Keto Rash: The Low Carb Diet Itch

keto rash

The keto diet is known for fast results when it comes to fat loss, improved athletic performance, mental focus, and all-day energy. However, one of the few ‘side effects’ of the keto diet it’s worth knowing about is the low carb diet itch, the keto rash. Before these itchy red bumps alarm you, let’s look closer at what the keto rash is: its causes, symptoms, and what you can do right now to begin healing it naturally.

What is the Keto Rash and What Causes it?

There’s a scientific term for the keto rash: prurigo pigmentosa. One study describes prurigo pigmentosa as a rare inflammatory skin disease with an unknown cause, but notes that ketosis and prolonged periods of fasting seem to be the common denominators. 8 out of the 16 patients observed in this study who had the rash were either fasting or in ketosis (1).

The keto rash is characterized by itching and discomfort, and typically appears on the chest, torso, back, and neck. It’s unclear exactly what causes the keto rash, and there’s a lack of scientific research done on prurigo pigmentosa, which can make it harder to pinpoint the cause and solutions.

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.

Dr. Andreas Eenfeldt

Dr. Andreas Eenfeldt explains that the keto rash tends to appear only in areas where sweat accumulates and usually occurs in the early stages of ketosis, which may cause irritation in some people when the ketones come in contact with the skin.

Online keto-diet forums and keto dieters have listed other potential causes of the keto rash:

  • Candida die off and fungal infections
  • Allergies or histamine intolerance
  • Nutrient deficiencies
  • Detoxification during ketosis

Founder of the keto-friendly Bulletproof Coffee, Dave Asprey, believes the keto rash is caused by aggravated gut bacteria, and cells releasing heavy metals, pesticides, DDT, and other toxins during ketosis.

On the Bulletproof Radio Q&A: Podcast episode #148, Dave explains

When your body starts to burn fat, you can seriously dump amazing amounts of toxins. Fat is a dumping ground for toxins, such as mercury, DDT, estrogen disruptors, and anything your liver can’t handle right now. 

Dave continues to explain that the keto rash can come from these toxins being released from fat cells, but may also come from having certain bacteria and yeast in your body, which are normally ‘quiet’ because they feast off carbs. Removing carbs from your diet can aggravate symptoms of fungal infections, which includes rashes— and may explain why the keto rash happens for some people.

Adding carbs back into your diet can ‘quiet down’ the yeast and bacteria again, which explains why increasing carbs helps the rash disappear. However, Dave’s solution in this case is to kill off yeast and bacteria altogether with natural antifungals such as grapefruit seed extract and garlic.

Some studies also suggest insulin resistance and type 2 diabetes are linked to the keto rash (3).

Although information about the keto rash online is sparse, it’s not uncommon for people on the keto diet experience this ‘mysterious’ rash, so let’s look closer at symptoms, whether or not you should be concerned, and how to clear it up.

Symptoms of the Keto Rash

  • Itchy, elevated red skin lesions on the neck, back, torso, chest or armpits
  • These lesions may appear or become aggravated from heat exposure, elevated body temperature or exercise
  • The keto rash tends to forms a reticulate pattern and is symmetrical on both sides of the body
  • Bumps can be red, pale pink or a brownish color

The Keto Rash: Should You Be Concerned?

There’s no doubt the keto rash can be alarming, especially if it becomes severe enough to interrupt your sleep or limit you to only being able to wear loose fitting clothing. But how do you know when you should get a doctor to check you out?

The good news is— while we’re not discouraging paying a trip to your doctor—  prurigo pigmentosa is non-life threatening, and is an apparently natural reaction some people have when entering ketosis. There are natural solutions to clearing up the keto rash that you can try right away, and if the rash doesn’t show any signs of improvement or relief within a few days, you may want to pay a trip to your doc at that time to see if he or she has any other solutions.

Here are our tips for clearing up the keto rash naturally.

How to Clear Up the Keto Rash Naturally

1. Increase Clean Carb Intake

clean carb

If the rash has occurred while you’re in ketosis, try increasing your carb consumption up to 50g of carbs by adding more fruit and starchy vegetables to your diet. Increasing your carb intake may throw you out of ketosis, but if the rash was triggered while you were in ketosis, this may be the most effective way to find relief.

In fact, some people report the keto rash clears up within 2-3 days once they add more carbs to their diet. However, they notice the keto rash reappears as soon as they enter ketosis again. If this is you, it may be worth getting your heavy metals checked by a naturopathic doctor to see if detoxification could be an underlying cause of your keto rash, and/or taking steps to improve your healthy gut bacteria (such as following a candida or leaky gut diet). Since the keto rash is associated with diabetes, it may also be helpful to get your blood sugar levels checked (3).

2. Drink Bone Broth

keto bone broth

Bone broth is one of the best foods you can eat on the keto diet, not only because it fits in with the keto diet plan, but because of all the natural anti-inflammatory nutrients it contains, such as glycine and proline (4)(5). As an inflammatory skin condition, one of the first places to begin healing the keto rash is to eat plenty of foods that reduce inflammation and can help you heal from the inside out.

We recommend Kettle and Fire Bone Broth on the keto diet because it fits perfectly into the keto macros. We can’t confirm the same macro profile for other store bought or homemade varieties.

3. Take a Fish Oil Supplement (And Eat More Wild Fatty Fish)


Due to their high omega-3 content, wild fish, such as salmon, sardines, or mackerel, also have strong anti-inflammatory benefits for the skin. One of the recommended foods on the keto diet are wild fatty fish, but we recommend also taking a fish oil supplement if you have the keto rash for a more concentrated dose of anti-inflammatory nutrients (additionally, as a fatty acid supplement, it helps you meet your daily fat macros for staying in ketosis— a win-win).

4. Take Anti-Inflammatory Superfood Supplements


For an in-depth list of the keto-approved superfoods, head over to our complete Keto Approved Supplements List. The top anti-inflammatory keto superfoods we recommend taking to help alleviate symptoms of the keto rash are chlorella and spirulina.

Chlorella is a single-celled green algae and spirulina is a blue-green algae, and both contain omega-3s and GLA, which is an anti-inflammatory omega-6 essential fatty acid (6)(7). Other vitamins, minerals, and antioxidants such as beta-carotene can also help fight inflammation naturally.

You can take chlorella or spirulina in tablet, capsule, or powdered form, which you can add to green keto smoothies and veggie based juices.

One word of caution when choosing an algae supplement: always be sure they’re batch tested for heavy metals, such as mercury. Since an underlying cause of the keto rash may be heavy metal accumulation in cells, the last thing you want to be putting in your body is more heavy metals.

Spirulina and chlorella are at a greater risk for contamination than most supplements because they grow abundantly in regions that are exposed to high amounts of pollution and radiation, such as Japan and China. Most supplement companies will have information about testing on their websites, or will provide this information to you over the phone.

5. Avoid the Primary Keto Rash Trigger: Sweat


Since it’s suggested that increasing your body temperature can aggravate or worsen the keto rash, try changing up your exercise routine to light cardio in the early stages of ketosis, and avoid wearing tight fitting clothes or being in direct sunlight for a few days.

Now, the keto rash doesn’t mean you won’t be able to enter ketosis again. In fact, some people have reported the rash clearing up on its own within a few days without leaving ketosis or trying any other treatment. In any case, you know your body best,  so give these natural remedies for the keto rash a try and speak to a doctor or other healthcare professional with any other concerns.

Got keto rash? Should you be concerned? Here is how you can cure it naturally in 5 ways.

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