Medical context: Eczema has multiple causes - genetics, environment, skin barrier function, and immune response all play roles. Diet is one piece of the puzzle, not a cure. Work with your GP or dermatologist for comprehensive treatment.
If you have eczema (atopic dermatitis), you've probably noticed that some days are better than others - and wondered if food might be involved. The honest answer: sometimes yes, sometimes no, and it's frustratingly individual.
About 30% of people with eczema have food sensitivities that trigger or worsen flares. For the other 70%, diet has minimal impact. The challenge is figuring out which group you're in.
Common Trigger Foods
Research has identified foods that most frequently trigger eczema flares. These aren't universal - your triggers may be different or you may have none at all.
Dairy Products
Cow's milk proteins (casein and whey) are the most frequently identified eczema triggers, especially in children.
- Milk, cheese, yoghurt
- Butter and cream
- Foods containing milk solids
Eggs
Egg proteins, particularly in the whites, are common triggers. Some people tolerate well-cooked eggs but react to runny preparations.
- Whole eggs
- Mayonnaise
- Baked goods with eggs
Wheat & Gluten
Wheat proteins can trigger inflammation in some eczema sufferers. This isn't necessarily coeliac disease - it's a different mechanism.
- Bread and pasta
- Cereals
- Baked goods
Nuts & Peanuts
Tree nuts and peanuts are established eczema triggers. Reactions can be immediate or delayed by several hours.
- Peanuts and peanut butter
- Tree nuts (almonds, cashews, etc.)
- Nut oils and spreads
Soy
Soy proteins can trigger eczema, which is frustrating since soy milk is often suggested as a dairy alternative.
- Soy milk and tofu
- Edamame
- Soy sauce and miso
Fish & Shellfish
Some people react to fish proteins. Interestingly, fish oil supplements may actually help eczema - it's the protein, not the fat, that's problematic.
- All fish varieties
- Prawns and shellfish
- Fish sauce
Delayed reactions: Eczema food reactions often appear 6-48 hours after eating - not immediately like a typical food allergy. This delay makes identifying triggers much harder.
The Gut-Skin Connection
Why Gut Health Matters for Eczema
Research increasingly shows a link between gut microbiome health and skin conditions. The gut-skin axis works through:
- Immune modulation: 70% of immune cells are in the gut - gut health affects whole-body inflammation
- Intestinal permeability: A compromised gut barrier may allow food proteins to trigger immune responses
- Microbiome diversity: People with eczema often have less diverse gut bacteria
- Short-chain fatty acids: Beneficial gut bacteria produce anti-inflammatory compounds
Supporting Gut Health
Focus on foods that nourish beneficial gut bacteria:
- Prebiotic foods: Onions, garlic, leeks, asparagus, bananas, oats
- Fermented foods: Sauerkraut, kimchi, kefir (if you tolerate dairy), kombucha
- Fibre variety: Aim for 30 different plant foods per week
- Polyphenols: Berries, dark chocolate, green tea, olive oil
Anti-Inflammatory Foods
While avoiding triggers is important, so is actively including foods that reduce inflammation.
Foods That May Help
Omega-3 Fatty Acids
The evidence for omega-3s in eczema is promising. These anti-inflammatory fats may help reduce eczema severity, particularly when omega-6 intake is also reduced.
- Best sources: Salmon, mackerel, sardines, anchovies
- Plant sources: Flaxseeds, chia seeds, walnuts (if tolerated)
- Supplements: Fish oil supplements may help - discuss with your doctor
The Elimination Diet Approach
If you suspect food triggers but aren't sure which ones, a structured elimination diet can help identify them.
How to Do an Elimination Diet
-
Baseline Phase (2 weeks)
Keep a detailed food and symptom diary. Note eczema severity daily. This establishes your baseline.
-
Elimination Phase (3-4 weeks)
Remove all common triggers: dairy, eggs, wheat, nuts, soy, fish. Eat simple, whole foods. Your skin should improve if food is a factor.
-
Reintroduction Phase (6-8 weeks)
Add one food back every 5-7 days. Eat it daily for 3 days, then stop and observe for 4 days. Watch for flares.
-
Personalisation
Build your long-term diet based on what you've learned. Avoid confirmed triggers; reinclude foods that passed the test.
Important: Elimination diets should ideally be supervised by a dietitian, especially for children. Removing too many foods long-term can lead to nutritional deficiencies.
What About Histamine?
Some eczema sufferers find that high-histamine foods worsen symptoms. Histamine is an immune compound that's also found in certain foods:
- High histamine: Aged cheeses, fermented foods, alcohol, cured meats, vinegar, tomatoes, spinach, aubergine
- Histamine releasers: Citrus fruits, strawberries, chocolate, shellfish
Histamine intolerance is less common than people think, but if you notice patterns with these foods, it's worth investigating with a healthcare professional.
Hydration and Skin Health
Dry skin is a hallmark of eczema. While moisturising externally is essential, hydration from within also matters:
- Drink adequate water throughout the day
- Limit caffeine and alcohol, which can be dehydrating
- Eat water-rich foods: cucumber, watermelon, oranges
- Consider herbal teas that may also have anti-inflammatory benefits
Supplements to Consider
While food-first is ideal, some supplements have evidence for eczema support:
- Vitamin D: Deficiency is linked to worse eczema; many UK residents are low
- Fish oil: Anti-inflammatory omega-3s; dosage matters
- Probiotics: Specific strains (Lactobacillus rhamnosus) may help, especially in children
- Evening primrose oil: Mixed evidence, but some find it helpful
Discuss supplements with your doctor, especially if you're on medication.
The reality: For some people, dietary changes make a significant difference to eczema severity. For others, the impact is minimal. The only way to know is careful, systematic testing. Whatever you discover, diet should complement - not replace - your medical treatment plan.
References
- Bath-Hextall, F., et al. (2012). Dietary supplements for established atopic eczema. Cochrane Database of Systematic Reviews
- Schlichte, S.L., et al. (2016). Diet and eczema: a review of dietary supplements for the treatment of atopic dermatitis. Dermatologic Therapy
- Lee, S.Y., et al. (2021). Microbiome in the Gut-Skin Axis in Atopic Dermatitis. Allergy, Asthma & Immunology Research
- National Eczema Society. (2023). Diet and Eczema.
- British Association of Dermatologists. (2023). Atopic Eczema Patient Information.
