Eczema and diet: which foods to avoid and favor?

Causes, symptoms and risk factors

Atopic eczema or atopic dermatitis is a chronic inflammatory skin disease that develops in outbreaks. Atopic dermatitis arises from alteration of the skin barrier (water, cold, chemical substances, metals, etc.). This alteration causes dryness of the skin and increases the risk of allergens penetrating into the epidermis. In response to these allergens (environmental antigens such as pollen, mites, dust, animal hair, etc.), the immune system produces antibodies type IgE and specific T lymphocytes. The latter release inflammatory substances at the origin of symptoms of the disease :

• Skin dryness

• Skin lesions : redness, oozing blisters (rough appearance), crusts

• Itching (pruritus)

Atopic eczema mainly affects infants and children but can persist into adolescence and adulthood, particularly for women. It most often results from the accumulation of various risk factors; factors genetics and environmental (excess hygiene, poorly ventilated housing, smoking eating habits, pollution, etc.). In addition, as with other inflammatory pathologies, researchers believe that psychoaffective conflicts and stress encourage the expression of eczema. Complications of eczema are seen because it is usually a chronic problem. Chronic lesions due to scratching cause thickening of the skin called lichenification, and prurigo (crusted papules), or even ulcerations. Wounds therefore become susceptible to bacterial and viral infections.

Role of diet: reducing inflammation

In the case of atopic eczema, we can study three areas of food consideration:

• tHE foods not recommended : a balanced diet is often sufficient, limit foods acidifiers, omega-6 and saturated fatty acids are a plus for preserving the skin barrier and limiting inflammation.

• tHE recommended foods : these are anti-inflammatory, anti-oxidant foods and those which preserve our intestinal microbiota.

• tHE forbidden foods : in this case we are dealing with atopic eczema resulting from a food allergy, it is a very specific case which most often concerns young people.

These eating habits should be adopted daily to promote a beneficial balance in the long term, since it is a chronic disease. It can also act in flare-ups, in which case the advice is all the more necessary, particularly for the foods not recommended which most often cause these flare-ups.

Note that we differentiate between atopic eczema and contact eczema. Contact eczema is caused by an external allergic reaction: cosmetics, fabrics, household products, etc. In this case, treatment consists of treating the source of the allergy. This guide only covers atopic eczema.

Scientific articles show that the total lipid profile of our diet modulates the severity of eczema. Among these lipids, we find saturated, monounsaturated (omega-9) and polyunsaturated (omega-3 and 6) fatty acids which differ due to their biochemical structure and therefore their properties.

Omega-6 (LA = linoleic acid, precursor of AA = arachidonic acid) are pro-inflammatory, they seem to worsen the symptoms of eczema, an inflammatory disease. Omega-6, following successive enzymatic oxidation, gives rise to prostaglandins and leukotrienes, intermediate metabolites involved in the inflammatory process. They contribute to inflammatory manifestations, vasodilation, redness, pain, etc. 

Today, our diet is unbalanced: we consume too much omega-6 compared to omega-3. In general and particularly in the case of eczema, it is essential to favor omega-3 and limit omega-6 in the diet. 

We recommend you of mix the contributions of omega-3 to those of omega-6:

• Seeds and nuts: sunflower seeds, pine nuts, sesame seeds should be limited and mixed with seeds rich in omega-3, walnuts, pumpkin seeds, flax seeds, hemp seeds, chia seeds.

• Vegetable oils: safflower, grape seed and sunflower oils should be limited and mixed with a chia oil, linseed oil, camelina oil, a walnut oil, a rapeseed oil, which are richer in omega-3 or better balanced in the omega-3/omega-6 ratio.

Fast sugars, with a high glycemic index (GI) are to be limited. They are quickly assimilated by the body, they produce blood sugar peaks responsible for the secretion of insulin, the pancreatic hormone reducing blood sugar. It would seem that theinsulin can have consequences on other hormones in the body such as steroid hormones, androgens. Among them, testosterone but also indirectly estrogen produced from the latter. These hormones stimulate the activity of sebaceous glands, causing changes in skin cells, particularly inflammations such as eczema or even blemishes. In addition, fast sugars seem to promote the development of pathogenic bacteria such as staphylococcus. The latter can cause complications such as a skin infection for example.

We recommend you :

• Limit fast sugars with a medium to high GI. They are present in many everyday foods, notably prepared, ultra-processed, even savory dishes... but also industrial cakes, sweets, sweet drinks, white bread, etc.

• To favor slow sugars with a low to medium GI wholemeal breads, wholemeal starches, cereals, etc.

For years, several studies have shown the impact of endocrine disruptors on our health and in our specific case, they seem to be harmful in cases of atopic eczema.

Substances like bisphenol A, phthalates, triclosan and paraben are at the heart of everyone's attention, especially for people with eczema. Their use through the skin would promote the development of allergies.

In our case, these are the pesticides, additives, preservatives, found in food which, associated with these substances, would cause a hormonal imbalance and one skin imbalance.

We recommend you :

• To favor seasonal, local products, whose origin you know and/or come from a organic Agriculture, reasoned.

• To limit the industrial foods containing too many additives (preservatives, colorings, etc.) which are sources of endocrine disruptors. To give you a concrete idea, if the label of your product indicates more than 4 ingredients including additives, it is better to avoid it.

• To limit the plastic packaging.

Acid-forming foods should be limited. Modern diets tend to be too rich in acid-forming foods. However, it seems that the acidity of foods is found in body fluids, particularly sweat. Acidic sweat can alter the barrier and the skin microbiota and therefore promote skin imbalance and eczema. 

We recommend you :

• To encourage fruits, vegetables, spices, nuts and seeds which are alkalizing.

• To limit the processed products, meats, milk, coffee, alcohol which are acidifying.

Cow's milk and dairy products should be consumed in moderation due to their richness in:

• Milk proteins (casein, lactoglobulin): they probably have a link with intestinal permeability. The latter would allow passage of the casein type proteins which could be at the origin of reactions inflammatory diseases favoring atopic eczema. This is not to be confused with milk protein allergy. Eczema and milk protein allergy are often unrelated, however the allergy can make eczema worse.

• Saturated fatty acids (SFA) and omega-6: they can be harmful in cases of eczema since they are pro-inflammatory.  

Please note, we are not talking about lactose here because “lactose intolerance” should not be confused with an allergy to milk proteins. Lactose intolerance tends to manifest itself through digestive symptoms.

We recommend you, apart from a diagnosis of allergy requiring the removal of milk proteins:

• To limit your consumption to two dairy products per day, for example natural yogurt and cheese to vary the pleasures and nutritional intake. Milk and dairy products remain important for our bone health in particular.

• Do not change your baby's milk without medical advice. Plant-based milks, for example, can cause dramatic deficiencies in your infant.

Among the fatty acids mentioned above, fortunately the omega-3 are anti-inflammatories, they seem to improve the symptoms of eczema. Today, our diet is too rich in saturated fatty acids and is unbalanced: we consume too much omega-6 compared to omega-3. Since eczema is an inflammatory disease, focusing on anti-inflammatory nutrients seems obvious. Omega-3 (ALA, alpha-linolenic acid) are the precursors of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), themselves precursors of anti-inflammatory molecules: resolvins, protectins, maresins. These inhibit inflammatory mediators, replace damaged cells and restore normal functioning of the body.

Where can you find the majority of omega-3?

• Fish oils : on average, we find 24% omega-3 and 6% omega-6 in these oils. These contents give a perfectly balanced omega-6/omega-3 ratio. In addition, within the polyunsaturated fatty acids of fish oils, we find EPA and DHA directly available. Be careful not to confuse fish oil with fish liver oil. Their lipid profile is very similar, fish liver oil still contains many more micronutrients (vitamin A, D, E and iodine). In view of the complications caused by excess vitamin A, without medical advice and as a precautionary measure, we recommend that you opt for fish oils.

• Vegetable oils: l'linseed oil, Hemp oil, Camelina oil, Chia oil contain almost 60% ALA while being low in omega-6. Other oils such as Rapeseed and Olive are rich in omega-9 which disrupts the metabolism of omega-6 and can therefore also be beneficial. To note that, in addition to this richness in omega 9, rapeseed oil also has an optimal omega-3/omega-6 ratio.

• Oleaginous seeds and fruits: nuts, pumpkin seeds, flax, hemp, chia seeds are rich in omega-3 in the same way as their oils.

• Oily fish: we think here of sardines, mackerel, herring, anchovies, salmon.

• Products Blue-White-Heart: it’s a label that you can find on many mass-market products. This often concerns eggs, milk, or meats. This certifies that plants rich in omega-3, such as rapeseed, alfalfa and linseed, have been reintroduced into the diet of certain livestock. Namely, chickens whose diet has been enriched with sources of omega-3 produce eggs which contain on average fifteen times more omega-3 than a standard egg.

We recommend you :

• Generally speaking, vary all sources of omega-3.

• A course of one tablespoon of fish oil per day for 3 months.

• One teaspoon per day of vegetable oils rich in omega-3. They can also be incorporated into the daily diet as a seasoning.

• Incorporate a handful of seeds and nuts per day, or around 15 grams, into your diet.

• Eat at least one fatty fish per week.

• To encourage the purchase of Bleu-Blanc-Cœur products when possible.

Scientific studies show the benefit of probiotics on the inflammation of eczema. This seems even more effective in young subjects. However, the mechanisms of action are not yet well understood. It would seem that these benefits come from the relationships between the intestinal microbiota and the immune system.

Probiotics are live microorganisms which, when ingested in sufficient quantities, exert positive effects on health, beyond traditional nutritional effects (WHO). To put it simply, they are found in all fermented foods.

In addition, it seems that the intestinal microbiota in pregnant women influences the likelihood that the child will develop eczema as they grow up. It therefore seems essential to have a balanced microbiota.

We recommend you :

• Regular consumption of different fermented foods : dairy products (fermented milk, cheeses, dairy products), lacto-fermented vegetables, fermented tea (kombucha), fermented fruit juice (fruit kefir), miso, tempeh, kimchi, yeast, etc.

• To consume these fermented foods in combination with prebiotics to potentiate their effects.

Prebiotics are dietary ingredients that beneficially influence the host by stimulating the growth and/or activity of one or a limited number of bacterial groups in the colon and thereby improve the health of the host. In other words, these are specific dietary fibers that will nourish a particular strain of the intestinal microbiota (bifidobacteria). This support will positively influence the effects of the microbiota on our health, including modulating the immune system.

Their place in the prevention and fight against atopic eczema is closely linked to probiotics: prebiotics reinforce the action of probiotics. To illustrate, we can say that prebiotics are the food necessary for probiotics to function properly. Indirectly, it will therefore be important to include prebiotics in your diet.

Prebiotics are specific fructan-type nutrients: inulin, olifofructose, fructo-oligosaccharides (FOS), xylo-oligosaccharides (XOS) and galacto-oligosaccharides (GOS). They are mainly found in plants of the Asteraceae family (chicory root, artichoke, salsify, dandelion), of the Liliaceae family (asparagus, onion, shallot, garlic), in Jerusalem artichokes, breast milk, vegetables. dry and certain fractions of wheat.

We recommend you :

• Regular consumption of different prebiotics cited above.

• To consume these foods in combination with probiotics to potentiate their effects.

The inflammation encountered during eczema can be accentuated by various phenomena, stress, pollution, tobacco, lack of sleep For example. These risk factors are vectors of free radicals causing oxidative stress. To counter the latter, antioxidant foods can be beneficial. In addition, they allow better regeneration and repair of damaged skin.

The best known antioxidants are vitamin E, vitamin C, polyphenols, carotenoids, selenium, zinc in particular.

We recommend you :

• Eat at least 5 fruits and vegetables per day.

• Incorporate spices and aromatic herbs into your dishes: cloves, cinnamon, turmeric, etc.

• Favor drinks and infusions rich in antioxidants: tea, hibiscus, rosemary, ginger, etc. 

• A small square of 70% or more dark chocolate, as a snack.

In the case of atopic eczema, certain foods are directly involved in the appearance of the pathology, we then speak offood allergy. This is particularly the case for young children, it affects 1 in 5 children. This diminishes or even disappears during adolescence. In this case, an allergological assessment must be carried out by a health professional in order to determine the food or foods in question. Most of the time, atopic eczema in children is made worse by an allergy:

• with cow's milk
• with chicken eggs
• with peanut
• aux fish
• with wheat
• with soy

In this case, it is obviously recommended to avoid ingesting the incriminated food during the child's first years of life. Follow-up with a healthcare professional is recommended.

How can we explain the increasing frequency of these food allergies in young children? Currently, several hypotheses are described:

• a dietary diversification too early and/or too “diversified” : globalization leads to much more varied exposure over the years.

• of the overly processed foods : industrialization processes lead to complex food preparations sometimes composed of more than 5-6 ingredients. We thus find ourselves confronted without knowing it with hidden ingredients. For example, wheat proteins are used in certain foods, sauces, ice creams, as a stabilizer or in meats, as a substitute.

• a plant selection : fruits, vegetables, cereals undergo selections, modifications, crossings. This modifies their compositions.

• an impact of the air pollution on crops and agriculture.

Note that food allergy manifests itself in the presence of a so-called allergenic food. It takes place in 2 stages:

• step 1 : sensitization to the food in question in the intestine, production of antibodies (IgE) against this food and fixation of the latter on immune cells, mast cells.

• 2nd step : during a second ingestion of the allergen, the antibodies are present in the body and react. Mast cells are stimulated and release inflammatory mediators (histamine, leukotrienes, prostaglandins, cytokines). Clinically, this manifests itself as eczema (redness, itching) but it can also be swelling, breathing difficulties, nausea, digestive disorders, etc.

• Think about the benefits of breastfeeding: It appears that children breastfed exclusively with breast milk during the first months are less likely to develop atopic dermatitis than those breastfed for a shorter period. This does not promise to prevent atopy. No guilt if breastfeeding is unwanted or complicated.

• Review your cosmetic routine and household products: certain household products and cosmetics promote the appearance of eczema. We go on a case by case basis: it's up to everyone to find the right products that do not induce or aggravate eczema and that protect the skin.

• Improve stress management: stress management can use different techniques such as meditation, sophrology or even yoga. Practicing regular physical activity can greatly reduce stress.

• Ventilate enclosed spaces: get into the habit of ventilating every day to renew the air in the house: this limits the presence of certain allergens such as dust mites and prevents the air from being too dry.

• Call on essential oils to prevent eczema : certain essential oils are anti-inflammatory and skin regenerative, they help calm itching, soothe redness and repair the skin. Rosat Geranium, Roman Chamomile or Lavender Aspic can be used combined with Nigella, Borage and/or Calophyll Inophyle vegetable oil.

• Carry out a Cedar bud macerate treatment: The latter is draining and revitalizing the skin. As a 3-week treatment, it can be combined with Walnut and Blackcurrant to regulate inflammation and drain the body.