Should You Try an Elimination Diet for Eczema?

Should You Try an Elimination Diet for Eczema?
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Updated on December 10, 2024
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Many things can trigger eczema (also known as atopic dermatitis): fragrance, laundry detergent, hot or cold weather, stress, and, in some cases, the foods you eat.

 One proposed way to identify whether any foods may be problematic for you is through an elimination diet. This diet involves avoiding specific foods that you think may be responsible for your symptoms, and then reintroducing the foods to note if your symptoms return.

Common food triggers for eczema flare-ups include milk, eggs, peanuts, and fish for people who are allergic to these foods.

 Wheat is another one to add to the list, says Daniel P. Friedmann, MD, a board-certified dermatologist with Westlake Dermatology in Austin.

Some people believe excluding these foods through an elimination diet has helped them identify the root cause of their flare-ups, but research isn’t so sure the benefit is there.

Common Signs and Symptoms of Eczema

Atopic dermatitis is the most common form of eczema.
Common Signs and Symptoms of Eczema

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Eczema Elimination Diet: What Research Shows

About one-third to two-thirds of children with moderate to severe eczema also have a food allergy, suggesting a link between food and eczema.

 But food and food allergies are rarely the root cause of eczema, according to the National Eczema Association.

Still, many people who wonder whether their diet affects their skin turn to elimination diets to see whether a particular food is to blame. Research has examined whether it’s an effective strategy for reducing symptoms or flares.

One systematic review and meta-analysis that included data from nearly 600 people found that dietary elimination led to slight improvements in eczema severity for people with mild to moderate eczema. About 50 percent of those who eliminated foods saw improvement, compared with 41 percent of those who ate as usual.

Those findings seem to promote elimination diets as beneficial for those with eczema, but take them with a grain of salt.

“The study found that while elimination diets may help some patients, the risks of elimination diets may outweigh the potential benefit,” says Alice Hoyt, MD, a food allergist with Hoyt Institute of Food Allergy in Metairie, Louisiana, who was not involved with the study.

An article from the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology Joint Task Force argued that this review isn’t clinically significant because most of the trials weren’t randomized controlled trials.

Finally, it’s possible that even if you identify a potentially problematic food, avoiding it won’t lead to notable symptom improvement. An older review found that among adults who have a food allergy as proven by a food allergen test, only 50 percent saw eczema improvements when they eliminated that food from their diet.

What Are the Benefits and Risks of an Eczema Elimination Diet?

This type of diet for eczema relief comes with pros and cons.

The benefit of trying the eczema elimination diet is that you may successfully identify a food that triggers skin issues, helping you to avoid flare-ups by cutting that food from your diet. But there are some downsides you may run into during the process of figuring out if a food is to blame.

Nutrition Problems

Elimination diets can lead to unbalanced eating if you rule out entire food groups in an effort to find your trigger, says Susan Bard, MD, a board-certified dermatologist with Manhattan Dermatology Specialists in New York City. This excessive restriction can lead to malnutrition.

Unproven Results

You also may be spending your time following an unproven diet rather than pursuing more effective and well-established eczema treatment options, such as topical medication.

 “The reason we don't typically recommend long-term elimination diets to modify atopic dermatitis is because there's no evidence that it will actually change the disease process,” Dr. Hoyt says.

Severe Food Allergies

Hoyt adds that avoidance of a food may increase the risk of anaphylactic food allergy. Research suggests that elimination diets could lead to increased food intolerance and more sensitivity to the food in the future.

 One study found that after confirming food-triggered eczema, about 19 percent of participants had an immediate negative reaction when they were next exposed to the ingredient, which had never happened before.

Expense and Difficulty

Following an elimination diet could also raise food costs and add an extra burden to you as an individual or caregiver.

 Plus, it can be particularly challenging for children who may be asked to give up goodies and favorite foods.

Is It a Good Idea to Try an Eczema Elimination Diet?

Because of the potential risks, the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force does not recommend elimination diets.

 There’s currently not enough research supporting elimination diets to improve eczema if you’re not truly allergic to a food.

It can be worth a try, however, if it seems clear that a food is to blame for an outbreak, Dr. Bard says. “I tell patients that if they see an obvious association between a certain food and eczema flares to avoid that food,” she says. Better yet: If you’ve been diagnosed with an allergy to a certain food through a food allergen-specific serum immunoglobulin E test or skin prick test, then it’s a good idea to eliminate that food from your diet.

Your dermatologist will likely recommend you visit a board-certified allergy specialist to determine what food allergies you have and to advise on whether an elimination diet will be right for you, Dr. Friedmann says.

And a registered dietitian can also help you make sure you’re sourcing necessary nutrients, Hoyt says. For instance, if you eliminate dairy, you’ll need to find other ways to meet your calcium needs. “The point is to optimize good nutrition,” Hoyt says.

The Takeaway

  • Eczema (atopic dermatitis) and food allergies seem to overlap, and some people have tried an elimination diet to determine if a food is causing eczema flare-ups.
  • If you’re not truly allergic to a food, experts warn it’s a bad idea to try an elimination diet to improve eczema.
  • Potential downsides include malnutrition, delaying proper eczema treatment, and the possibility of developing a food intolerance as a result of avoiding a particular food.
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Susan-Bard-bio

Susan Bard, MD

Medical Reviewer

Susan Bard, MD, is a clinical instructor in the department of dermatology at Weill Cornell Medicine and an adjunct clinical instructor in the department of dermatology at Mount Sinai in New York City. Her professional interests include Mohs micrographic surgery, cosmetic and laser procedures, and immunodermatology.

She is a procedural dermatologist with the American Board of Dermatology and a fellow of the American College of Mohs Surgery.

Dr. Bard has written numerous book chapters and articles for many prominent peer-reviewed journals, and authored the textbook The Laser Treatment of Vascular Lesions.

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Moira Lawler

Author
Moira Lawler is a journalist who has spent more than a decade covering a range of health and lifestyle topics, including women's health, nutrition, fitness, mental health, and travel. She received a bachelor's degree from Northwestern University’s Medill School of Journalism and lives in the Chicago suburbs with her husband, two young children, and a giant brown labradoodle.
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Resources
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  2. The Elimination Diet. UW Integrative Health. November 2018.
  3. Institute for Quality and Efficiency in Health Care. Eczema: Research summaries – Eczema: Can eliminating particular foods help? InformedHealth.org. February 11, 2021.
  4. Eczema. American College of Allergy, Asthma & Immunology. June 28, 2023.
  5. Johnson JL. A Look at the Food Elimination Diet Trend for Atopic Dermatitis. National Eczema Association. January 3, 2024.
  6. Oykhman P et al. Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis. Journal of Allergy and Clinical Immunology in Practice. October 2022.
  7. Chu DK et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE− and Institute of Medicine−based recommendations. Annals of Allergy, Asthma & Immunology. November 9, 2023.
  8. Manam S et al. The association between atopic dermatitis and food allergy in adults. Current Opinion in Allergy and Clinical Immunology. October 2014.
  9. Institute for Quality and Efficiency in Health Care. Eczema: Research summaries – Eczema: Can eliminating particular foods help? InformedHealth.org. February 11, 2021.