Pharmaceutical intervention may be necessary
If additional treatment is required, minocycline 100 to 200 mg/d has been reported most effective, likely due to its anti-inflammatory properties.1,4 Topical corticosteroids and oral antihistamines provide symptomatic relief in some patients.1,4
Our patient had resolution of the pruritis and urticarial lesions within 2 days of resuming a normal diet; however, residual asymptomatic hyperpigmentation persisted. A retrial of the ketogenic diet initiated a flare of the rash in the same distribution. It rapidly resolved with carbohydrate intake.
CORRESPONDENCE
Daniel Croom, MD, 34520 Bob Wilson Dr, Naval Medical Center San Diego, San Diego, CA 92134; daniel.l.croom.mil@mail.mil