720-P: Prurigo Pigmentosa: An Acute Complication of Ketogenic Diet

Abstract

A 22-year old female with type 1 diabetes (T1DM) presented with generalized rash. She was diagnosed at the age of 9 years and is treated with insulin pump and CGMS (continues glucose monitoring sensors), her recent HbA1c was 7.4%. Four weeks prior to her rash presentation she started a low carbohydrate diet (50 gr of carbs per day) in order to improve her glycemic control. Pruritic erythematous papules, papulovesicular, and vesicles appeared on her axillary region, upper back and groins. Lesions were associated with severe pruritus and negatively affected her quality of life. Various therapies were initiated by dermatologist as: antifungal agent, Itraconazole, and Betamethasone Esters, without any improvement. Her serum beta-hydroxybutyrate levels were between 1.1-1.2 mmol/l. Prurigo pigmentosa, a rare pruritic inflammatory dermatosis secondary to her high ketones levels was diagnosed. Her condition resolved after she increased her carbohydrate intake to 75 gr per day. Beta-hydroxybutyrate level decreased concomitantly to 0.1-0.2 mmol/l. When carbohydrate restriction was rechallenged, she again entered ketosis, followed by recurrence of the pruritic lesions. Carbohydrate intake was increased and subsequently all lesions resolved with remaining reticular hyperpigmentation. During the last few years low carb diets have gained popularity among patients with T1DM. This case illustrates the rare side effect of high ketones body levels. Health care providers should be familiar with this side effect. Disclosure N. levran: None. K. Mazor-Aronovitch: None. S. Grenberger: None. N. Levek: None. B. Sher: None. E. Mauda: None. Z. Landau: None. E. Monsonego-Ornan: None. O. Pinhas-Hamiel: None.

Ketogenic diet‐induced prurigo pigmentosa: a rising association

“…In a case series of nine patients, Goh et al 11 found that 33.3% of their cases were on KD before PP appearance. Furthermore, several other cases have reported the induction of PP following KD commencement with a satisfactory improvement of the lesions following the reintroduction of carbohydrates 7,11–23 . In total, we reviewed 22 cases of PP manifested following KD including two cases among our patients.…”

“…International Journal of Dermatology 2022, 61, 779-782 reintroduction of carbohydrates. 7,[11][12][13][14][15][16][17][18][19][20][21][22][23] In total, we reviewed 22 cases of PP manifested following KD including two cases among our patients. Most of the patients were female (18/22; 81.8%) with an average age of 24.9 years old.…”