Inflammatory Effects of a Ketogenic Diet. Oxford Medicine Online. doi:10.1093/med/9780190497996.003.0017
  2. El-Mallakh, R. S. (2004). Potential Applications of the Ketogenic Diet in Disorders Other Than Epilepsy. Epilepsy and the Ketogenic Diet, 153-159. doi:10.1007/978-1-59259-808-3_12
  3. Oh, Y., & Lee, M. (2011). Prurigo pigmentosa: A clinicopathologic study of 16 cases. Journal of the European Academy of Dermatology and Venereology, 26(9), 1149-1153. doi:10.1111/j.1468-3083.2011.04263.x
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