Prurigo pigmentosa

In recent years, the ketogenic diet has exploded in popularity – with no surprise. The amazing results you can get by reducing your carbohydrate intake and increasing your fat intake have been reported far and wide. Substantial weight loss coupled with some fantastic mental benefits (increase in productivity, focus) are the driving forces behind the diet’s popularity.

If crazy fat burning and razor sharp focus sound too good to be true, then you’re somewhat right. The keto diet does have a few negatives that turn people away. The first being the “keto flu,” or the flu-like symptoms that dieters face when making the switch from burning carbs to burning fats. Generally lasting about a week, the keto flu is the effect where your body is searching for carbs but doesn’t find many. It’s not yet prepared to welcome fats as its main fuel source, so you feel weaker, sluggish, and might want to curl up in bed like you were down with a cold.

The second downside is “prurigo pigmentosa,” or the keto rash. It’s an inflammatory response found on the skin of a small portion of people on the keto diet. It starts out as small, puffy, red bumps that can grow into larger legions and eventually can create boils. It’s quite itchy and can turn incredibly painful at the slightest touch, especially during the later stages. It is commonly found on the upper body: chest, stomach, arm pits, back, and neck, and is typically symmetrical around the torso. The exact mechanism that drives this skin response is currently unknown, or at least not entirely agreed upon. Some hypotheses include a sudden release of toxins (fats can essentially quarantine toxins, as they burn they’re released through the skin), a response to acetone (one of 3 major products of ketosis, usually exhaled but can also be released through sweat), or even a response to acidic blood (ketones slightly alter the pH of blood, making it slightly more acidic).

Rarely are rashes a good thing, especially if someone wants to experience the benefits of keto. Some cases have reported a variety of potential treatments, but they most certainly depend on each individual’s response and body chemistry to the treatment. Additionally, many treatments are currently anecdotal. First, an increase of carbohydrates seems to be the most gaurunteed solution, although one of the least desired since it essentially defeats the purpose of the diet. Whether it be an insulin response, or just reduction of ketone concentration in the blood, the effect is not entirely clear – but it works. Another treatment is antibiotics, specifically doxycyline and minocycline. These two antibiotics happen to have anti-inflammatory properties, perfect for this inflammation-causing condition. However, taking an antibiotic without a bacterial infection should definitely raise an eyebrow (although, don’t take our word for it, listen to your doctor!). Common household remedies include rubbing apple cider vinegar, Gold Bond, cold showering (to relieve burning sensations), and drinking dandelion extract tea seem to alleviate the pain and inflammation as well. Although they are anecdotal, individuals finding success with household remedies are certainly worthy to take note of. Black seed oil certainly falls under that category as well. Finally, just waiting it out has been reported as well, although it may take a few weeks for it to go away on its own.

Despite the lack of information and experimentation on prurigo pigmentosa, the popularity of the keto diet has certainly increased the occurence of the keto rash. It’s quite clear that more research needs to be conducted to provide a mechanism behind the inflammatory response, and hopefully steer us into the right direction towards a cure.