Keto Rash: Relieve The Itch

I have been on the paleo-ketogenic diet for exactly 8 weeks now. As many of you know, I am using this diet as a way to help manage the symptoms of my severe ME/CFS (read more about my CFS here). Things are going well and I have seen some improvements in a few areas already.

People who switch to the low carb, high fat way of life often see great results in weight management and general health, so I am pleased that I also saw such improvements despite my chronic condition. I have less general pain, the heaviness that made moving very difficult and painful has lifted quite a bit, I feel lighter with more mental clarity, I don’t suffer from the munchies anymore, and when I brush my teeth, I no longer get heart palpitations and breathlessness!

This past week has been rather frustrating, though, I started itching all over my body!
I had been itching previously too, but put it down to the fact that I wasn’t showering very frequently due to my CFS.

With the paleo-ketogenic diet I have actually improved my condition slightly and have been able to shower every 3-4 days rather than only once a week. This is when I realised that the itching wasn’t related to the showers. I’d itch more in the evenings, even on days I’d already had a shower. Very strange!

Is this itching and rash normal?

Strangely enough, it is not such a rare occurance!
The phenomenon is commonly referred to as Keto Rash, but it’s scientific name is Prurigo Pigmentosa.

Fortunately, not everybody who goes into ketosis will experience the rash. It only seems to affect some people and it’s still unclear why. The itching will usually start in the torso area, chest, back and shoulders, but can spread across the body. Personally, I don’t really have the rash as much as general itching all over the place. It’s super itchy!

EDIT 07/09/20017 – I now know that in my case it was not keto rash, but a histamine related allergic reaction which I’m still working on with my doctors, possibly a new diagnosis on the way, but the info below might help you if you’ve developed a rash after starting a ketogenic way of eating, so please keep reading.

How can I stop the itching?

The science is not conclusive, there are few studies and varying results. People have had success in treating it with a number of things including antibiotics and creams. Though the easiest and cheapest way would be to simply increase the amount of carbs you consume in a day or come out of ketosis completely.

Apparently, coming out of ketosis and entering back in again might be good enough too. Some people have not had the rash return the second time they entered the ketogenic state, while others get it each time they enter ketosis. You would have to test it and see how your body responds. Give it a few days though, it usually takes 2-3 days to heal the itchy rash completely.

Some people manage to stay in ketosis and relieve the Keto Rash by finding a carbohydrate sweet spot. They basically increase carb intake slowly until they find the amount of carbs that is just enough to keep the rash at bay, but not quite enough to kick them out of ketosis.

This will take some time and patience, but if you’re determined to benefit from being in a ketogenic state, then it’s worth it. Also, there is evidence that fasting is a trigger, so reducing the amount you fast should also help to eliminate the Keto Rash.

My solution

I have decided to increase my daily carbs a bit and avoid skipping meals, I’ll only fast overnight between dinner and breakfast.

For my first month on the paleo-ketogenic diet, I was aiming to stay just below 30g a day, but after that first month, I went down to below 20g a day. This is possibly too low for me personally. So I am once again going to aim for somewhere between 25-30g a day and see if that eases the itch.

It’s one thing being constantly itchy, it’s completely something else when you have ME/CFS and scratching constantly is an exertion you just do not have the energy and strength for. I woke up with such aching, heavy arms this morning – just too much scratching!

I hope my solution will work for me over the next few days, if not I will consider coming out of ketosis altogether, but I do not look forward to the side-effects of the reentry!

Have you ever had Keto Rash?
How did you handle it?
Let me know if you try any of the methods I mentioned above!

UPDATE: I have discovered that in my personal case, I did not have keto rash, the above test didn’t eliminate the itching and it only got worse as the months went on. If you try the above test for keto rash and find you’re still itching, perhaps histamine is the problem and this post will be of more use to you.

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Dirk - July 6, 2017 Reply

Maybe it comes from histamine rich food and liberators????
(Avocado, egs, coffee etc.)

    Chronically Hopeful - July 6, 2017 Reply

    Yes! In a later post I have written about this. I am currently on a low histamine diet. It was definitely not Keto rash in my case.

    I am still struggling with the itch though, it’s taking a long time to eliminate the histamine in my system.

    Chronically Hopeful - July 20, 2017 Reply

    Thanks for your reply, Dirk. I have been on a low histamine diet for some time now, no relief unfortunately.

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