Keto Rash: The Itchy Side Effect of Going Keto

The ketogenic diet, or keto for short, has taken the world by storm. This high-fat, low-carb eating plan promises weight loss, improved blood sugar control, and even enhanced cognitive function. But like any major dietary change, keto comes with its own set of side effects, and one of the more perplexing ones is the infamous “keto rash.”

What is Keto Rash?

Keto rash, also known as prurigo pigmentosa, is an inflammatory skin condition characterized by an itchy, red rash. It’s considered a rare side effect of the keto diet, although the exact cause remains unknown. Research suggests it primarily affects Asian women, but anyone following a keto regimen can develop it.

Symptoms of Keto Rash

The hallmark symptoms of keto rash include:

  • Itchy red bumps: These small, raised bumps, called papules, typically appear on the upper body, particularly the neck, chest, back, and abdomen.
  • Web-like pattern: The bumps often form a network or web-like pattern on the skin.
  • Discoloration: After the bumps heal, they may leave behind temporary brown spots on the affected areas.

The rash can be quite bothersome, leading to intense itching and discomfort. In some cases, the rash may also appear on the arms and legs.

Here’s what keto rash is NOT:

  • Acne: While keto rash can cause bumps, they differ from acne in their location (upper body vs. face) and lack of pus.
  • Hives: Keto rash doesn’t typically spread rapidly or change shape like hives.
  • Eczema: Eczema tends to be more widespread and often causes flaking or crusting, which isn’t typical with keto rash.

If you experience any rash, especially one accompanied by fever, blistering, or severe pain, consult a healthcare professional immediately. These could be signs of a more serious underlying condition.

What Causes Keto Rash?

Researchers haven’t pinpointed the exact cause of keto rash. However, several theories are being explored:

  • Histamine release: The keto diet can lead to increased levels of histamine, a compound that triggers inflammation and itching in the body.
  • Changes in gut bacteria: The drastic shift in macronutrient intake with keto might alter gut bacteria composition, potentially impacting the immune system and contributing to skin inflammation.
  • Fungal overgrowth: Some studies suggest that changes in the skin’s microflora due to keto could promote fungal growth, leading to irritation and rash development.

Risk Factors for Keto Rash

While anyone on keto can develop a rash, certain factors might increase your risk:

  • Asian ethnicity: Research suggests a higher prevalence of keto rash in Asian individuals, particularly women.
  • Underlying skin conditions: Those with pre-existing eczema or atopic dermatitis might be more susceptible.
  • Rapid weight loss: Rapid weight loss on keto could be a contributing factor, though the link isn’t fully established.

Diagnosing Nagashima


Diagnosing keto rash often involves a physical examination by a doctor or dermatologist. They’ll inquire about your medical history, diet, and medications.

In some cases, a skin biopsy, where a small sample of skin is removed for microscopic examination, might be necessary to rule out other skin conditions with similar symptoms.

Treating Nagashima disease

The good news is that Nagashima disease is usually a temporary condition that resolves on its own within a few weeks to a month. However, if the rash is causing significant discomfort, some treatment options can help alleviate symptoms:

  • Moisturizers: Applying fragrance-free, gentle moisturizers regularly can soothe dry, itchy skin.
  • Antihistamines: Over-the-counter antihistamines like diphenhydramine (Benadryl) can help reduce itching.
  • Steroid creams: In severe cases, a doctor might prescribe topical steroid creams to reduce inflammation.

Here are some additional tips to manage Nagashima disease:

  • Hydration: Drink plenty of water to stay hydrated and support healthy skin.
  • Loose clothing: Wear loose, breathable clothing to avoid irritating the rash.
  • Cooling compresses: Apply cool compresses to the affected areas for temporary relief from itching.
  • Stress management: Stress can exacerbate skin conditions, so practice relaxation techniques like yoga or meditation.

The most effective treatment for Nagashima disease, however, might be addressing the root cause – the keto diet itself.


What is the Nagashima disease?

Nagashima disease, also known as prurigo pigmentosa, is an itchy, inflammatory skin condition that can develop in some people following a ketogenic diet. It’s a relatively rare side effect, but it’s important to be aware of the signs and symptoms.

What are the symptoms of Nagashima disease?

The most common symptoms of Nagashima disease include:

  • A red, itchy rash that appears on the upper body, particularly the neck, chest, back, and abdomen.
  • Raised, red bumps (papules) that sometimes form a net-like pattern.
  • Dark brown spots that may linger after the bumps clear up.

What causes Nagashima disease?

The exact cause of Nagashima disease is unknown, but researchers believe it might be linked to the body’s adjustment to ketosis, the metabolic state where fat becomes the primary fuel source. Other theories suggest a potential link to changes in gut bacteria or the immune system.

Who is most likely to get Nagashima disease?

Nagashima disease can affect anyone on a keto diet, but it seems to be more common in Asian women according to available studies.

How long does Nagashima’s disease last?

The duration of Nagashima diseaseketo rash can vary. It may clear up within a few weeks or persist for a month or more.

How is Nagashima’s disease diagnosed?

A dermatologist can usually diagnose keto rash based on a physical examination and your medical history, particularly your adherence to a keto diet.

How is keto rash treated?

In most cases, the rash resolves on its own once you increase your carbohydrate intake and transition out of ketosis. To soothe the itching, you can try:

  • Over-the-counter anti-itch creams or calamine lotion.
  • Cool compresses.
  • Topical corticosteroids (prescription).

How can I prevent Nagashima disease?

There’s no guaranteed way to prevent Nagashima disease, but slowly transitioning into a keto diet and ensuring adequate hydration might help.

When should I see a doctor about Nagashima’s disease?

See a doctor if your rash is severe, doesn’t improve with increased carbs, or is accompanied by additional symptoms like fever or blistering.

Are there other things that could be causing my rash besides the keto diet?

Yes, there are many other potential causes of a rash. If you’re unsure, it’s always best to consult a healthcare professional for proper diagnosis and treatment.

Disclaimer: This information is not a substitute for professional medical advice. Always consult with your doctor before making any changes to your diet or treatment plan.

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