On the keto diet? Experts explain how to keep your skin from breaking out. 

By Samantha Lauriello
July 29, 2019

When it comes to the keto diet, you either love it or you hate it. But even the biggest keto devotees admit that the high-fat, low-carb plan can have some unwanted side effects (think stinky breath, diarrhea, and flu-like symptoms).

Lately, we've been hearing about a new side effect to add to the diet's rap sheet, and it's called keto rash. Here's everything we know about this red, itchy body rash some keto followers wind up with, including the main symptoms and most effective treatments. 

RELATED: 7 Dangers of Going Keto

Keto rash symptoms

Keto rash, officially known as prurigo pigmentosa, is a rare form of dermatitis, or skin inflammation. It appears as raised, red, itchy bumps on the skin that take on a web-like appearance. The rash may resemble contact dermatitis, or an allergic reaction, but it can be distinguished by the brownish discoloration of the skin that remains after the inflammation subsides. Keto rash can show up anywhere on the body, but it's more common on the chest, back, and neck. 

What about the keto diet causes it?

Experts aren't sure, but there are a few theories. "Because the keto diet is 75% to 90% fat, people may be eating large quantities of common allergens, including dairy, eggs, and seafood," Cynthia Sass, RD, Health contributing nutrition editor, tells Health. "These foods can also be triggers of food sensitivities, which are non-allergic reactions that cause the immune system to release inflammatory compounds which in turn lead to reactions, including skin inflammation and joint pain."

Another possible cause, according to Sass, is that the diet's lack of fiber and plant-based foods alters gut bacteria in a way that increases the production of inflammatory compounds. "A high intake of red meat, another common pattern in a keto diet, can do the same," she adds. Yet another theory has it that the keto diet exposes the body to a larger chemical load, thanks to the emphasis it places on meat and dairy.

"In my opinion, keto rash is a sign that your body is not responding well to the keto diet," she says. 

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How to treat keto rash

In many cases, keto rash can be eased by adding carbs back into your diet. But if you're not ready to give up on keto, Sass advises that you "prioritize plant-based monounsaturated fats, like extra virgin olive oil and avocado, over cream and butter." She also suggests eating at least five cups of veggies per day, adding back a few servings of fresh fruit, limiting or eliminating red meat, and consuming small portions of nutrient- and fiber-rich whole carbs, such as lentils, quinoa, potatoes, and oats. 

Debra Jaliman, MD, New York City-based dermatologist, tells Health that reintroducing foods like fruits and veggies to your diet will also provide your body with essential vitamins your skin may have been missing while on keto. "The best diet for the skin is one that's varied with antioxidants," Dr. Jaliman says. She also recommends eating a moderate amount of healthy omega fats, which can be found in foods like salmon, flaxseeds, and soybeans. 

If your keto rash doesn't go away by making these tweaks to your diet, speak with your doctor. Some antibiotics, such as minocycline and doxycycline, can treat prurigo pigmentosa. Your doctor can also help you get to the bottom of what caused the rash in the first place and made it noticeable when you started keto. 

RELATED: 5 Long-Term Health Risks of Going Keto

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