Prurigo Pigmentosa Following Ketogenic Diet

Ketogenic diet‐induced prurigo pigmentosa: a rising association

“…Certain exogenous, hormonal, and metabolic triggers have been reported in association with PP. However, PP has increasingly been observed with conditions accompanied by ketosis such as diabetes, fasting, ketogenic diets (KD), and post‐bariatric surgery 2–4,7,8 . Ketogenic diets are characterized by restriction of carbohydrates (˜<50 g/day) and a higher consumption of protein and fat.…”

“…The absence or scarcity of dietary carbohydrates leads to decreased insulin production, lipolysis, and increased ketone bodies 9 . It has been suggested that ketosis induces PP via ketone body deposition within the vasculature triggering a neutrophilic perivascular inflammation 4,7 . KD is gaining more popularity nowadays and is considered itself as a treatment of choice for some conditions, 9 therefore, we briefly reviewed the PP cases associated with KD in the literature and present our experience of treating two patients to provide an update regarding this potential side effect of KD for clinicians.…”

“…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.…”

“…Apart from the antimicrobial effects, tetracycline and dapsone also have anti‐inflammatory activities by inhibiting neutrophil chemotaxis and attenuating proinflammatory processes in epidermal keratinocytes 25,26 . In cases of KD‐induced PP, a daily intake of carbohydrates (>50 g) is required to correct ketosis 1–4,7 . Topical and systemic corticosteroids as well as antihistamines are not effective, and the residual hyperpigmentation may persist even after the resolution of PP 1,4,27 .…”

“…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.…”