Dietary modifications and supplements are often sought by patients with atopic dermatitis (AD), although their efficacy may be limited. While food allergies can influence disease severity, elimination diets carry risks. As discussed during a session at the recent 2025 American Academy of Dermatology (AAD) Annual Meeting, a balanced approach to incorporating diet into AD management should include healthy eating and prioritizing medical treatment to establish disease control before implementing dietary adjustments.

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Following this presentation, featured expert Peter A. Lio, MD, was interviewed by Conference Reporter Medical Director Lauren Weinand, MD. Clinical perspectives from Dr Lio on these findings are presented here.

As I mentioned during our session at the 2025 AAD Annual Meeting, “Dietary Triggers and Modifications of Common Dermatologic Conditions: An Evidence Based Approach,” I often discuss dietary modification and supplementation because patients with AD very much want to incorporate them into their treatment. If we totally ignore diet, they often become frustrated. Most of my patients come in believing that diet is the root cause of their AD; this is a very widespread notion that I think is misinformed, to some degree. Like many half-truths, there is some part of this notion that is reasonable, but, for the vast majority of patients with AD, we find that even extreme dietary changes do not fix their disease.

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That being said, it is not as easy as simply saying, “Diet doesn’t work.” It ends up being more nuanced. We know that there is a very powerful connection between true food allergies resulting in urticaria or anaphylaxis and both the presence of AD and the severity of the disease. The more severe your AD is, the more likely you are to have life-threatening food allergies. This is an important connection.

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There are many types of food reactions that may still play a role in AD. However, it is not all or nothing, even though many patients want it to be the whole story. They might say, “I just want to quit eating gluten and dairy, and I want to be better.” Unfortunately, it is rarely that simple. For the majority of people with AD, if they eat a healthy diet but find that some foods seem to make their AD worse, their condition might improve slightly if they stop eating those foods, but it is very unlikely to totally resolve. The hard part is trying to figure this out during a visit.

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This is why food is not the most important topic for me to discuss during an initial patient visit. It is far better for me to give the patient a treatment that changes their objective and subjective measures and makes their skin better. This is because of the fact that when many of my patients with AD meet me, they are in such bad shape that it is impossible for me to tell whether a specific food is driving their condition. I cannot tell whether they are allergic to something because I cannot perform patch testing due to their affected skin. So, our first order of business is to get them a bit better to obtain something of a baseline. Then, if they are still having a lot of flare-ups, we can more intelligently ask whether diet is contributing.

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There was a time when dietary change was more endorsed than it is today. The 2012 Joint Task Force on Practice Parameters guidelines for AD were actually more friendly toward it. However, in our 2023 guideline update, we specifically recommended against implementing elimination diets for AD. People may wonder what the harm is in trying an elimination diet. Well, the potential for harm lies in the chance of becoming truly allergic to a food after you stop eating it, because we now understand that tolerance to foods and food proteins happens through the gut. So, if you turn off that exposure, it turns out that some percentage of patients may become dangerously allergic to the foods they have avoided.

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Thus, I would say that diet can play a role, but it should probably be relegated down a rung or two until we get things under better control, get a better sense of baseline, and get some more stability. In the meantime, one of my favorite things to recommend to patients with AD is overall healthy eating. The diet that I usually suggest is the autoimmune protocol diet, which is not necessarily a strict diet but rather an effort to provide healthy guidelines. Do not eat processed foods or excessive sugar and grains. Just keep it simple. That is a very good place to start and is hard to argue against.

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There are also some supplemental strategies that might help in AD. One of them is drinking oolong tea, and this has actually been studied in AD. In addition, a study from 2017 showed that introducing the supplement L-histidine, which is a filaggrin precursor, into the diet results in an improvement that is on par with that of a mid-potency topical steroid. Finally, we recently wrote a review on oral lipids and fatty acid supplements that found that fish oil supplements and oral ceramides seem to have an effect, although there are fairly limited data. For ceramides and other lipids, the effect is thought to be barrier mediated, resulting in a strengthening of the skin barrier.