Ketogenic diet‐induced prurigo pigmentosa: a rising association

Shahrigharahkoshan, Shaghayegh; AlHalees, Zeinah; Pehr, Kevin

doi:10.1111/ijd.15991

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…Social media sites describe this as "the keto rash," and although generally rare, dermatologists have noted an apparent increase in prevalence over the past 7 years, attributing this to the increased popularity of the LCHF diet. 28 Although the etiology is unknown, it has been associated with other scenarios of ketosis including poorly controlled diabetes, fasting, anorexia nervosa, or bariatric surgery. 29 A recent systematic review of 369 case studies included in 118 papers reported that of the 25% of patients who reported that dietary changes preceded the onset of the rash, 40% were associated with a ketogenic LCHF diet.…”

Section: Discussionmentioning

confidence: 99%

Adherence to a Ketogenic Low-Carbohydrate, High-Fat Diet Is Associated With Diminished Training Quality in Elite Racewalkers

McKay

Ross

Tee

et al. 2023

International Journal of Sports Physiology and Performance

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Purpose: To examine the effects of a high-carbohydrate diet (HCHO), periodized-carbohydrate (CHO) diet (PCHO), and ketogenic low-CHO high-fat diet (LCHF) on training capacity. Methods: Elite male racewalkers completed 3 weeks of periodic training while adhering to their dietary intervention. Twenty-nine data sets were collected from 21 athletes. Each week, 6 mandatory training sessions were completed, with additional sessions performed at the athlete’s discretion. Mandatory sessions included an interval session (10 × 1-km efforts on a 6-min cycle), tempo session (14 km with a 450-m elevation gain), 2 long walks (25–40 km), and 2 easy walks (8–12 km) where “sleep-low” and “train-low” dietary strategies were employed for PCHO. Racewalking speed, heart rate, rating of perceived exhaustion, and blood metabolites were collected around key sessions. Results: LCHF covered less total distance than HCHO and PCHO (P < .001); however, no differences in training load between groups were evident (P = .285). During the interval sessions, walking speed was slower in LCHF (P = .001), equating to a 2.8% and 5.6% faster speed in HCHO and PCHO, respectively. LCHF was also 3.2% slower in completing the tempo session than HCHO and PCHO (P = .001). Heart rate was higher (P = .002) and lactate concentrations were lower (P < .001) in LCHF compared to other groups, despite slower walking speeds during the interval session. No between-groups differences in rating of perceived exhaustion were evident (P = .077). Conclusion: Athletes adhering to an LCHF diet showed impaired training capacity relative to their high-CHO-supported counterparts, completing lower training volumes at slower speeds, with higher heart rates.

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Section: Discussionmentioning

confidence: 99%

Adherence to a Ketogenic Low-Carbohydrate, High-Fat Diet Is Associated With Diminished Training Quality in Elite Racewalkers

McKay

Ross

Tee

et al. 2023

International Journal of Sports Physiology and Performance

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“…PP has gradually been reported from many different places around the world suggesting different pathogenesis than originally proposed by the Japanese dermatologist Masaharu Nagashima [1], who first described the condition in Japan in 1971. PP has been associated with Helicobacter pylori infection [2], nutrition [3] and especially ketogenic diets [4][5][6][7], weight loss, and anorexia nervosa [8]. In a review by Böer et al [9], they conclude that PP is highly distinctive clinically, histopathologically, and biologically, and the group raises question marks to all factors mentioned as being causative of PP due to short follow-up, incomplete and imprecise histopathology descriptions of biopsies performed in both early and late stages of disease.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Prurigo Pigmentosa in a Danish Sibling Couple

et al. 2023

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Prurigo pigmentosa (PP) is probably underdiagnosed due to lack of awareness. Previously, it was assumed that PP primarily affected Japanese females; however, more cases are reported worldwide, and the pathogenesis is still not completely understood. In this case report, we present two healthy Danish siblings, who developed PP approximately 2 weeks after starting a ketogenic diet, suggesting that both increased levels of ketone bodies in the blood together with a genetic predisposition might play a role in the development of PP.

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“…Although the etiology of PP is not clearly understood, perivascular accumulation of ketone bodies is thought to trigger a neutrophilic infiltration [ 2 ]. There is a growing association of PP with ketosis, with 25% of patients having a history of dietary changes [ 2 , 4 ]. In our series, this association was striking with history of diet changes prior to development of PP in 75% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Follow-Up of Prurigo Pigmentosa: A Case Series

Oba¹,

Arican²

2022

Cureus

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Introduction Prurigo pigmentosa (PP) is an underrecognized disease in the Western population. Our aim is to describe the clinical features and follow-up outcomes of Caucasian patients diagnosed with PP. Methods This case series was conducted in the dermatology outpatient clinic of a tertiary hospital. Patients with confirmed PP from May 2020 to June 2021 were included in the study. Patient demographics, clinical features, potential triggers, treatment and follow-up data were recorded. Results A total of eight patients with female predominance were identified. The mean age of the patients was 24.5. The duration of symptoms ranged from four days to six months. All patients presented with pruritic, papular or papulovesicular lesions. Net-like hyperpigmentation was also present at the initial visit in two patients, in whom the duration of the symptoms was the longest. Lesions were most commonly located on the chest and back. Six of eight patients reported alteration of diet that potentially led to ketosis. Doxycycline 200 mg daily for two weeks led to a complete response in all six medically treated patients. Duration of follow-up ranged from 1-14 months (mean: 7.2 months). In five patients with a follow-up duration of more than three months, postinflammatory hyperpigmentation was resolved without any treatment. Only one patient had a recurrence. Conclusion PP does not seem to be a rare disease. Young women are most commonly affected, and ketosis stemming from decreased calorie intake may be the etiological factor in the majority of the patients. Dermatologists should be familiar with early signs of PP in order to minimize unnecessary therapies, recurrences and long-lasting hyperpigmentation.

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Ketogenic diet‐induced prurigo pigmentosa: a rising association

Cited by 8 publications

References 26 publications

Adherence to a Ketogenic Low-Carbohydrate, High-Fat Diet Is Associated With Diminished Training Quality in Elite Racewalkers

Adherence to a Ketogenic Low-Carbohydrate, High-Fat Diet Is Associated With Diminished Training Quality in Elite Racewalkers

A Rare Case of Prurigo Pigmentosa in a Danish Sibling Couple

Clinical Features and Follow-Up of Prurigo Pigmentosa: A Case Series

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