Let's Talk About Eczema and Diet
When it comes to this skin condition and nutrition, it isn't as simple as eat this, not that. But knowing the correlation between certain foods and the complex disease can help take a bite out of the itch.by Jennifer Tzeses Health Writer
In a perfect world, eliminating eczema would be as simple as eating a magic food—and poof, those itchy, red, scaly patches would get outta dodge in an instant. But who are we kidding? The world is far from perfect, and eczema is not only a super complicated condition, but it’s also incurable (as of yet). The reality is, the link between food and eczema is not so simple, and scientists are still trying to fully understand it. While there is no research to show that particular diets or foods can ease your eczema symptoms, there are studies that suggest certain allergens in foods can trigger eczema flareups in some people who have the condition. We get it, there’s a lot of complex stuff to digest here. So, to help you make sense of it all, let’s get to the meat of the matter.
Our Pro Panel
We went to some of the nation's top experts in eczema and diet to bring you the most up-to-date information possible.
Emma Guttman, M.D., Ph.D.
Director of the Center for Excellence in Eczema
Mount Sinai Hospital
New York, NY
Dawn Marie R. Davis, M.D.
Professor of Dermatology and Pediatrics Division Chair, Clinical Dermatology
JiaDe Yu, M.D.
MGH Contact Dermatitis and Occupational Dermatitis Clinic at the Massachusetts General Hospital/Harvard Medical School
Some good research shows exclusively breastfeeding during the first three months of life may reduce the incidence of eczema in children. Scientists believe this might be because breast milk contains compounds such as α-tocopherol, β-tocopherol, and prolactin, which all help reduce inflammation, increase immune function, and decrease sensitivity of infants.
According to the American Academy of Allergy, Asthma & Immunology, half of patients with moderate to severe eczema also suffer from food allergies. But it's not that eczema is caused by any type of allergy; rather it is believed that eczema develops first, making the person more susceptible to a food allergy. Food allergies can also serve as a trigger for an eczema flare.
No. A high rate of false positive results can lead to misdiagnosis and unnecessary food avoidance. The National Institute of Allergy and Infectious Diseases recommends that only children under five with moderate to severe eczema should be tested for a food allergy if they experience symptoms right after eating a specific food. They also recommend testing if eczema is unresponsive to traditional treatment.
There have been some studies that show mothers who took specific strains of probiotic supplements two months before delivery and during the first two months of breastfeeding reduced eczema development in high-risk infants. But researchers say more studies are needed to determine recommendations, so talk to your doctor before taking any kind of supplement.
A Quick Eczema Refresher
Here’s the short story: Eczema is a chronic skin condition driven by inflammation that can cause the skin to react with red, itchy, scaly patches. You can’t catch it by coming into contact with someone who has it: Eczema is believed to be an inherited condition.
Certain things (called triggers) can set off symptoms—these can be anything from household products to changes in the weather. While there is no cure for eczema, there are many ways to control it and stop symptoms in their tracks, including keeping an eye on the things you eat. Speaking of which, some food for thought.
Eczema and Food Allergies
It’s widely known that many people with eczema also have allergic conditions like food allergies. In fact, according to the American Academy of Allergy, Asthma & Immunology, half of patients with moderate to severe eczema also suffer from food allergies, as well as asthma and hay fever.
The current thinking is that eczema develops before the food allergy does, and the more severe the eczema, the higher the risk for an allergy. Researchers believe this could be because those with eczema have a weakened skin barrier, meaning certain allergens in the environment, including proteins that trigger food allergies, have a one-way ticket inside the body. When these allergens reach the immune cells in your skin, you can become sensitized to certain foods, possibly leading to a food allergy.
Generally, food allergies are more common in kids—and even more common in kids with eczema. About 40% of babies and young children with moderate or severe eczema have food allergies.
Studies show that children with both eczema and a food allergy actually have structural and molecular differences in the top layers of healthy-looking skin near the eczema lesions, whereas children who just have eczema don’t. This is significant because defining these differences in the skin might help to diagnose kids who are at risk for developing food allergies.
In addition to eczema flares, allergic reactions to food can cause symptoms like:
shortness of breath
The National Institute of Allergy and Infectious Diseases recommends that children under five with moderate to severe eczema should be tested for a food allergy only if they experience one of these symptoms right after eating a specific food. They don’t recommend testing all kids with eczema for food allergies because there’s a high rate of false positive results—which can lead to misdiagnosis and unnecessary food avoidance. They also recommend food-allergy testing (particularly for peanut, egg, and milk, which are the most common allergies in this age group) if eczema is unresponsive to traditional treatment.
Eczema Food Triggers
Like people who chew with their mouth open or talk during a movie, triggers are irritants—in this case, things that irritate your skin. They may be in the environment, in your household, in your day-to-day, even in your body, and can cause eczema symptoms to rage.
Triggers can also be found in certain foods. In fact, foods have been shown to be a trigger in nearly 30% of cases of moderate to severe eczema. In these instances, certain foods set off the overactive immune system in people with eczema, causing inflammation in their body that leads to itchy, scaly skin.
While foods can be a trigger for causing eczema flareups, they don’t cause eczema in the first place—genetics are thought to be the main cause. Also, keep in mind that not everyone who has eczema has the same triggers. Knowing your unique offenders can help you manage eczema symptoms.
The below potential food triggers for eczema are very different from the typical food allergies. If you have a known contact allergy to any of the below foods, then consuming the associated foods may cause a flare in eczema, but this is rare. When trying to figure out food related eczema triggers, different types of allergy testing may need to be done. The type of allergy testing that can help identify these triggers is called a patch test.
Here’s the lineup of likely suspects when it comes to common food triggers:
Balsam of Peru
A liquid resin harvested from trees grown in Central America, balsam of Peru is commonly used as a fragrance in shampoos, deodorants, lotions, air fresheners, and pesticides. It’s mixed into some flavoring agents and alcoholic beverages to boost flavor.
And it’s also found in flavored spices like:
If you’re allergic, ingesting it can cause your skin to react with redness, swelling, itching, or fluid-filled blisters.
While most commonly associated with jewelry, like earring backings and watch bands, a higher nickel content is also found in some foods including:
The most common reactions can be itchy, red patches or purple or ashen grey, if you have darker skin, on hands and elbows.
A derivative of petroleum that can act as a good emollient and humectant, propylene glycol is found in many skin-care products, cosmetics, and medications. It’s also used as a thickening agent in foods such as:
Reactions may include itchy, red, scaly patches on the face, neck, or hands.
Formaldehyde from aspartame, an artificial sweetener, may cause eyelid or hand eczema in those who are allergic. Aspartame converts to formaldehyde, which is also one of the most common contact allergens found in skin and haircare products, in the liver as it metabolizes in your body.
The Dangers of Elimination Diets
Having learned about the above offenders, you might be thinking, “OK, let me just avoid them like the plague.” But the problem is, these triggers are in a lot of foods, so avoiding all of them is pretty much impossible, and if you did, you would get really, really hangry. While some studies show a diet low in nickel can improve skin, doctors are very cautious about elimination diets in general.
Elimination diets can be especially dangerous for babies and young children. Eliminating certain foods could result in dietary and nutritional deficiencies that stunt development. Not to mention, some studies have shown that removing a food from the diet of a child who regularly eats that food can lead to an allergic reaction when it’s reintroduced later. (Also food allergy tests can sometimes turn up false positive results, so removing offending foods would be for nothing.)
Before a food allergy evaluation, doctors will recommend thorough skin care treatment. If all else fails and symptoms persist, then they’ll move on to food allergy testing. In some cases, if a suspected food has tested positively during an allergy workup, they may suggest an elimination diet for four to six weeks. The bottom line is: For those diagnosed with food-triggered eczema, treatment should be discussed and closely managed by a doctor.
The Dangers of Elimination Diets for Eczema: The Journal of Allergy and Clinical Immunology. (2016). “Elimination Diets in Eczema—A Cautionary Tale.” jaci-inpractice.org/article/S2213-2198(15)00573-5/fulltext
The Role of Food Triggers in Eczema: The Journal of Clinical and Aesthetic Dermatology. (2014). “Diet and Dermatitis: Food Triggers.” ncbi.nlm.nih.gov/pmc/articles/PMC3970830/#!po=67.6471
Kids and Food Triggered Eczema: The Journal of Allergy and Clinical Immunology. (2016). “Natural History of Food Triggered Atopic Dermatitis and Development of Immediate Reactions in Children.” ncbi.nlm.nih.gov/pmc/articles/PMC4789144/#!po=90.0000
Food Allergens & Contact Dermatitis: Current Allergy and Asthma Report. (2014). “Systemic Contact Dermatitis to Foods: Nickel, BOP, and More.” aaifnc.org/Documents/symposium_2018/addendum/SystemicContactDiet2.pdf
Balsam of Peru Allergy & Eczema: Dermatitis. (2013).“Balsam of Peru Past and Future.”
The Role of Dietary Supplements in Eczema Treatment and Prevention: Dermatology Practical & Conceptual. (2016). “Diet and Eczema: A Review of Dietary Supplements for the Treatment of Atopic Dermatitis.” ncbi.nlm.nih.gov/pmc/articles/PMC5006549/
Breastfeeding & Eczema Prevention: Canadian Family Physician. (2011). “Breastfeeding and Maternal Diet in Atopic Dermatitis.” ncbi.nlm.nih.gov/pmc/articles/PMC3237513/
Food Allergies & Eczema in Kids: Oxford University Hospital. “Food Allergies and Kids.” ouh.nhs.uk/patient-guide/leaflets/files/14460Peczema.pdf
The Link Between Eczema and Food Allergies: American Academy of Asthma & Immunology. aaaai.org/global/latest-research-summaries/Current-JACI-Research/eczema-food-allergy