Prurigo Pigmentosa (skin inflammation related to ketosis)

[wetroof]

I believe my brother did find the correct diagnosis of the rash that we both have on our chests. I got it around the time of going into ketosis (4 month ago). Basically it occupies about 3 square inches on my chest, but will creep up to my shoulders and neck where it gets super itchy, but then die back down to just my chest, where I am relatively unbothered by it. the worst part is when it is in the very-inflamed stage (on my shoulders etc) and I have a shower and i scrub my shoulder accidentally then I feel lots of pain that lasts. the itchy-ness can become painful but not usually.

I noticed it can get worse when I run or exercise. The way i have treated it is to apply coconut oil, which does lessen the red-ness and itchiness.

Months previously I had thought the diagnosis was Tinea versicolor, however I had tried the protocols that work on a majority of patients. such as coconut oil, raw honey, or apple-cider vinegar applied to the skin. but this did not yield results. The coconut oil just mildly reduced the inflammation, the honey and vinegar did other interesting stuff but not get rid of the rash.

because of the descriptions and pictures of Prurigo Pigmentosa match what I have, and because it is found in diabetics (with elevated ketones) or anorexics or in people who go on fasts, and because the acquirement of the rash coincided with changing my diet to a ketosis one, those are the reasons to be convinced.

but previous to ketosis I did have an odd patch on my chest perhaps 1/2 inch by 1/2 inch, where the skin was different. And I have always thought that it was this patch that expanded 3-4 months ago. And people do get Prurigo Pigmentosa not in ketosis. so perhaps I already had it and the ketosis expanded it.

I will provide some data below. my brother is really the one who did the research on this and he is going to the doctors tomorrow to be prescribed a certain medication that I will probably also use. I'm not sure on the details of it.

Abstract
Background  Prurigo pigmentosa is a rare inflammatory disease of unknown origin. It is characterized by the sudden onset of pruritic erythematous papules, usually involving the trunk and neck, which coalesce to form reticulated, mottled patches.

Methods  We studied 16 patients with prurigo pigmentosa. The patients were selected from those attending the outpatient Department of Dermatology at the Kyung Hee University Hospital from January 2002 to January 2010. All clinical information was retrospectively collected from medical records. The serum concentrations of ketones (acetoacetic acid, 3-hydroxybutyrate acid [3-OHBA]) were examined in four patients, and a test for ketone in the urine was performed in 10 patients.

Results  The age at the time of diagnosis ranged from 18 to 36 years (mean age: 23.5 years), and the female : male ratio was 14 : 2. Skin lesions were almost always characterized by recurrent pruritic erythematous papules that had resolved, leaving a peculiar, reticulate hyperpigmentation. Eight of 16 patients showed a chronological relationship between a prurigo pigmentosa appearance of skin lesions and dieting or fasting. Histopathological findings were either of fully developed lesions (4/16) or late lesions (12/16). Most patients responded well to minocycline treatment. Ketosis was observed in six patients.

Conclusions  In conclusion, we propose that ketosis was caused by fasting, and that diet may contribute to the pathogenesis of prurigo pigmentosa. Thus, physicians need to warn that excessive fasting can cause prurigo pigments.

http://www.reddit.com/r/keto/comments/ol31l/rash_from_keto/c3i77ih (this post links to other data)

this is what it looks like on my shoulders when it begins to creep up. (a picture of Prurigo Pigmentosa, not mine)



It looks like only a hundred people are diagnosed a year or something like that in the USA. probably because of misdiagnosis. In Japan there is more diagnosis. but it does not seem that frequent.

[truth seeker]

I've had a bit of this at times (nowhere near as extreme). For what it's worth, I don't think it's ketosis per se that sets it off. What I think happens is that during times of diet change, fasts, etc., the body may be detoxing inflammation that was always there but hidden.

What exactly are you eating and what supplements are you taking? The reason I ask is because if I eat a carb or something with a rancid or "just" a vegetable oil at this point, I will start to get itchy bumps. I also have this reaction to coconut oil. I would tentatively suggest that you may want to leave the coconut oil alone for awhile and see what happens.

[Alana]

I've had a bit of this at times (nowhere near as extreme). For what it's worth, I don't think it's ketosis per se that sets it off. What I think happens is that during times of diet change, fasts, etc., the body may be detoxing inflammation that was always there but hidden.

Yes, some of us reported getting rashes in the Life Without Bread thread, when we were transitioning to the high-fat, low carb diet. My rash looked similar to the one in the picture you posted, only on a smaller surface.

It could also be allergy reaction, if you are eating something that does not agree with your body, or IBS symptom. I found these posts from LWB thread, so that you have more info to investigate the cause of your rashes:

http://cassiopaea.org/forum/index.php/topic,22916.msg281507/topicseen.html#msg281507
http://cassiopaea.org/forum/index.php/topic,22916.msg283793/topicseen.html#msg283793
http://cassiopaea.org/forum/index.php/topic,22916.msg284327/topicseen.html#msg284327
http://cassiopaea.org/forum/index.php/topic,22916.msg303697/topicseen.html#msg303697
http://cassiopaea.org/forum/index.php/topic,22916.msg303904/topicseen.html#msg303904
http://cassiopaea.org/forum/index.php/topic,22916.msg306179/topicseen.html#msg306179

[Psyche]

Yeah, we discussed it in Life Without Bread. I thought it could be related to histamine, which is produced to digest meat and since in this diet you eat more meat, then more histamine might be produced. In other paleo forums it has been suggested that it is increased sensitivity to spices in some processed meats.

But another thing that I think is relevant is what Dr. Kruse pointed out.  Sometimes, people have rashes after cold exposure which seems to have a relation to your membrane's composition of fatty acids. So if there are hives and other itchy rashes, Dr. Kruse suggests that it is because you have more inflammatory fatty acids on your body. I thought this could be related to the rashes some people have had, appearing not necessarily after cold exposure but after ketoadaptation. They usually get worse in winter as well.  It is important to get enough omega 3s along with your saturated fat. The latter one will help stabilize the omega 3s that are more vulnerable to oxidation.

On the other hand, I noticed that my rashes disappeared with cold adaptation. Before I couldn't have certain spices without having allergies or getting an itchy patch on my torso. Now I can get away with spices without major problems. So it seems to me that the anti-inflammatory and hormone balancing effects of cryotherapy do help a lot. Cryotherapy has worked pretty well in certain skin conditions. I did 11 or so sessions of cryotherapy and have been taken cold showers twice per day ever since. I'm to the point of considering ice baths since I seem to be pretty adapted to the cold showers.

[Atomas]

I have the similar issue for last 3-4 weeks except the last two days. Suddenly after eating sweet cherries bought on a market my legs had been covered by rashes. Firstly, small red spots appears in particular area of my body (usually on hips or knees) and later they grow up forming one big red spot (3-6 cm of length, 2cm width for example). It feels hot and itchy, however, after a couple of hours the itchiness goes away and the redness starts shrinking. I'd say the picture above illustrates the situation after 2-3 hours from the start of inflammatory of my skin when it the worst part in past already. After a couple of more hours it disappears completely.

A half year ago I took out of my diet bread, dairy products, wheat products, vegetable oils (except olive oil), all sweets and sugar. My weakly menu consist of red meat, flitch/fat, chicken, sometimes fish, lots of buckwheat, potatoes, salads, vegetables. I'm using coconut, palm oil, lard or ghee butter for roasting.

In addition, everyday I'm taking the following supplements:
5-HTP 100mg
B-6 100mg
ALA 600mg
Magnesium (Citrate) 3g
Calcium (Citrate) 3g
Alfalfa 10g
Spirulina 2g
CoQ10 100mg
Melatonin 3mg
Vitamin C 5-6g
D3 - 5000UI (once in every three days)

All supplements except CoQ10, ALA and D3 are produced by Now foods.

I've stopped taking the supplements 4 days ago and just considering what to do next. A few type of pills do belong to antioxidant category in one or another way. I'm just thinking that rashes might be as the result of detoxifying the body, but I don't want to fall into wishful thinking (hey, look, the supplements are working!) OR my body is full of some kind of supplements (ALA for example) already which gives side effects. So, I would really appreciate if someone could help me with advices on next actions.
Thanks in advance.

[Alana]

I have the similar issue for last 3-4 weeks except the last two days. Suddenly after eating sweet cherries bought on a market my legs had been covered by rashes. Firstly, small red spots appears in particular area of my body (usually on hips or knees) and later they grow up forming one big red spot (3-6 cm of length, 2cm width for example). It feels hot and itchy, however, after a couple of hours the itchiness goes away and the redness starts shrinking. I'd say the picture above illustrates the situation after 2-3 hours from the start of inflammatory of my skin when it the worst part in past already. After a couple of more hours it disappears completely.

That sounds to me like an allergic reaction to sweet cherries. I think that if you just stop eating cherries for, say, 6 months, and work on healing your gut, you could try them again then and see what happens.

A half year ago I took out of my diet bread, dairy products, wheat products, vegetable oils (except olive oil), all sweets and sugar. My weakly menu consist of red meat, flitch/fat, chicken, sometimes fish, lots of buckwheat, potatoes, salads, vegetables. I'm using coconut, palm oil, lard or ghee butter for roasting.

Have you read the Life Without Bread thread? Are you in the process of reducing your carb intake and increasing your fat intake? It's not clear from what you write whether that's the case. Also, if your buckwheat does not state that is gluten-free, you might be getting some gluten by eating it if the place where it is processed processes also wheat and gluten-containing grains. I personally avoid buckwheat as well because the tiniest amount of gluten inflames my body and my brain, and it takes about 6 months to get rid of gluten from our system. 

In addition, everyday I'm taking the following supplements:
5-HTP 100mg
B-6 100mg
ALA 600mg
Magnesium (Citrate) 3g
Calcium (Citrate) 3g
Alfalfa 10g
Spirulina 2g
CoQ10 100mg
Melatonin 3mg
Vitamin C 5-6g
D3 - 5000UI (once in every three days)

I don't think you need the Calcium supplement, and it seems like you could increase your Magnesium intake as well (check out the Magnesium thread). Also, you might want to add some L-glutamine supplement since it assists in gut healing. Also, Omega 3 amino acids are essential and they are lacking from the foods we eat due to agricultural practices, so those are important to add too, and they help a lot with inflammation. 

I've stopped taking the supplements 4 days ago and just considering what to do next. A few type of pills do belong to antioxidant category in one or another way. I'm just thinking that rashes might be as the result of detoxifying the body, but I don't want to fall into wishful thinking (hey, look, the supplements are working!) OR my body is full of some kind of supplements (ALA for example) already which gives side effects. So, I would really appreciate if someone could help me with advices on next actions.
Thanks in advance.

I am not sure I understand, did you stop taking the supplements because of the rush? If that's the case, I don't think the supplements have anything to do with it, it's the cherries.

[Scarlet]

Apologies for going off topic here, wetroof. 

In addition, everyday I'm taking the following supplements:
5-HTP 100mg
B-6 100mg
ALA 600mg
Magnesium (Citrate) 3g
Calcium (Citrate) 3g
Alfalfa 10g
Spirulina 2g
CoQ10 100mg
Melatonin 3mg
Vitamin C 5-6g
D3 - 5000UI (once in every three days)

Hi Atomas, I recently lowered my calcium supplement to 100mg/day after doing some research.  Have you read up about calcium supplements on the forum or SOTT?  Here's one interesting article, in case you're curious: http://www.sott.net/articles/show/212868-Calcium-Supplements-May-Raise-Risk-of-Heart-Attack

Edit: Sorry, I just read Alana's post to see it just got redundant with mine added a min later.  Well, hope the article link helps.

[Atomas]

That sounds to me like an allergic reaction to sweet cherries. I think that if you just stop eating cherries for, say, 6 months, and work on healing your gut, you could try them again then and see what happens.

My first impression was that this is allergic reaction to cherries as you say. I ate cherries more than three weeks ago. Can it be that all those three weeks I have been experiencing the allergic reaction caused by that one time event three weeks ago? If yes, I just wonder to know what sort of the chemicals were used for growing those cherries that my body have been so much affected... Previously, I haven't noticed that sweet cherries is my weak place.

Have you read the Life Without Bread thread? 

Frankly, I haven't read it completely. But from the given question I understand that this is highly advisable.

Are you in the process of reducing your carb intake and increasing your fat intake? It's not clear from what you write whether that's the case. Also, if your buckwheat does not state that is gluten-free, you might be getting some gluten by eating it if the place where it is processed processes also wheat and gluten-containing grains. I personally avoid buckwheat as well because the tiniest amount of gluten inflames my body and my brain, and it takes about 6 months to get rid of gluten from our system. 

I cannot say that I'm following a particular well known diet on this forum (paleo or ultra-simple one, for example). I'm just trying to read separate threads in diet section and SOTT articles on what ingredients/food one should reduce/ get rid off, however, I still miss the big picture.
It's interesting what you are saying about buckwheat, I thought it's completely safe food after spending some time on research... What about soaking them in water? I read that it works with rice if one wish to remove gluten from it.

 
I don't think you need the Calcium supplement, and it seems like you could increase your Magnesium intake as well (check out the Magnesium thread). Also, you might want to add some L-glutamine supplement since it assists in gut healing. Also, Omega 3 amino acids are essential and they are lacking from the foods we eat due to agricultural practices, so those are important to add too, and they help a lot with inflammation. 

Thanks a lot for these recommendations. May I ask you why you are suggesting to stop use Calcium? My rationale behind this was that if one doesn't consume dairy products he should find alternative source of Calcium (including via supplements). What about Iron, Phosphorus, Selenium, Zinc, pro-biotic, etc? Are these highly advisable or just "good" to take. Just trying to find out the right balance of my daily intakes.

I am not sure I understand, did you stop taking the supplements because of the rush? If that's the case, I don't think the supplements have anything to do with it, it's the cherries.

Yes, that was my thoughts since the rush didn't stop after couple of days. There were two times during these three weeks when I felt some difficulties while breathing - I felt a pressure on my chest and it seemed that something is climbing up through my pipes.

Apologies for off-topic in advance. Much appreciate for your help.

[Alana]

That sounds to me like an allergic reaction to sweet cherries. I think that if you just stop eating cherries for, say, 6 months, and work on healing your gut, you could try them again then and see what happens.

My first impression was that this is allergic reaction to cherries as you say. I ate cherries more than three weeks ago. Can it be that all those three weeks I have been experiencing the allergic reaction caused by that one time event three weeks ago? If yes, I just wonder to know what sort of the chemicals were used for growing those cherries that my body have been so much affected... Previously, I haven't noticed that sweet cherries is my weak place.

I thought it was the cherries because you wrote: "Suddenly after eating sweet cherries bought on a market my legs had been covered by rashes." If the allergic reaction started right after you ate the cherries, it can take a while to go away. Also, I used to eat everything, and since I started clearing my system from inflammatory foods, I found many foods that I am allergic too that I was not aware I was before. It's like with the detoxification my body got more sensitive to what bothers it. 

Have you read the Life Without Bread thread? 

Frankly, I haven't read it completely. But from the given question I understand that this is highly advisable.

Oh yes, a lot of things will become clearer once you read the entire thread, regarding diet and symptoms. I highly recommend that you do so asap.

Are you in the process of reducing your carb intake and increasing your fat intake? It's not clear from what you write whether that's the case. Also, if your buckwheat does not state that is gluten-free, you might be getting some gluten by eating it if the place where it is processed processes also wheat and gluten-containing grains. I personally avoid buckwheat as well because the tiniest amount of gluten inflames my body and my brain, and it takes about 6 months to get rid of gluten from our system. 

I cannot say that I'm following a particular well known diet on this forum (paleo or ultra-simple one, for example). I'm just trying to read separate threads in diet section and SOTT articles on what ingredients/food one should reduce/ get rid off, however, I still miss the big picture.

It's better to read the Life without Bread thread first, and then get the books as well if you can. It is very important to have the whole picture and the full knowledge before you embark on diet changes. Eliminating gluten, dairy, sugar, corn, soy, etc, that's ok for a start, anyone can do it without any adverse effects. But there's so much more you can do to give your body and mind the right fuel they need to function optimally, and you need the research to know exactly how to do it and why.
 

It's interesting what you are saying about buckwheat, I thought it's completely safe food after spending some time on research... What about soaking them in water? I read that it works with rice if one wish to remove gluten from it.

I am not sure that soaking removes gluten.

 
I don't think you need the Calcium supplement, and it seems like you could increase your Magnesium intake as well (check out the Magnesium thread). Also, you might want to add some L-glutamine supplement since it assists in gut healing. Also, Omega 3 amino acids are essential and they are lacking from the foods we eat due to agricultural practices, so those are important to add too, and they help a lot with inflammation. 

Thanks a lot for these recommendations. May I ask you why you are suggesting to stop use Calcium? My rationale behind this was that if one doesn't consume dairy products he should find alternative source of Calcium (including via supplements).

Scarlet posted a relevant article above, in addition I suggest you also read the Magnesium thread.
 

What about Iron, Phosphorus, Selenium, Zinc, pro-biotic, etc? Are these highly advisable or just "good" to take. Just trying to find out the right balance of my daily intakes.

If you don't have severe need of any of those, a good multivitamin/multimineral supplement should cover it. You can take the UltraMind Solution quizzes to see what supplements you need.

[wetroof]

Here is an update on my skin condition. I'm taking Minicycline whenever it flares up. Usually a pill a day for three days and it stays gone for a while. it even clears up from my chest pretty much completely. it is an antibacterial. not sure there is consensus how it applies to this diagnosis/symptoms completely. It is observed to modulate immune cell functioning, so that is maybe how it works.

I would ultimately like not to take it, so I am planning to look into what Truth Seeker mentioned about spices being the cause. I have not eliminated red pepper from my diet. I do not want to but I am planning to look into that, and perhaps other causes. I was without red pepper / all other spices, for a week, did not notice any changes. That does not say too much. I know red pepper causes inflammation so that is why i signaled that out, but I have done zero reading up on it yet.

 My brother did eat eat around 40g sugar a day after it flared up and did think it affected the rash positively. But I would rather not go out of ketosis at the moment. For now I'm doing really well with the medication.

[Laura]

Here is an update on my skin condition. I'm taking Minicycline whenever it flares up. Usually a pill a day for three days and it stays gone for a while. it even clears up from my chest pretty much completely. it is an antibacterial. not sure there is consensus how it applies to this diagnosis/symptoms completely. It is observed to modulate immune cell functioning, so that is maybe how it works.

I would ultimately like not to take it, so I am planning to look into what Truth Seeker mentioned about spices being the cause. I have not eliminated red pepper from my diet. I do not want to but I am planning to look into that, and perhaps other causes. I was without red pepper / all other spices, for a week, did not notice any changes. That does not say too much. I know red pepper causes inflammation so that is why i signaled that out, but I have done zero reading up on it yet.

 My brother did eat eat around 40g sugar a day after it flared up and did think it affected the rash positively. But I would rather not go out of ketosis at the moment. For now I'm doing really well with the medication.

Red peppers or any member of nightshade family can be totally evil and inflammatory.  The tiniest little bit in a sauce or whatever, and I'm down for two or three days.  (Nightshades include potatoes, too.)

Being "in ketosis" is not the main point; the main thing is being adapted to burning fat and not fuelling yourself with carbs.  However, once you are fat adapted, you can eat a certain amount of basic carbs such as are found in some veggies, and things go fine.  Do keep up with the "Life Without Bread" thread where all info is posted as we find it.

[Eboard10]

Red peppers or any member of nightshade family can be totally evil and inflammatory.  The tiniest little bit in a sauce or whatever, and I'm down for two or three days.  (Nightshades include potatoes, too.)

Being "in ketosis" is not the main point; the main thing is being adapted to burning fat and not fuelling yourself with carbs.  However, once you are fat adapted, you can eat a certain amount of basic carbs such as are found in some veggies, and things go fine.  Do keep up with the "Life Without Bread" thread where all info is posted as we find it.

Would that also include unrefined carbs such as with wild rice and sweet potato? I'm curious as I'm still eating some every other day. 

[Laura]

Red peppers or any member of nightshade family can be totally evil and inflammatory.  The tiniest little bit in a sauce or whatever, and I'm down for two or three days.  (Nightshades include potatoes, too.)

Being "in ketosis" is not the main point; the main thing is being adapted to burning fat and not fuelling yourself with carbs.  However, once you are fat adapted, you can eat a certain amount of basic carbs such as are found in some veggies, and things go fine.  Do keep up with the "Life Without Bread" thread where all info is posted as we find it.

Would that also include unrefined carbs such as with wild rice and sweet potato? I'm curious as I'm still eating some every other day.

A bit of sweet potato every day seems to be pretty good for most people.  Wild rice is okay once or twice a week, too. I'd stick with green beans and some salad greens and maybe beets, occasionally carrots.

We have been having some really good results taking D-ribose along with niacin here (as discussed a bit on the Life Without Bread thread). 

[wetroof]

Since I moved away from home my diet was rapidly changed but same macro nutrient ratio.. The important thing to mention is I have not ate any spices but a bit of black pepper. the first month I ate cured meats and butter. this last month, I ate suet as the primary fat, and grass-fed beef for protein. and seafood.

My skin condition still persists. Since I've been away from home it flared up 2 times and dissipated. this is the third time and by far the worst. I began to see uneven bumps but no discoloration about Saturday and feel itchy. and tonight it turned red and expanded up to the edge of my shoulders. needless to say it's not very pleasant.

I took some photos, so later on I can upload and share them here. I plan to visit some heath forums or paleo forums, and make a post as well. I can't believe I'm the only one. It looks like the original picture of the woman I posted of Prurigo Pigmentosa. except a bit lighter (none of the darker red spots). the area it covers is 4x the picture shows. It's in that exact spot but also further down, and both sides.

I applied coconut oil which seems to help marginally. and just took one of the prescription pills I have. I did not take it this weekend, because I thought I would ride it out. the other 2 times I did end up taking it, though I don't for sure to the degree it works.

The interesting thing to note is that I've been recovering from being sick so paradoxically, I guess, I went off the ketogenic diet for monday-friday this week. Subsequent to vomiting a lot over the weekend, I had residual stomach aches after many of my meals, and I thought carbs (sweet potatoes) were easier on my stomach. Also suet was unappealing. but I have been back to animal fat over this weekend and low carb.

So if I think I have "Prurigo Pigmentosa" which is a skin inflammation related to ketosis, maybe it is not what I have...

[Psyche]

If possible, you might want to look into hyperoxygenated oils which are usually sold to prevent "decubitus ulcers", that is, to prevent ulcers from staying in bed for too long. It is just oxygenated fat which deals with skin problems fast and effectively because the oxygenated part deals with bugs and the fats are just great for the skin.

Depending on your location it may have various names. But asking in the pharmacy for the above might bring some brand.

I know and just started this one:

_http://www.brightsky.com.au/Products/Linovera_Oil_.aspx

Linovera is a blend of ingredients that repair, protect, heal and hydrate the skin that with regular use can assist to build and maintain skin condition. Includes Hyperoxygenated Essential Fatty Acids (EFA) that help to maintain skin elasticity and donate moisture to promote skin repair.

Long-term skin patches and problems started to just look better overnight! Nurses swear by it for the treatment of decubitus ulcers.

Another possibility is to look into ozoned oils, there is some research here:

Ozone and Ozonated Oils in Skin Diseases: A Review

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910505/

There is more research about it in this thread:

http://cassiopaea.org/forum/index.php/topic,28029.msg364459.html#msg364459