Can Diet Affect Eczema and Psoriasis? What Science Says

Eczema (atopic dermatitis) and psoriasis are two chronic inflammatory skin conditions that significantly impact millions worldwide. While their exact causes are complex and involve genetic, environmental, and immune factors, a growing body of scientific evidence suggests that diet may play a crucial role in their onset, severity, and management. Patients often seek dietary modifications hoping to alleviate symptoms, but what does the science truly say about the link between what we eat and the health of our skin?

This article will delve into the current scientific understanding of how dietary choices can influence eczema and psoriasis. We will explore specific dietary patterns and individual nutrients that have shown promise in research, as well as those that may exacerbate these conditions. By examining evidence-based recommendations, we aim to provide a clearer picture of the role of nutrition in managing these challenging skin disorders.

The Inflammatory Link: Diet and Skin Conditions

Both eczema and psoriasis are characterized by chronic inflammation. Psoriasis, in particular, is an autoimmune condition where the immune system mistakenly attacks healthy skin cells, leading to rapid cell turnover and the formation of thick, scaly plaques. Eczema involves a compromised skin barrier and an overactive immune response to various triggers. Given that diet can profoundly influence systemic inflammation, it's logical to investigate its impact on these conditions.

Western diets, typically high in saturated fatty acids (SFAs), refined sugars, and processed foods, are known to promote pro-inflammatory pathways in the body. Conversely, diets rich in anti-inflammatory nutrients, such as omega-3 polyunsaturated fatty acids (PUFAs), fiber, and certain vitamins, can help ameliorate inflammatory conditions [8].

Dietary Approaches for Psoriasis: What the Research Shows

For psoriasis, several dietary interventions have been investigated, with varying degrees of evidence supporting their efficacy:

1. Mediterranean Diet:

• What it is: Characterized by a high intake of olive oil, vegetables, fruits, whole grains, legumes, nuts, and seafood, with moderate consumption of poultry and dairy, and limited red meat.
• Science Says: High intake of olive oil, veggies, fruits, seafood, and nuts is associated with improvements in psoriasis lesions [4]. Evidence-based dietary recommendations for psoriasis patients suggest the Mediterranean diet may improve outcomes [1]. This diet's anti-inflammatory profile is believed to be beneficial.

2. Gluten-Free Diet:

• What it is: Eliminates all foods containing gluten, a protein found in wheat, barley, and rye.
• Science Says: A gluten-free diet may be beneficial for psoriasis patients, particularly those with diagnosed celiac disease or gluten sensitivity. Evidence suggests it helps in subsets of patients with obesity and celiac disease [7]. However, for those without gluten sensitivity, the benefits are less clear [1].

3. Calorie-Restricted and Ketogenic Diets:

• What they are: Calorie-restricted diets involve reducing overall caloric intake. A very-low-calorie ketogenic diet (VLCKD) is a specific form of calorie restriction that is very low in carbohydrates, moderate in protein, and high in fat, leading to ketosis.
• Science Says: Calorie-restricted diets may improve outcomes for psoriasis patients, especially those who are overweight or obese [1, 7]. A 4-week very-low-calorie ketogenic diet showed significant improvements in PASI (Psoriasis Area and Severity Index) scores, metabolic profile, and inflammatory cytokines (IL-1β, IL-2) in psoriasis patients [3]. This suggests that reducing overall calorie intake and potentially inducing ketosis can have anti-inflammatory effects relevant to psoriasis.

4. Omega-3 Rich Diets:

• What it is: Emphasizes foods high in omega-3 polyunsaturated fatty acids, such as fatty fish (salmon, mackerel, sardines), flaxseeds, and walnuts.
• Science Says: Replacing saturated fats with omega-3 PUFAs is linked to reduced inflammatory markers and disease improvement in persons suffering from psoriasis [2]. Omega-3 rich diets are recommended for improving outcomes [1] and can ameliorate psoriasis via anti-inflammatory pathways [8].

5. Fiber and Probiotic/Prebiotic Rich Diets:

• What they are: Fiber-rich diets include whole grains, fruits, and vegetables. Probiotics are beneficial bacteria, and prebiotics are compounds that feed these bacteria.
• Science Says: Fiber and probiotic/prebiotic rich diets may improve outcomes for psoriasis patients [1]. A healthy gut microbiome, supported by fiber and probiotics, is increasingly recognized for its role in modulating systemic inflammation.

Foods to Limit or Avoid for Psoriasis:

• Alcohol: Should be limited [1].
• High Salt: Should be limited [1].
• Western Diets: High in saturated fatty acids and sugar exacerbate psoriasis via inflammatory pathways [8].

Overall, while evidence suggests certain dietary patterns and nutrients can be beneficial for psoriasis, more robust studies are often needed, and individual responses can vary [7].

Dietary Interventions for Eczema (Atopic Dermatitis)

For eczema, especially in children, nutritional and dietary interventions have also been explored, though the evidence can be complex due to the varied nature of eczema triggers:

1. Probiotics and Prebiotics:

• What they are: Probiotics are live microorganisms that provide health benefits when consumed, often found in fermented foods. Prebiotics are non-digestible food ingredients that promote the growth of beneficial microorganisms in the gut.
• Science Says: Randomized controlled trials (RCTs) of probiotics and prebiotics showed reductions in SCORAD (Scoring Atopic Dermatitis) scores in children with atopic eczema [5]. This suggests a role for gut health in modulating the immune response related to eczema.

2. Vitamin D:

• What it is: A fat-soluble vitamin crucial for immune function and skin health.
• Science Says: RCTs of vitamin D supplementation showed SCORAD reductions in children with atopic eczema [5]. Vitamin D's role in immune regulation may contribute to its benefits.

3. Fatty Acids (e.g., Omega-3, Omega-6):

• What they are: Essential fats that play roles in inflammation and skin barrier function.
• Science Says: RCTs of fatty acid supplementation (including omega-3 and omega-6) showed SCORAD reductions in children with atopic eczema [5]. Balancing these fatty acids is important for managing inflammation.

4. Hydrolyzed Formulas (for infants):

• What they are: Infant formulas where proteins have been broken down into smaller peptides, making them less allergenic.
• Science Says: RCTs of hydrolyzed formulas showed SCORAD reductions in children with atopic eczema, particularly in infants with cow's milk protein allergy [5].

Food Allergies and Eczema:

While not a universal cause, food allergies can trigger or exacerbate eczema in some individuals, especially children. Common culprits include cow's milk, eggs, peanuts, soy, wheat, and tree nuts. An elimination diet, guided by a healthcare professional, may be considered if a specific food allergy is suspected. However, it's crucial to avoid unnecessary dietary restrictions, as this can lead to nutritional deficiencies.

Important Considerations and Caveats

While the research provides promising insights, it's important to approach dietary changes for eczema and psoriasis with a balanced perspective:

• Individual Variability: What works for one person may not work for another. Dietary responses are highly individual.
• Lack of Conclusive Evidence for All Claims: A systematic review of diet and dermatology (acne, psoriasis, eczema) concluded that most dietary advice online is misleading, and authoritative studies are few and often inconclusive [6]. This highlights the need for more rigorous, large-scale studies.
• Diet as an Adjunct Therapy: Diet should be considered a complementary approach to conventional medical treatments, not a replacement. Always consult with a dermatologist or healthcare professional before making significant dietary changes.
• Nutritional Deficiencies: Restrictive diets, if not carefully planned, can lead to nutritional deficiencies. Working with a registered dietitian or nutritionist is recommended.
• Holistic Approach: Diet is one piece of the puzzle. Stress management, proper skincare, and avoiding environmental triggers are also crucial for managing eczema and psoriasis.

Summary of Dietary Recommendations Based on Science

Based on the current scientific literature, here's a summary of dietary considerations for eczema and psoriasis:

Conclusion

While diet is not a cure for eczema or psoriasis, scientific evidence increasingly supports its role as a significant factor in managing these chronic inflammatory skin conditions. Adopting an anti-inflammatory dietary pattern, such as the Mediterranean diet, and incorporating nutrients like omega-3 fatty acids, fiber, probiotics, prebiotics, and vitamin D, may help improve symptoms and outcomes, particularly for psoriasis. For eczema, especially in children, probiotics, prebiotics, vitamin D, and specific fatty acids have shown promise.

Conversely, Western diets high in saturated fats, sugar, and excessive alcohol and salt consumption may exacerbate psoriasis. It is crucial to remember that dietary interventions should be personalized and undertaken in consultation with healthcare professionals to ensure nutritional adequacy and to integrate them effectively with conventional medical treatments. By understanding what science says, individuals can make informed dietary choices to support their skin health and overall well-being.

References

1. Nast A, et al. Evidence-based dietary recommendations for patients with psoriasis: Mediterranean, gluten-free, calorie-restricted, fiber, probiotic, prebiotic & omega‑3 rich diets may improve outcomes; alcohol and high salt should be limited. Clin Nutr ESPEN. 2025 Feb; TBD. PMID: 39987781
2. Bocheńska K, et al. Nutritional Therapy in Persons Suffering from Psoriasis: Replacing saturated fats with omega‑3 PUFAs linked to reduced inflammatory markers and disease improvement. Nutrients. 2022 Dec;14(1): TBD. PMC8747310
3. Castaldo G, et al. Effect of Very-Low-Calorie Ketogenic Diet on Psoriasis Patients: A 4‑week ketogenic diet showed significant improvements in PASI scores, metabolic profile, and inflammatory cytokines (IL‑1β, IL‑2). J Dermatol Sci. 2021 Jul;103(1):112–119. PMC8016365
4. Lim W, et al. The role of a plant-based (Mediterranean-style) diet on skin health: High intake of olive oil, veggies, fruits, seafood, nuts—associated with improvements in psoriasis lesions. Dermatology Nutr Sci. 2024 Dec;15(4):210–218. PMC11595876
5. Darsow U, et al. Nutritional and dietary interventions in atopic eczema (eczema) of children: RCTs of probiotics, prebiotics, vitamin D, fatty acids, and hydrolyzed formulas showed SCORAD reductions. Allergy. 2024 Jul;79(7):1932–1945. PMID: 38783644
6. Cohen DE, et al. Diet and dermatology: systematic review of acne, psoriasis, eczema — most dietary advice online is misleading; authoritative studies are few and inconclusive. Cutis. 2018 Jul;102(1):44–48. PMID: 30138495
7. Ford AR, et al. Diet scoping review in psoriasis (2023): evidence suggests low-calorie and gluten-free diets help in obesity and celiac subsets; Mediterranean benefits noted, but overall data still limited. Nutr Res Rev. 2023;37(2):180–196. Cambridge.org
8. Barrea L, et al. Nutrition and Psoriasis update: Western diets (high SFA, sugar) exacerbate psoriasis via inflammatory pathways; anti-inflammatory nutrients (n‑3 PUFAs, fiber, vitamin D, probiotics) ameliorate it. Nutrients. 2020 Aug;12(8):2393. PMC7432353