Introduction

Neurodermatitis, a form of eczema, is a chronic inflammatory skin condition characterised by intense itching and thickened patches of skin.¹ While the exact cause of neurodermatitis remains unclear, it is often linked to stress, anxiety, and environmental factors.⁴ Managing this condition can be challenging, but diet and nutrition are crucial in reducing inflammation and promoting overall skin health. By incorporating certain foods and avoiding others, individuals with neurodermatitis can potentially alleviate their symptoms and improve their quality of life.

Neurodermatitis basics

Symptoms

The clinical symptoms include dry lichenification plague (caused by excessive scratching) and thickened skin lesions accompanying hyperpigmentation. People may feel pain and bleeding when they scratch too much over time.⁴ Skin lesions are frequently found on the neck (sides), ankles, elbow, scalp, vulva, eyelid and face.² At more severe levels, the damaged skin can be infectious.

Long-term effects

Although neurodermatitis is not life-threatening, it can produce an important psychosocial burden. Stress, depression and anxiety are most common. Moreover, people with neurodermatitis tend to have poor social skills, sleep disturbance and sexual dysfunction.³ Hence, this disease can lead to overall poor quality of life.²

Anti-inflammatory diet

The importance of an anti-inflammatory diet

Neurodermatitis is fundamentally an inflammatory condition, so adopting an anti-inflammatory diet can be particularly beneficial.⁹ Anti-inflammatory foods help reduce skin inflammation and itching, thereby enhancing skin health.¹⁰

Vegetables and fruits

According to the American Society for Parenteral and Enteral Nutrition (ASPEN), key components of an anti-inflammatory diet include a high consumption of vegetables, and an emphasis on various colours to increase phytonutrients.¹⁰ Vegetables and fruits are rich in polyphenols, which give them their characteristic colours and provide significant anti-inflammatory properties.¹⁰ Studies have shown that children who consume more vegetables have a lower rate of developing eczema.⁹

Protein

Protein in an anti-inflammatory diet should primarily be plant-based, with some fish sources and small amounts of lean natural meats. Fresh-water fatty fish like salmon, mackerel, halibut, sardines, and herring, which are high in omega-3 fatty acids, are particularly beneficial. Wild-caught fish are preferred over farm-raised fish due to their higher levels of omega-3s

Regular milk consumption is also associated with a reduced risk of eczema, highlighting its potential benefits.⁹ Plant-based proteins, such as soy legumes (edamame, tempeh, tofu), are excellent sources and have been shown to decrease inflammatory markers.¹⁰ Nuts and potatoes, although showing a weaker negative association, still contribute to a reduced incidence of eczema.⁹

Carbohydrate

Whole-grain carbohydrates with a low glycemic index are crucial for an anti-inflammatory diet. Examples include buckwheat, barley, rye, and wild rice, which are also high in fibre and known to reduce inflammatory markers. Whole grains should be consumed in small amounts, focusing on high fibre and reducing refined carbohydrates.¹⁰ Rice intake is linked to a lower incidence of eczema,⁹ while low carbohydrate content diets have shown rapid improvements in some eczema patients.¹¹

Fats

Fish oil is a potent inflammation inhibitor and can be supplemented in an anti-inflammatory diet at doses higher than typically acquired through food alone.¹⁰ Omega-3 fatty acids, which are abundant in fatty fish (salmon, mackerel, sardines, and trout), as well as in nuts and seeds (walnuts, chia seeds, and flaxseeds) and plant oils (flaxseed oil, chia seed oil, and hemp oil), can be incorporated into the diet to provide these anti-inflammatory benefits.¹⁰ While omega-3 fatty acids are renowned for their anti-inflammatory properties, several studies have found no directly significant impact of omega-3 fatty acid supplements on reducing the risk of neurodermatitis, specifically.^{6 7} However, these fatty acids can still improve general skin health and may help alleviate depression, which is sometimes linked to neurodermatitis due to their influence on hormone levels.⁸

Other fats are beneficial too. Regular consumption of butter, defined as intake three or more times per week, is associated with a reduced likelihood of eczema.⁹ Olive oil is recommended as a fat source due to its beneficial monounsaturated fats and antioxidants.¹⁰ Some eggs are also fortified with docosahexaenoic acid (DHA), though there remains some controversy regarding the impact of eggs on chronic disease.¹⁰

Conversely, certain oils should be avoided as they are pro-inflammatory. These include soybean, cottonseed, peanut, and corn oil.¹⁰ Frequent fast food consumption three or more times per week is associated with an increased risk of current wheezing, which can be related to the symptoms of neurodermatitis.⁹

Tea

Replacing coffee or sugary beverages with tea can add anti-inflammatory benefits. Tea, mainly green and white varieties, contains antioxidants and polyphenols that reduce systemic inflammation.¹⁰

Spices and herbs

Ginger and turmeric have the most data supporting their anti-inflammatory effects. Including these, along with garlic and other anti-inflammatory spices, can help reduce inflammation.¹⁰

Probiotics

While probiotics have not shown significant protective effects for children with neurodermatitis, they can benefit individuals with established eczema.⁷ Probiotic-rich foods like yoghurt, kefir, and fermented vegetables support gut health, positively impacting skin health. Prebiotics have also been shown to prevent eczema in formula-fed infants with prolonged use (greater than 6 months).¹²

Eating patterns and habits

Mindful eating, focusing on quality over quantity, is essential for managing neurodermatitis. Eating slowly and thoughtfully in smaller portions can reduce inflammation. This mindful eating can lower morning cortisol levels, a stress marker in the body.¹⁰

Avoiding triggers

Identifying common food triggers

Common food allergens such as cow’s milk, hen's egg, wheat, soy, tree nuts, and peanuts are often responsible for neurodermatitis in infancy. However, studies show that elimination diets do not improve symptoms unless there is a known specific food allergy.⁵ However, studies show that elimination diets are not associated with improved symptoms unless people have historically known a specific food allergy.⁵,⁷

Maintaining a food diary

Keeping a food diary can help identify specific food triggers. By recording what you eat and noting any changes in symptoms, you can pinpoint and eliminate problematic foods from your diet effectively.

Conclusion

In conclusion, diet and nutrition are integral to managing neurodermatitis. An anti-inflammatory diet can help reduce inflammation and promote skin health. Regular consumption of butter, milk, fruits, pulses, nuts, potatoes, and rice has been shown to be beneficial for eczema while avoiding fast food is crucial. Although omega-3 fatty acids and probiotics may not directly reduce the risk of neurodermatitis, they support overall skin health and well-being. For personalized dietary recommendations, individuals with neurodermatitis should consult healthcare professionals to develop a tailored approach to managing their condition through diet and nutrition.

FAQs

Can neurodermatitis be cured with diet alone?

No, neurodermatitis typically requires a comprehensive approach that includes medical treatment, skincare management, and potentially dietary adjustments to manage symptoms effectively. While diet can play a supportive role in symptom management, it is usually not sufficient to cure neurodermatitis on its own.

Should I follow an elimination diet? 

Following an elimination diet may be beneficial for some individuals with neurodermatitis, especially if there is a suspected food allergy or sensitivity contributing to symptoms. It involves removing potential trigger foods for a period and then reintroducing them systematically to identify any that worsen symptoms. 

How quickly can dietary changes impact neurodermatitis symptoms? 

This varies among individuals. Some people may notice improvements within a few weeks of adopting a healthier diet that includes anti-inflammatory foods and avoids potential triggers. However, it's essential to give sufficient time for dietary adjustments to take effect

Is there a role for exercise in managing neurodermatitis?

Yes, exercise can play a beneficial role in managing neurodermatitis. Regular physical activity helps reduce stress levels, improve overall well-being, and enhance circulation, which can indirectly support skin health. However, it's important to choose activities that don't exacerbate itching or irritation of affected skin areas.