Atopic dermatitis (AD) is a common chronic inflammatory skin disorder, which can have a significant impact on quality of life. Presentation depends on age and disease severity. In general, dry skin and itching are the most common symptoms. It is especially common in infants and children. Over the past decades, there has been an increase in AD in industrialized nations and environmental factors, including diet, are aassociated with this increased risk.
Education about the disease is an important part of treatment. Especially, since food allergies may be associated with AD. In children, cow’s milk, eggs, peanuts, wheat, soy, nuts, and fish are responsible for >90% of food allergies, while adults are more likely to react to apple, celery, and hazelnut. Baring this in mind, allergy prevention has been studied extensively throughout recent years, leading to an interesting shift in the topic of nutrition and AD. While avoidance of potentially allergic foods used to be recommended, early exposure is now advised. Unless a real, proven food allergy exists, complex elimination diets are not recommended. They often affect the daily routine of several family members without being the determining factor in eczema progression, only leading to additional stress, which by itself is a known trigger of AD.
What is generally recommended:
- Exclusive breastfeeding for 4 months (if possible)
- A varied, seasonal, plant-focused diet to not only meet daily nutritional needs, but to benefit overall health
- Cooking at home is always the easiest way to stick to a conscious diet
- Maintenance of a healthy body weight as overweight children and adults seem to have a higher risk for AD
- Supplementation of zinc and vitamin D to combat potential deficiencies
What is generally not recommended:
- Dietary restrictions during pregnancy and breastfeeding
- Delay of introducing solid foods
- Elimination diets, unless a proven food allergy exists
Rustad AM, Nickles MA, Bilimoria SN, Lio PA. The Role of Diet Modification in Atopic Dermatitis: Navigating the Complexity. Am J Clin Dermatol 2022; 23: 27-36
Makrgeorgou, A., et al. Probiotics for treating eczema. Cochrane Database Syst Rev 11, CD006135 (2018).
Khan A, Adalsteinsson J, Whitaker-Worth DL. Atopic dermatitis and nutrition. Clin Dermatol 2021, DOI: 10.1016/j.clindermatol.2021.10.006
Skjerven HO, Rehbinder EM, Vettukattil R et al. Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet 2020; 395: 951-961
Greer FR, Sicherer SH, Burks AW et al. The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods. Pediatrics 2019; 14
Wollenberg A, Barbarot S, Bieber T et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol 2018; 32: 657-682
Wallenberg A, Barbarot S, Bieber T et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol 2018; 32: 850-87
Wang JF, Orlow SJ. Keratosis Pilaris and its Subtypes: Associations, New Molecular and Pharmacologic Etiologies, and Therapeutic Options. Am J Clin Dermatol 2018; 19: 733-75
Reese I, Werfel T. Do long-chain omega-3 fatty acids protect from atopic dermatitis? J Dtsch Dermatol Ges 2015; 13: 879-885