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Article written by
Kimberly Mugler, RDN, LDN
Eczema, also known as atopic dermatitis, is a chronic or recurrent skin disease. Eczema often occurs in children and adults as a rash on the inside of the elbows and knees, on the backs of hands, or on the scalp. It can occur in infants too, usually appearing as tiny dots on the cheeks. It is more common in children than adults, and often children outgrow the symptoms of eczema. According to the American Academy of Allergy and Asthma Immunology, symptoms of atopic dermatitis (eczema) include:
Eczema can be triggered by several different environmental factors. Individuals living with atopic dermatitis often turn to diet to identify trigger foods that may be exacerbating their symptoms.
A Note on Food Allergies
Atopic dermatitis and food allergies are highly correlated. Some individuals with eczema may have specific food sensitivities which could make symptoms worse. These food sensitivities are individualized and often difficult to pinpoint. To date, there are no specific foods generally recommended to eliminate from the diet to treat atopic dermatitis.
Food reactions are more common in infants and children than in the older population, when it comes to atopic dermatitis. Foods may trigger immediate immunoglobulin E-mediated hypersensitivity reactions, or eczematous reactions may occur hours later. Skin prick tests can identify food allergies. A diagnosis of food allergy requires specific signs and symptoms that occur repeatedly upon exposure.
The majority of food allergic reactions in the United States are triggered by peanuts, tree nuts, cow’s milk, eggs, soy, wheat, seafood, and shellfish. Food allergy reactions can range from life-threatening anaphylactic shock to a rash like eczema. Aside from food allergies, some individuals notice specific food sensitivities. Gluten and dairy are common foods associated with perceived intolerance.
One study showed that when children with a documented food allergy followed dietary elimination, most showed significant improvement of their eczema within one to two months. If children or adults do not have a documented food allergy, there is no evidence that eliminating a specific food group like dairy or gluten will improve symptoms of eczema. The National Institute of Allergy and Infectious Diseases (NIAID) only recommends food avoidance of documented food allergies. This may help decrease symptoms, but cannot alter progression of a disease such as atopic dermatitis.
Anti-inflammatory foods, like those including omega-3 fatty acids, can provide more benefits than just helping with skin. Research shows supplementing omega-3 fatty acids may be promising, but this has not been sufficiently studied in the prevention of atopic dermatitis. Studies suggest atopic dermatitis is not necessarily associated with a deficiency of omega-3 fatty acids, but more with altered metabolism that may compromise the level of omega-3 fatty acids in the bloodstream.
The American Academy of Dermatology has confirmed there is not conclusive evidence to recommend the use of fish oils to treat atopic dermatitis. Early research suggests it may prevent eczema onset if given at a young age. These studies are short term and do not conclude whether atopic dermatitis can still develop later in life.
Probiotics are commonly recommended to help improve the gut microbiota, which some experts believe may help with atopic dermatitis. Research has shown that, when compared with no probiotic treatment, treatment of eczema with probiotics makes little to no difference. Despite some physician recommendations for probiotics in the prevention of eczema, there is no reliable evidence to date to support this. Furthermore, clinical evidence on the use of specific probiotic strains to treat or prevent diseases is limited.
Vitamin D is a nutrient of concern regarding atopic dermatitis. Vitamin D supplementation is usually only found to be beneficial in individuals with a vitamin D deficiency. General dietary supplements, such as a multivitamin, are sometimes used to reduce symptoms and treat eczema. However, this strategy is not supported by any scientific evidence. A 2012 review looked at 11 studies with a total of 596 participants. They looked at a variety of supplements such as oral zinc, selenium, and vitamins D and E, and then compared them to placebo groups. According to the report, “There is no convincing evidence of the benefit of dietary supplements in eczema, and they cannot be recommended for the public or for clinical practice at present.”
Specific nutrients such as omega-3 fatty acids, probiotics, vitamin D, and vitamin E are popular in claims to prevent eczema flare-ups. To date, there is no scientific evidence to support the recommendations of taking specific oral supplements for these nutrients. However, consuming a well-balanced diet rich in these nutrients will not have any negative consequences and may potentially support a healthy immune system.
Foods that often get a bad rap are gluten, dairy, and sugar. These foods are difficult to isolate and associate specifically with eczema symptoms. For example, if you eat cookies and milk and notice a flare-up afterwards, it is difficult to associate the trigger with lactose, gluten, or sugar. All three are present in cookies and milk. To make matters more challenging, there are no tests that can indicate specific foods as a cause for an eczema flare-up.
You don’t necessarily have to avoid these foods unless you have a diagnosed intolerance, such as lactose intolerance. Some people may benefit from an elimination diet that can help identify if dairy, gluten, or sugar are exacerbating eczema flare-ups. However, a review of such studies looked at the effectiveness of removing various foods from the diet to determine whether it helped with short-term management of eczema. The studies in the review were considered weak.
One study found that an egg-free diet in infants suspected to have an egg allergy showed improvement, but other studies did not support this. Because of the lack of high quality research, it is not recommended to remove a specific food from a child’s diet. Furthermore, the potential of developing nutrient deficiencies — which may accompany any elimination diet — is concerning for children. It is important to work with your health care provider to analyze the pros and cons of eliminating a specific food in attempts to alleviate eczema.
Following a general anti-inflammatory diet is the best nutrition advice regarding atopic dermatitis to date. An anti-inflammatory diet coincides with a Mediterranean diet. This includes foods rich in omega-3 fatty acids and fiber. This eating plan focuses on lean protein, fish, whole grains, legumes, nuts, seeds, vegetables, fruits, and healthy (polyunsaturated and monounsaturated) oils.
On MyEczemaTeam, the social network and online support group for those living with eczema, members talk about a range of personal experiences and struggles. Diet is one of the top 10 topics most discussed.
Here are a few question-and-answer threads about diet:
Here are some conversations that have taken place about diet:
Are there certain foods that exacerbate or improve your symptoms? Share your experiences in the comments below or directly on MyEczemaTeam.