There is a reason for the title of this post to be as it is; because I believe there is relevance of mentioning both the Ketogenic Diet and the specific fungal infection (Pityrosporum folliculitis or Malassezia folliculitis) I was suffering from.
I started the Ketogenic Diet about five moths ago. It is generally a very low carbohydrate, high fat diet, for those that are reading this just because of Malassezia. Basically I went cold turkey and stopped all carb intake at first.
I was quite excited and hungry for information about ketosis from the onset and also quite hungry for food when I was starting. That quickly went away and I adapted( the hunger for food not for information).
I traveled out of my country to live in South Africa around this time. I carried my coconut oils, butter from home as much as I could carry. This was so I could have some before I knew my way around getting this stuff and what brands I would like in my new country.
About a month into my stay in South Africa, I was struck by a rash. At first it was just itching on my neck and chest and then it grew into some itchy pimples in the middle of my chest. I thought nothing of it because I had always been strong and never had to see a doctor from being ill for more than 10 years. I am 30 years old.
When the itch got a little intense after a few days and the pimples in the sternum region became a little more, I begun to take action.
First I changed my shower gel I was using Old Spice Swagger, I bought Nivea For Men (Pure Impact). This was my first guess because I had just switched to Old Spice from Nivea around the time the rash started but I couldn't be 100%certain. Also if you google any skin care product followed by the word 'rash' you will get results. And then you think you are right with your first guess. The next day and the day after that, more pimples and more itching.
I had kind of gotten used to my discomfort and scratching but alarm bells went off when I went swimming with some friends and they were more than a bit shocked by my rash. When people are shocked by your rash, it is time to do something more drastic.
I went out and bought a disinfectant, 3CP it was called. It had such a strong smell my roommate started complaining before I opened the bottle. But I was determined, I also informed him that some people have to use it as a mouth wash so he was having it easy. It stung like hell, but still I didn't relent. I put it on after shower before bed and scratched myself to sleep. By this time a few of these pimples started to appear on the skin below my 'breasts'. I was scratching away like there was a reward. And leaving horrible scars.
The disinfectant did not do any good and my condition got worse.
I then remembered I had been to the barber around the time my condition started and imagined it must have been an infection from the barbershop. I googled away about the barber's itch and infections you might get from a barbershop. I was getting concerned. I decided I would never go to the barbershop again. My roommate would cut my hair. I went out and bought a shaving machine.
By this time my chest region was a war zone and some itching has began in the middle of my back. My neck was also showing the itchy spots.
I was curious as to why my rash appeared to be concentrated in the middle of my chest, my neck and in the middle of my back but not on my stomach or my face or my arms. This was when I first read about Pityrosporum Folliculitis or Malassezia folliculitis and its symptoms fit exactly what was happening with my skin.
For remedies, I read about Ketoconazole 2% shampoo. Went, bought it, used it for five days, no improvement. I tried Apple Cider vinegar for about three days. Stung a lot but the condition was still getting worse.
At this point, I decided I was defeated and had to go to the doctor.
She acted shocked when I removed my shirt, and I knew I had waited too long (unnecessarily so because I was insured). I had read extensively about this fungal infection and she ticked the right box when she gave me 200mg fluconazole (two tablets to be swallowed a week apart each). She also gave me about 50ml Whitfield ointment to apply twice a day until finished.
Fluconazole seemed to work overnight and the pimples begun to noticeably dry out the next day. By the time I was taking the second tablet after a week, only a few itchy spots remained and I happily swallowed it.
My disappointment was immense when the itchy spots begun to come back only three days after my second tablet. I went back to the doctor immediately and she recommended I do another round of two fluconazole tablets over two weeks and more Whitfield ointment. I also mentioned to her that I was doing the ketogenic diet but she thought it had nothing to do with it.
There was no relief.
The rash had gotten worse and although it was not as bad at it had been when I first went to the doctor, it was clear it was not going to go away. It was also clear it would get worse.
I was panicking and wondering if I would have to put up with this horrible condition for a long time.
All this time I had been using ketoconazole shampoo every day, twice a day, for my showers. I begun reading on alternative shampoos and topical antifungals that I could use for this most horrible case of Pityrosporum folliculitis.
I also read about alternative systemic treatment. I had now already tried fluconazole 200mg and clearly it had failed. There was Itraconazole which had a lot of positive commentary and articles on the internet. There was Ketoconazole tablets as well. So the next time I was going to see the doctor, I would ask for one of these. And I did.
The doctor, she really impressed me with how she seemed to want me cured as badly as I did. She told me she had been doing research about my stubborn case. She had talked to a few of her doctor friends about it and when she suggested these same drugs I was going to ask her for, I was pleased.
The doctor also informed me that I wasn't covered for any of the new drugs Ketoconazole oral or Itraconazole. She advised that Ketoconazole would be more affordable but had a reputation for potentially nasty side effects. I was also skeptical about the liver related information I had read on the internet about Ketoconazole oral, as well as the fact that Ketoconazole shampoo wasn't doing anything for me. When I told her this, she quickly corrected me,that oral and topical have completely different capabilities and outcomes. She was sure it would work and she recommended Ketoconazole for its friendly price in comparison with Itraconazole. She, favored resulting to Itraconazole as a measure of last resort.
Off I went to the pharmacist with my prescription and purchased fourteen tablets of Ketoconazole to be taken one daily, for two weeks. The doctor also gave me a spare prescription for an extra fourteen tablets if the rash wouldn't go away in two weeks.
Before I left the doctors office, we had a discussion about the possible underlying conditions that could be encouraging fungal growth. She indicated three possible reasons: antibiotics, diabetes or HIV. I had read as much during my research and I inquired if there was value in ruling the last two out with blood work. The doctor agreed and sent me to the lab. I was not on any antibiotics so I was more than a little bit nervous it would be one of the other two. Again I had brought up my ketogenic diet but she still did not think it was having anything to do with the infection. The results of my blood work would be available after the weekend as I was having the tests on a Friday.
I started on the Ketoconazole tablets immediately and by Sunday morning(two days later) the results were visible. I was careful not to be too excited as this had happened before with fluconazole, only for my condition to get worse after initially getting better.
I visited the doctors office on Tuesday and it was clear Ketoconazole was wiping out the Malassezia. The results of my blood work were also in. I was more than elated that I did not have HIV. I was glad I did not also have diabetes. My blood cell count had no discrepancies according to the doctor's reading of my results. It was good news through and through. So what was going on with my body?
I was determined not to get back to the horrific state of scratching myself to sleep. I begun reading once more about the ketogenic rash and what people on the internet thought it was. I begun also considering the food I was consuming to determine if any of it had the possibility of carrying antibiotics that would be killing the normal flora in my gut and encouraging a fungal infection.
My final strategy
The internet is a scary place when it comes to symptoms and diagnosis. It is not easy to zoom in on any clear consensus on many complex conditions and their causes. I read scary antibiotic articles on animal products especially pork/bacon and butter and I was kind off convinced. These were my main sources of nourishment on the ketogenic diet and it seemed to me that I could have been consuming antibiotics used by farmers to raise their animals, ingesting huge quantities on the daily. The material on use of human antibiotics in animal farming is very damning. This to me felt like a huge possibility.
On the Ketorash website, theketorash.com, I explored the stories of different posters who had had to deal with this problem. The most consistent remedy was to up the intake of carbohydrates to a level where the rash would go away. It also seemed probable to me that my rash could have a lot to do with my diet despite my doctor's view to the contrary.
Since I did not want to risk not taking care of the real underlying condition, between the low carbohydrate intake and possible antibiotic intake from animal products, I decided to take care of both. I decided that I would only eat beef and chicken products and not any pork or bacon; the antibiotic use in animal production was most severe in pig farming (the volume of damning articles was overwhelming to me). I also decided that I would consume grass-fed butter(Kerrygold Irish butter was the nearest to organic I could get). I also decided to up my daily carb intake from an initial below 20g per day to around 50g-70g per day. I achieved this by having two slices of Low GI bread with my earlier no-carb breakfast. I also started taking a daily dose of at least 250ml of plain yogurt, the one that still has the cultures, in order to restore my normal good bacteria which judging from my fungal infection, were not thriving.
By the time I finished my two week dose of Ketoconazole, the folliculitis had been completely wiped out and I stopped with the tablets. I went on with my new 50g-70g low carb, high fat diet.
Since the rash has not come back to me in two months, I believe that my new diet regimen is working to keep me free of the rash. I am more than encouraged that I can remain relatively low carb and not have a rash. I believe the yogurt cultures are my indispensable allies.
What are my reasons for writing this blog post?
It is because of how much I suffered. It is because I still can see the fading scars of what pityrosporum folliculitis/ malassezia /keto rash did to my skin. I still cannot confidently remove my shirt infront of people, except my spouse, until the scars fade a little bit more. It is winter here so there is time before I have to swim again.
I decided to put down all my thought and action processes during the ordeal so that if there is more helpful deductions from the sequence of the events that I haven't been able to pick out, someone will.
'I had pityrosporum folliculitis/ malassezia and I am now cured' I searched on the internet for this line and I am happy to be the one to lay it down.
