Twenty-five year-old female with sudden onset itchy skin eruption over her upper back and chest three weeks after starting a ketogenic diet.

Prurigo pigmentosa is a rare pruritic inflammatory dermatosis with a unique staged clinicopathological presentation. It was first reported by Nagashima in 1971, and recently, more cases have been reported We introduce a case of a young Saudi female who developed biopsy proved prurigo pigmentosa after she followed strict ketogenic diet. Her condition resolved after she resumed a regular diet.