Posted by Katarina Fajfar
on March 18, 2025
Atopic dermatitis is a skin disease that affects not only children but also adults. As patients want to avoid conventional treatment with corticosteroids, numerous studies have been conducted to determine whether nutritional supplements can alleviate the symptoms of atopic dermatitis.
What is atopic dermatitis?
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intense itching and the appearance of eczematous plaques, or eczema in the home language. Initially, scientists believed that it was a disease that occurs and resolves in childhood. Today, atopic dermatitis is recognized as a lifelong condition that can also begin in adulthood. Atopic dermatitis affects up to 20% of the population in developed countries, making it one of the most common chronic diseases. The prevalence of atopic dermatitis has increased two to threefold since the 1970s.
What is wrong with the skin of patients with atopic dermatitis?
The pathophysiology of atopic dermatitis involves epidermal dysfunction and subsequent inflammation. Dysfunction of the upper layer of the skin contributes to increased transepidermal water loss and altered lipid composition with a reduced proportion of ceramides.
The disease is associated with an increased immune response to external factors
Epidermal dysfunction is also associated with an imbalance of immune cells, such as T-helper cells (Th2, Th22, and Th17). Immune cells react to allergens via immunoglobulin (IgE), which are harmless to individuals who do not have atopic dermatitis.
Certain factors, such as food, polluted air, and contact allergens, are thought to trigger outbreaks or worsen the disease. However, other non-specific factors, such as temperature, humidity, and psychological stress, may also influence the disease.
What do we currently know about the treatment of atopic dermatitis?
Current treatment of atopic dermatitis focuses primarily on alleviating and controlling symptoms and avoiding exacerbations. The mainstay of treatment is the restoration of the epidermal barrier with emollients and anti-inflammatory therapy with topical corticosteroids, calcineurin inhibitors, and phosphodiesterase inhibitors.
Since many patients want to avoid corticosteroid treatment, mainly due to side effects, various nutritional supplements are often recommended to alleviate the symptoms of atopic dermatitis. However, are nutritional supplements actually effective in treating atopic dermatitis?
Probiotics
Probiotics are live microorganisms (e.g. bacteria) that are the same as or similar to microorganisms naturally found in the human body and may be beneficial for health. If the number of T-cells of the immune system in the large intestine is too low and the individual has a poorly developed microbiota, they may be more susceptible to allergies. This predisposes them to the development of atopic dermatitis.
Some studies have shown the effectiveness of probiotics in improving symptoms of atopic dermatitis. A 2010 study in Ukraine showed that administration of a probiotic mixture with added fructooligosaccharide was associated with significant clinical improvements in children with AD. The effectiveness of probiotic therapy in adults with AD has not yet been demonstrated.
Prebiotics
To promote a healthy gut microflora, a new treatment strategy involves the use of prebiotic supplements. Prebiotics are foods or supplements that contain indigestible ingredients that selectively stimulate the growth and/or activity of non-pathogenic bacteria in the colon. Prebiotics are often in the form of oligosaccharides. Mixtures of probiotics and prebiotics have been shown to be most effective in alleviating the symptoms of atopic dermatitis.
Vitamin D
Several studies have evaluated the possible link between vitamin D deficiency and the occurrence of atopic dermatitis. Namely, people who live in areas where they receive less sunlight are also more exposed to vitamin D deficiency.
Some patients with atopic dermatitis have been found to have reduced serum vitamin D levels, and a weakened immune system has reduced the ability to produce antimicrobial peptides. The fewer antimicrobial peptides there are in the skin, the worse the skin's defenses against infections.
Phototherapy using narrow-spectrum UVB radiation has also been tested for the treatment of atopic dermatitis. They found that the therapy significantly increased serum vitamin D levels, while also increasing the expression of antimicrobial peptides in eczema.
Several studies have indicated that serum vitamin D concentrations should be further investigated in selected subgroups of patients and, based on this, a decision should be made as to whether vitamin D supplementation is necessary.
Fish oils
Patients with atopic dermatitis have a defect in the enzyme delta-6 desaturase, which makes them unable to produce gamma-linolenic acid. Gamma-linolenic acid (GLA) is an essential fatty acid of the omega-6 family. It is recommended that patients with atopic dermatitis replace gamma-linolenic acid in the form of dietary supplements with omega-6 acids, paying particular attention to the GLA content.
Another problem in patients with atopic dermatitis is the incorrect ratio of omega-3 and omega-6 fatty acids. Usually, despite the lack of essential gamma-linolenic acid, there is more omega-6 than omega-3 fatty acids. Recent studies have shown that oral intake of long-chain omega-3 fatty acids could be promising for alleviating the symptoms of atopic dermatitis. This method has not yet been sufficiently studied, but so far it has shown positive effects in patients.
Evening primrose oil and borage oil
Evening primrose oil and borage oil are natural supplements that are often used to treat eczema. Both oils are high in gamma-linolenic acid (GLA), with evening primrose oil containing 8-10% GLA, while borage oil contains as much as 23% GLA.
Both oils are particularly effective topically, as the addition of gamma-linolenic acid topically promotes the healing of eczema. This is why evening primrose oil and borage oil are included in the Skinfairytale line against atopic dermatitis. You can find these oils in the products AtopicCream, AtopicBalm and Renew Cream.
Minerals and vitamins
Mineral deficiencies play an important role in the development of atopic dermatitis. Patients are usually deficient in micronutrients such as zinc and selenium. Zinc deficiency is associated with impaired wound healing.
Oxidative stress is another pathophysiological factor that contributes to the development of dermatitis. So far, studies have tested whether suppressing oxidative stress by supplementing with antioxidants such as vitamins A, C and E could be effective. Vitamins C and E in particular protect against the harmful effects of free radicals. Given that the skin barrier function is severely impaired in atopic dermatitis, protection against the harmful effects of radicals is also impaired. For this reason, the consumption of vitamins C and E is recommended to increase the body's antioxidant defenses.
So which dietary supplement is effective in relieving the symptoms of atopic dermatitis?
In principle, before taking any nutritional supplements, it is recommended that you first get tested to see if you are deficient in a particular vitamin, mineral or fatty acid. If you are not deficient in, for example, vitamin D, you cannot expect that supplementation will have any effect. In general, you should not prescribe nutritional supplements yourself, as this can do more harm than good. Excessive amounts of vitamins or minerals can also have side effects. Therefore, if you want to help relieve the symptoms of atopic dermatitis with nutritional supplements, first have blood tests done to show how much or which vitamin/mineral you are deficient in.
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