Back to the topic of the keto rash- answers!

#1

Ok so I googled “pruritus pigmentosa” because this is the real name of the keto rash.
There were a few case histories described concerning not only dieters, but ketosis has also been used to treat epilepsy, among other things. And the authors noted that there are 2 therapies which work:

  1. higher carbs
  2. doxycycline ( tetracyline, minocycline)

Cortisone doesn’t work at all.

They think the antibiotic works because there might be a connection to the gut biome. The antibiotic must clean up the intestines and that leads to a healing of the rash.The rash seems to have to do with an infiltration of neutrophilic cells around the blood vessels and this seems to be connected to an adverse reaction to bacteria in the intestine. Doxycyline attacks the bacteria there and straightens out things. Rash goes away.
They also said that oftentimes the rash goes away by itself after a few weeks.
I think I am going to take the antibiiotics - doxycycline- because nothing else really works anyway. This therapy is supposed to resolve the rash in about a week. The alternative is to play the waiting game if you are unwilling to increase your carbs.
So big hug to all you keto rash sufferers. I am going to try doxycycline !!!

(Joey) #2

Look, I’ve got no formal medical training, so take this with a grain of white rice…

Taking an antibiotic to get rid of a kind of bacteria that is causing a temporary rash doesn’t sound like a wise cost/benefit balance to me.

Your gut microbiome is a delicate and vital part of your body’s good health. Very few antibiotics are rifle shots… they’re more like shotguns … and will wipe out far more than just one particular strain of bacteria.

I would encourage you to consider probiotic solutions… like adding additional fiber and fermented vegetables (containing lactobacillus bacteria). This will likely do you far more good in getting over a rash (and will promote an inter-germ squabble that will leave you in a better situation) without destroying the rest of the bacteria that are important for your well-being - both short-run and long-run.

Just my $0.02. Best wishes!

(Gregory - You can teach an old dog new tricks.) #3

Just my shot in the dark, has fungal related been considered?

Trying some anti fungal cream might be worth a try before going the antibiotic route…

#4

@SomeGuy
Thx and I know you are trying to protect me. But you dont know how bad I have got it. I am full of red spots from almost head to toe. I even have an itchy scalp. The back of my neck, my thighs and my knees- even behind my knees - it gets close to a reason to drop this diet which I dont want to do. I LOVE keto!
I have to add that I have had very many intestinal problems that I could never really identify. Well one was lactose intolerance which lasted for 2 years after my cancer treatment- I had prophylactic radiation. I am well now and it has been 5 years since. The other dissolved when I started keto and I think i must have had a wheat allergy because I have the impression it is the absence of bread which healed me within 72 hours of starting keto. What I am trying to say is that it wouldn’t surprise me if my gut biome was messed up and the result actually is a really bad case of pruritus pigmentosa.
I have taken a round of doxycycline before and it was well tolerated by me. If this is my ticket out of this torture of itchiness- then I will do it for a week. They say it works. I dont want to wait 3-9 months or however long it takes for the rash to resolve by itself. I not only look hideous, but I have a trip planned and as miserable as I feel, I would even consider cancelling my flight if this doesnt go away. And walking around smelling like ACV is no joke either. :woozy_face:

(Joey) #5

@Chantarella Sounds like you’re making a well-informed decision. Sorry to hear you’re feeling so miserable with this rash!

One last sliver of (free) advice … make sure to take whatever the full antibiotic regimen requires. Taking less than the full prescribed amount for the full period can easily leave you with a residual and resistant strain of the offending bug.

Wishing you a speedy recovery!

#6

@SomeGuy
Thanks sweetie! But I studied medicine so I know all about it. :+1:

(Joey) #7

Then sounds like you’re in good hands! :vulcan_salute:
(FWIW, I’ve taken medicine, but that barely qualifies … :wink:

#8

@OldDog
Hello Gregory
I have read of some theories about fungal infections of the intestines as a trigger for the rash as well. But a cream wouldn’t get there. A fungus in the intestines is a very tricky thing to treat- even hard to identify. The sad thing is that none of the wise people really know why the rash happens! They just know it has something to do with the ketone production in relation to something else-whatever it may be! Because not everybody in ketosis gets the rash. There has to be a second factor involved.

(Paulene ) #9

I’m at 10 weeks and counting… :cry:

Let me know if the Doxycycline works. My Dr. wouldn’t give it to me with without blood work and trial of Artisocort first.

This week I’m starting increased carbs - 50g daily.

#10

@Paulene
The rash might also last 9 months and it can also be recurring! The bottom line is that they said it isn’t dangerous. But I was really suffering under the itchiness and it was practically my whole body. Lately I am up during the night - usually 4 am - scratching myself. I wonder if the ketones are particularly high at that hour? Then in the morning the itching is gone, but only for a while and then it returns. Plus I want to travel pretty soon. So I just popped the first doxycycline pill and will see how it goes.
BTW - I am ecstatic. The scale showed a loss of 7 kilos today. YIIPPEEEE
No way is this rash going to stop me from keto…:frowning_face:

(Paulene ) #11

Ahhh…I hope you get some relief! Yes, I have read on this forum that the rash reoccurs on a regular basis. What else did the dermatologist say? any further insights to offer?

I’m trying increasing carbs to 50g per day this week, possibly next week as well, to see what effect it has on the rash. Today my total carbs were 55g (net 34g). I last ate at 4pm and just took my blood ketone measure (8pm), and I’m still in ketosis! (.8mmol). This is unexpected and surprising because I ate quite a bit of fresh mango yesterday (the trees are loaded and it kills me not to eats them) as well as sweet potato and flour gravy with my roast beef last night.

And congratulations on losing 7kg (it always sounds better in pounds -15lb - see!). It’s a great feeling.

#12

@Paulene
Oh 15 lbs does sound a LOT better.:+1:
May I dare say something about your increase in carbs? I think you are going about it in the wrong way. You are just supposed to add like some berries to your diet. I raised my carbs by eating some raspberries one night. I got a package from America with some keto sweets which turned out to be low carb but not keto- and managed to eat some “candy bars” without realising beforehand. So that was all the carbs I ate- and the rash did start to heal and the itching went away. But now I am on keto again because just in those 2 days I actually gained a kilo. I did not want to sabotage my weight loss and would have endured the itching before I let the weight gain happen. I am adamant about remaining not simply in ketosis but fat adapted!! Like it is now after noon here and I still have not had any breakfast because I am just not hungry.
I did not see the dermatologist. Yet. I have an appointment end of this week but did not want to wait that long after another night of itching and scratching. I decided to see my regular doctor, an internist, who is also a friend of mine- because I wanted the prescription for the antibiotic. She was appalled at the way my skin looks. My whole back is full of red crusty welts! Of course she didn’t know what to make of it and suggested I see a dermatologist- and I told her the dermatologist wont tell me anything different of what I dont already know from my own research. So she gave me the prescription. I took the first dose an hour ago. I`ll let you know how it worked.
But upping the carbs ( a bit not a lot- like I think I was at 25g) did help right away. It just didn’t help my waistline.

(Paulene ) #13

I’m not sure what you imagine I am doing. You seem to think I’m derailing and going way off keto. I am in no danger of reverting to a SAD, carbage diet - that way of eating no longer has a pull on me.

I am increasing my carbs using low GI fruits and vegetables, today 50g sweet potato with my salmon salad bowl at lunch, followed by 100g mixed berries and cream. And I’m still in ketosis. And I actually don’t mind if I slip out of ketosis from time to time (and I do - on purpose!) because I am fat adapted and it takes little effort to slip back into ketosis.

#14

@Paulene
Oh! ok!
Most of all let me know how your rash is doing. ( If it does not go away by raising your carbs then I strongly doubt it is a keto rash…because that seems to work every time )

(Joey) #15

Interesting. My layman’s understanding is that serum glucose is indeed elevated in the early morning (through gluconeogenesis, to “kickstart the metabolism” even before we have a chance to eat). As such, I also thought that BHB ketone levels were somewhat lower at that same point in time, all else equal.

[E.g., upon waking up yesterday my glucose measured 105 and serum BHB was 0.8 (“dawn effect”). Later, just before dinner (which turned out to be my first meal of the day), my glucose measured 85 and BHB was 1.6, both of which are more typical for me these days.]

In any event, hearty congratulations on your 7 kilos lost! That must feel great.

And hopefully the antibiotic starts doing its magic for you soon. :fireworks:

#16

Thank you Joey!

#17

Feeling a bit less itchy but am afraid I might be imagining things. Wishful thinking or real? It feels less intense. At least I didn’t wake up with unbearable itching during the night. I woke up but didn`t itch toooooo much. Now I am wondering about insomnia? Isnt keto supposed to render us the best sleep ever?
My doctor told me my blood work was looking pretty good. Cholesterol was less, morning glucose is normal ( used to be prediabetic) and only my inflammation titers were a bit elevated. I think this is because of my skin eruptions. Vitamin D was on the low end of normal, and still waiting for B2. She was adamant that I see a dermatologist. Thats to explain how AWFUL I look - I really shocked her. My whole trunk is full of angry red splotches. But I know a dermatologist wont tell me anything new and most likely offer me cortisone cream which I know wont help at all. If the doxycycline works in 2-3 days, I will cancel my appointment with the dermatologist.

(Paulene ) #18

I’ve been wondering how the antibiotics have been going.

#19

@Paulene
Well from what I have read, they said it cleared up in a week of beginning treatment. So I am giving it a few days. But I do think the intensity of the itch has lessened. That might be because it is morning though and I usually had less itch in the mornings. I will keep you informed.
I just saw your thread on fasting. I think i heard Dr Fung say that extended fasting over days was not superior to fasting every other day, because the body shifts to starvation mode and metabolism slows down because of this. I am only going to worry about loose skin when I get there. LOL. Fasting for a day or 2 still scares me. But 18/6 has become oh so easy.

(Paulene ) #20

Hmm… this doesnt sound Fungian… more Phinneyish. They disagree when it comes to extended fasts.