Keto Rash: Ketoacidosis-Induced Prurigo Pigmentosa.

Mayo Clin Proc

Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung branch, Taiwan; Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan. Electronic address:

Published: January 2022

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http://dx.doi.org/10.1016/j.mayocp.2021.11.019DOI Listing

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Article Synopsis
  • * A skin biopsy showed mild spongiosis and inflammation, confirming the diagnosis of PP.
  • * Treatment involved stopping the ketogenic diet and using oral doxycycline, which cleared the lesions within a month, although some post-inflammatory hyperpigmentation remained.
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Background: Prurigo pigmentosa (PP), also referred to as Nagashima disease, is an acquired dermatological condition that is characterized by pruritic erythematous eruptions including papules and plaques surrounded by a reticular pattern of hyperpigmentation. It was first described in 1971 when Japanese dermatologist Masaji Nagashima noticed similar dermatological manifestations among 8 patients of Asian descent. The disease has been strongly associated with ketosis and ketogenic diet; however, the underlying etiology is unknown.

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Prurigo pigmentosa is an important cause of reticular pruritic rash that has been under-reported in the United States. To ensure proper patient care, it is important for dermatologists to be aware of its presentations and associated factors. Here, we present an uncommon case of prurigo pigmentosa induced by a ketogenic diet and discuss the links between this condition and the state of ketosis, a relationship every provider should be conscious of.

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Article Synopsis
  • Prurigo pigmentosa (PP) is an inflammatory skin condition with an unknown cause that leads to itchy skin lesions.
  • A 50-year-old healthy Arab man experienced six months of persistent itchy brownish lesions on his lower back, prompting a skin biopsy that confirmed the diagnosis of PP.
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