Ever since high school I’ve struggled with eczema. It’s an issue that is typically addressed by a Dermatologist, who prescribes topical treatment. However, I was curious to explore the relationship between the diet and eczema.
There are many recognized triggers of eczema. Let’s review the evidence to find out if there is a connection between diet and eczema.
What is Eczema and Who Does it Impact?
Eczema, also referred to as atopic dermatitis (AD), is a chronic and recurrent inflammatory skin condition that causes itchy, red, and swollen patches of skin.
There are numerous types, with the most common developing in 1 in 5 infants, referred to as infantile eczema (1). However, eczema can affect anyone at any age. In fact, 334 million people worldwide were said to have eczema in 2013, and 10-30% of people in the U.S (2). Prevalence is on the rise with rates increasing by 2 to 3-fold in industrialized nations over the past few decades (3).
What Causes Eczema?
Several factors contribute to the likelihood of developing eczema.
Eczema risk factors include:
- Genetics/family history: If one or both parents suffer from eczema, then the child is 2-3 times more likely to suffer. Studies show higher correlation among identical twins (4)
- Environment: Those raised in developed countries with more pollution and colder climates increase risk
- Gender: Females are more likely to suffer than males
- Defects in skin barrier: Eczematous skin may have less water retaining properties (5)
- Immune abnormalities: Eczema may have an autoimmune nature in some individuals. Those with eczema are more likely to suffer from allergy symptoms like asthma, hay fever and food allergies (6, 7).
Conventional Treatment Approaches:
Despite no known cure for eczema, various treatments are available to manage and prevent flare ups.
Dermatologists treat severe eczema with topical (on the skin) or oral medications and phototherapy. Milder cases require skin care and lifestyle modifications (8). Commonly prescribed medications include antihistamines, antibiotics, and corticosteroids (oral or topical). Unfortunately, these treatments also have undesirable side effects and lack long-term relief.
Those with eczema are also typically instructed to avoid common triggers including:
- Extreme changes to body temperature
- Poorly moisturized skin
- Dry climates
- Prolonged water exposure
- Exposure to skin irritants (e.g. chlorine, perfumes, smoke, soaps/cleansers, pollutants, itchy clothing, etc.)
- High stress levels
Diet Triggers for Eczema:
Current research is unclear about the connection between eczema and specific food triggers.
Food Allergies and Eczema
Those with eczema are more likely to have food allergies, particularly in children under the age of 3 or 4.
Common food allergies in children with eczema include cow’s milk, eggs, peanuts, soy, wheat, cod/catfish and cashew (9).
Studies suggest the connection between childhood food allergy and eczema is 33 to 63%. Adult onset eczema is less likely linked with food allergy at a rate of 10%. However, this does not mean that food allergies cause eczema (10, 11).
Additionally, age reduces the likelihood that food allergy contributes to eczema, as most children outgrow their food allergies (12). The exception is adults with a birch pollen allergy. One study found their eczema was triggered by foods that cross-react with birch pollen like green apples, carrots, hazelnuts, celery, and pears. Therefore, if you have a birch pollen allergy and eczema, consider removing these foods from the diet (13).
Food Sensitivities and Eczema
Food allergy testing may have poor reliability in those with eczema.
Adults with eczema typically don’t suffer from classic food allergies (i.e. IgE-mediated allergy), but rather experience delayed reactions after eating certain foods. This type of reaction is a delayed food hypersensitivity, also referred to as a food sensitivity.
Presently, there is no gold-standard test for diagnosing food sensitivities. Therefore, if you suspect food sensitivities trigger your eczema, consider keeping a food/symptom diary and working with a healthcare provider to identify problematic foods (14).
Pseudoallergens and Eczema
The connection between pseudoallergens like food additives, histamine, salicylates and benzoates triggering eczema is controversial (15).
While the reason is still unclear, it’s theorized that these chemicals can cause inflammation in mast cells, a type of white blood cell. Those with eczema have higher levels of mast cells in the areas of skin with the rash (15).
One double-blind-placebo-controlled study on 50 adults found that 63% benefited from a 6-week low-pseudoallergen diet. This diet avoided all foods containing preservatives, dyes and/or antioxidants (16).
Celiac Disease and Eczema
Even relatives of those with CD are twice as likely to have eczema. This connection is based on the possible role of autoimmunity causing eczema (18).
Eczema Elimination Diet
Elimination diets are commonly recommended to help identify dietary triggers for a specific symptom, in this case eczema.
Following an elimination diet for 4 to 6 weeks may be beneficial for eczema sufferers. Remove all possible trigger foods and notice any changes in the skin (19).
There is no standardized elimination diet for this condition, but consider developing a plan based on your suspected trigger foods. Below is a list of eczema trigger foods to help you get started.
- Gluten (if you have Celiac disease): wheat, barley, rye, kamut, spelt, etc.
- Foods that cross react with birch pollen (if you have a birch pollen allergy): apples, apricot, cherry, carrots, hazelnuts, peanut, soy, celery, pears, peach, plum, kiwi, parsley
- Pseudoallergens: foods containing food coloring/dyes, preservatives (sorbic acid, benzoates, nitrates), monosodium glutamate (MSG), salicylic acid, antioxidants (e.g. BHT, BHA, tocopherol, propylgallate)
- IgE-mediate food allergies (if you are diagnosed by an allergist)
- Food sensitivities: this list is specific to the individual and based on a thorough review of your food/symptom diary
Monitor eczema symptoms after strict avoidance of these suspected foods. While change in symptoms may be coincidental, presence of food hypersensitivities could also explain the change.
Thereafter, carefully challenge the avoided foods back into the diet, ideally under the supervision of a dietitian or other healthcare practitioner. When challenging foods, allow a few days between trials for the development of delayed symptoms (12).
Keep in mind that eczema has multiple causes and triggers. An elimination diet is not appropriate for everyone, so talk to your doctor or dietitian before starting one.
Other Eczema Relief Tips
Sometimes a change in diet does not provide much help.
Many search for other natural approaches instead:
- Probiotics: Varieties with the strain plantarumCJLP133 may help prevent eczema, although research is in early stages (20)
- Aloe Vera: Applied topically may help soothe and hydrate the skin
- Evening Primrose Oil (EPO): One study found that 500mg EPO capsule improved eczema, but this study needs to be repeated (21)
Eczema is a complex inflammatory skin condition that is most common in children but can develop at any age. Conventional treatment options are available, yet don’t offer long-term relief or a cure.
Unfortunately, there are no solid dietary recommendations either. Removing any known food allergies or sensitivities is a good place to start, which is best done through an elimination diet.
The diet-eczema connection is still being uncovered in research. In the meantime, pay attention to your body and notice if there are any specific dietary triggers for you.