Nutrition for eczema: can diet make a difference?

If you've ever found yourself desperately googling "best cream for eczema" for the hundredth time, searching for yet another product that promises to calm your angry, itchy skin, I see you. Or perhaps you're a parent who's watched your little one scratch until they bleed, trying every elimination diet under the sun, feeling utterly exhausted and confused. The truth is, whilst topical treatments can bring relief, eczema is rarely just a skin-deep issue. When your skin flares, it's often reflecting something happening beneath the surface, particularly in your gut.

Today, we're diving deep into eczema (also known as atopic dermatitis), and I promise you, this isn't just another article telling you to "just stop eating dairy" or "avoid stress". We're going to explore the science behind why your gut health might be the missing piece of your eczema puzzle, and what you can do about it.

Nutrition for eczema: what's really going on?

Eczema affects roughly 20% of children and 10% of adults globally. If you're dealing with it, you know it's not just about dry, itchy skin. It's about sleepless nights, constant discomfort, feeling self-conscious, and the mental load of managing a condition that can flare unpredictably.

What's important to understand is that eczema isn't just a skin problem. It's a whole-body condition involving your immune system, your gut, your genetics, and yes, your skin barrier too. Think of your skin as a brick wall. In eczema, those bricks (your skin cells) and the mortar holding them together (proteins like filaggrin) aren't quite doing their job properly. This creates a disturbed epidermal barrier, which means water escapes more easily (hello, dry skin), and irritants, allergens, and even bacteria can sneak in more readily, triggering inflammation and persistent itching.

What makes eczema particularly significant is that it often increases the risk of developing other atopic conditions like food allergies, hay fever, and asthma, especially when eczema begins in childhood.

The gut-skin axis: your internal ecosystem matters

Now, let's talk about something that might surprise you: your gut. Your digestive system and your skin are in constant communication, and when things go sideways in your gut, your skin often shows it.

Here's what the research tells us: people with eczema frequently have something called gut dysbiosis, essentially, an imbalance in their gut bacteria. Studies show lower levels of beneficial bacteria and higher levels of the troublesome ones. I'm intentionally not naming specific strains here because I don't want you rushing out to buy random probiotics or, worse, following some questionable online protocol to eliminate certain bacteria.

Many people with eczema also show signs of increased intestinal permeability. When your gut lining becomes more permeable, allergens and pathogens can slip through into your bloodstream, triggering systemic inflammation that can manifest as skin flare-ups. It's all connected.

The magic of short-chain fatty acids

Right, this is where it gets really interesting. Your gut bacteria produce these incredible compounds called short-chain fatty acids (SCFAs) when they feast on fibre from your diet. The star player here is butyrate, and it's essentially liquid gold for your skin and immune system.

People with eczema often have lower levels of butyrate, and that's a problem because butyrate does some pretty spectacular things:

• Calms inflammation: It reduces inflammatory signals that drive redness and irritation in your skin

• Strengthens barriers: Both your gut lining and your skin barrier benefit from butyrate

• Balances your immune system: It helps your immune system respond more appropriately, reducing the tendency towards allergic reactions

• Supports your skin directly: Butyrate helps your skin stay strong by giving skin cells the energy they need to repair, encouraging the production of barrier-building proteins and healthy fats, and calming inflammation

Studies have found that infants with lower faecal butyrate levels have a higher risk of developing eczema. When butyrate levels are optimised through diet or supplementation, we often see improved skin barrier function and reduced inflammation.

The diet and nutrition connection for eczema: what you eat really matters

Fibre is your friend

Fibre-rich nutrition patterns that feed your gut bacteria and promote SCFA production have been associated with improved eczema outcomes. This isn't about restriction, it's about abundance. Loading up on vegetables, fruits, whole grains, legumes, nuts, and seeds gives your beneficial bacteria the fuel they need to produce those beneficial SCFAs.

The Mediterranean approach

The Mediterranean diet keeps showing up in research for good reasons. It's packed with anti-inflammatory components such as extra virgin olive oil, vegetables, fruits, whole grains, and fish, which provide antioxidants, polyphenols, and omega-3 fatty acids. People who eat this way tend to have lower rates of allergic diseases, including eczema. It's about eating well, not eating less.

And even if you're not ready for a complete dietary overhaul, just adding more vegetables can help. Vegetables are packed with plant compounds, vitamins, and minerals that help reduce oxidative stress and calm inflammation. More plants on your plate can genuinely support your skin from the inside out.

Probiotics and fermented foods: supporting your gut naturally

The research on probiotics for eczema shows real promise, particularly when used strategically during key windows like pregnancy and early infancy for prevention, or as part of a comprehensive approach for those already dealing with eczema.

But here's something even more accessible for everyday life: fermented foods. Regular consumption of foods like kimchi, sauerkraut, kefir, yoghurt, kombucha, and miso has been linked to lower rates of eczema development. These foods naturally contain beneficial bacteria and compounds that help balance your immune system and reduce inflammation.

The beauty of fermented foods is that they're delicious, diverse, and work with your body's natural processes. They're not a magic bullet, but they can be a genuinely supportive part of your overall approach to managing eczema, especially when combined with other dietary and lifestyle strategies.

A note on histamine and dairy: Some people with eczema are sensitive to histamine, and fermented foods are naturally high in this compound. If you notice your symptoms worsen after eating fermented foods, this might be worth exploring with a practitioner. Histamine intolerance can be complex and often relates back to gut health issues, so it's about finding the right approach for your individual situation rather than ruling out fermented foods entirely.

Similarly, if you have a dairy allergy, opt for non-dairy fermented options like sauerkraut, kimchi, water kefir, or coconut yoghurt instead of traditional dairy-based kefir and yoghurt.

The omega-3 and omega-6 balance

People with eczema often show an imbalance in their essential fatty acids, typically too much omega-6 and not enough omega-3. This matters because these fats directly influence inflammation in your body. Supporting this balance through diet and targeted supplementation can help.

Food triggers: a balanced approach

For some people, certain foods can act as triggers for skin flare-ups. The reaction can look different from person to person and may appear soon after eating or take longer to show up.

In those with eczema, certain foods don't cause the condition, but they can make symptoms worse. For others, especially those with allergic contact dermatitis, specific foods or ingredients might actually be the main cause of their skin irritation.

Identifying and avoiding these food triggers, ideally with proper guidance, can make a real difference. Many people find that once they understand what's setting off their skin, their symptoms improve, and flare-ups happen less often.

However, and this is important, overly restrictive elimination diets carry risks, including developing food allergies and nutrient deficiencies. If you suspect food triggers, work with a nutrition practitioner to identify them properly through your medical history and appropriate testing, rather than randomly cutting out food groups.

What to limit: ultra-processed foods

Research shows us that heavily processed foods such as ready-made meals, processed meats, and foods laden with additives are associated with higher rates of eczema, particularly in children. In contrast, wholefood eating patterns tend to be protective.

Some people with eczema find that certain food additives can trigger flare-ups. I'm not about restrictive, fear-based diets but being mindful of heavily processed foods and focusing on whole, nourishing options can make a real difference.

Nutrition for eczema: where to begin

I know this is a lot of information, and eczema is complex. But that means there are multiple pathways to improving your symptoms and supporting your skin health, and different approaches work for different people. This is where personalised nutrition comes in.

If I were sitting across from you with a cup of tea right now, here's what I'd suggest:

1. Focus on gut health first: Increase your fibre intake and add in fermented foods. If you're avoiding dairy due to allergy or intolerance, there are plenty of non-dairy fermented options like sauerkraut, kimchi, and water kefir

   
   

2. Embrace anti-inflammatory eating: Think Mediterranean-style eating pattern, more plants, quality fats, oily fish

   
   

3. Reduce ultra-processed foods: Not through restriction, but through crowding out with wholefood, nourishing alternatives

   
   

4. Consider targeted supplementation: These might include omega-3 fatty acids, vitamin D, zinc, or others based on your individual needs and any deficiencies. Always work under the supervision of your GP or a qualified nutritional therapist

   
   

5. Investigate properly if needed: If you suspect food triggers or want to understand what's going on beneath the surface, consider appropriate testing. Based on additional symptoms, this might include an omega-3 index test, comprehensive stool analysis, vitamin D levels, zinc status, or screening for coeliac disease and intestinal permeability (zonulin). Testing takes the guesswork out of supplementation

   
   

6. Work with someone who gets it: Eczema is multifaceted, and having support makes all the difference

A personalised approach to eczema management

Managing eczema can feel overwhelming. When we look at the whole picture including your gut health, diet, nutrient status, and individual triggers, rather than just treating symptoms on the surface, meaningful change becomes possible.

If you're tired of the endless cycle of creams that don't work and advice that feels impossible to follow, I'd love to chat with you about your unique situation. Together, we can create a personalised plan that supports your skin from the inside out, fits naturally into your life, and actually feels good to follow.

Ready to explore what might be driving your eczema? Book a free chat with me and let's work out what your body needs now.

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The information in this article is for educational purposes and is not intended to replace medical advice. Always consult with your healthcare provider before making significant changes to your diet or supplement routine, especially if you're managing a chronic condition or are pregnant.