Apple Cider Vinegar on Keto Rash : Does it Work? (A Comprehensive 2020 Guide)

​Have you been itching your way on keto? ​Are you wondering if apple cider vinegar will work on keto rash?

Hey, you're in the right spot!

In this Athletic Muscle guide, I'll be covering:

  • ​Does keto diet cause skin rash?
  • ​Is apple cider vinegar a possible solution to keto rash?
  • What ​other solutions are there for keto skin rash?
  • And ​a whole lot more!

Prurigo pigmentosa (PP), a rare form of inflammatory dermatitis; otherwise referred to as “keto rash”, has risen in prevalence as the ketogenic diet has become more and more popular.

While the keto diet is used in the treatment of many conditions, such as epilepsy, Parkinson’s and Alzheimer’s, brain tumours, and obesity, it may be accompanied by some side effects in certain individuals.

The most frequently reported adverse effects reported by individuals following a ketogenic diet are: fatigue, lethargy, hypoglycemia, and the “keto flu” (a flu like syndrome presented with muscle weakness, headache, brain fog, nausea, body pain).

PP is a much rarer occurrence (however this may be due to health practitioners’ unfamiliarity with the condition).

It has been mainly found in young Japanese women. Notably, women are also three to four times more likely to suffer with PP than men.

It presents as an itchy, red rash, occurring primarily on the upper back, chest, and abdomen.

Those suffering from the skin condition may also suffer with red spots, called papules, that take on a web-like appearance.

Aesthetically, the rash may also leave a dark brownish marking once the spots begin to clear.

Many of those presenting with PP have been found to be in a state of ketosis; hence “keto rash” due to the correlation.

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​Does Keto Diet Cause Skin Rash?

At the moment, that’s unclear. The studies in relation to the condition have only observed that many of those suffering with PP are also in ketosis, but there is no clear mechanistic link. So correlation, yes, but no proven causation. 

It has been suggested that a change in gut bacteria may be the culprit and that making dietary and lifestyle modifications could stem the inflammatory response leading to the outburst.

It has also been suggested that those with previous conditions, such as Still’s disease, Sjögren’s syndrome and H.Pylori infection, may be at greater risk.

It should be noted that many cases presenting with PP are not in a state of ketosis, so how do we account for these?

Arguably, the more common association in all the presented case studies is not the presence of ketosis but some kind of energy deficiency, restriction and or fasting protocol.

This thought is reinforced when we look at the study by Courtois et al. who found no association between the condition and blood glucose levels.

Although, other researchers have found improvement of the condition by resolving their ketoacidosis;  however, more recent case studies have, again, found no link between blood ketones, glucose and development of PP.

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keto rash facts

Does Keto Cause PP and Does it Deserve to be Called “Keto Rash”?

​Quite frankly, it is unknown, however it appears that it may be more likely tied to periods of fasting and energy restriction as opposed to following a ketogenic diet per se.

Is Apple Cider Vinegar a Possible Solution to the Keto Problem?

One of the more interesting treatments for keto rash is the use of an apple cider vinegar (ACV) as a dermatological aid.

apple cider vinegar

While others will cite that, for some reason, it is “uncontrolled glucose” causing the rash, we know from the previously mentioned studies that this simply is not a reliable statement to make (nor a very educated one).

Direct application to the skin may hold some merit however.

ACV soaks provide antimicrobial activity and have the potential to acidify the skin, improving on more alkaline skin states which may be at a greater risk of inflammatory skin diseases.

Some dermatologists have even started recommending ACV baths for atopic dermatitis and other skin conditions.

No studies have directly investigated ACV soak treatment on improving symptoms of PP, although, a recent 2019 study by Luu et al investigated the treatment on atopic dermatitis (a common inflammatory skin condition).

Findings are fairly limited (as they only tested on source of ACV) they found that there was no improvement on skin barrier integrity but actually ended up causing increased skin irritation in a majority of subjects.

More work needs to be done in this area but at the present time it’d be wise to stay clear of this treatment.

Instead, here are some alternatives which may have a benefit (bearing in mind what we know of the successful treatment of PP is in its infancy).

​What May Actually Work?

Being in ketosis doesn’t mean you have to be fasting / in an energy deficit

- Try more frequent smaller meals, tracking your calories to ensure you’re not in a severe deficit. These two factors, fasting and energy deficit  have been associated with the occurrence of keto rash.

Ensure you’re getting enough fibre in your diet

- Limiting carbohydrate is a given for a ketogenic diet, however, inadequate fibre intake should be avoided. This can affect your gut microbiome, possibly for the worse.

Use a probiotic

A lot more work has to be done in this field, addressing dysbiosis (gut bacteria imbalances) may have some benefit.

Antibiotics, such as minocycline, doxycycline and dapsone may also be effective treatments

However, these can wreak havoc on your gut bacteria, so there’s a major downside to this method given the influential effect our gut bacteria can have on both our mental and physical health.

It should be noted, topical steroids have not proven effective in the treatment of PP.

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​Conclusion

In conclusion, the “keto rash” might not have anything to do with ketosis whatsoever; it is simply unknown at this stage and the whole association is based on observation, not direct cause (because it is also unknown why the rash appears in the first place and why it only affects some people and not others).

Internet “experts” have been citing ACV as a possible remedy for the condition, however, it should be viewed with caution.

In other studies, investigating ACV as a dermatological treatment for similar skin conditions, found no mechanistic improvement or improvement of the symptoms.

In fact, subjects reportedly felt worse, not better after treatment!

A few dietary and lifestyle modifications which may be worth exploring: smaller, more frequent meals; increasing your energy intake; ensuring adequate fiber intake; probiotic usage; and avoiding antibiotic use.

Ultimately, seek out a dermatologist for proper medical treatment if you suspect you are suffering with PP.

​Read Also: ​​​​​​5 Best Electrolytes For A Keto Diet​​​

Jamie Wright

Jamie Wright

Jamie is a registered nutritionist and REPs recognized personal trainer with a MSc in Nutrition and BSc in Sports and Exercise Science. He runs his own nutrition and exercise coaching company, OUTWRK, and has authored a number of books of which include HealthyHer and FitHer. He has contributed on a number of external organisations nutritional guidance educational notes/booklets aimed at recreational exercisers/dieters to elite, internationally competing athletes. Additionally, Jamie has worked with this spectrum of clients in the past and just released his new program Everyday Athletes aimed at recreational exercisers/dieters. Reach out to him on his website for nutrition advise or consulting.

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