Published on in Vol 5 , No 3 (2022) :Jul-Sep

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From the Cochrane Library: Dietary Supplements for Established Atopic Eczema

From the Cochrane Library: Dietary Supplements for Established Atopic Eczema

From the Cochrane Library: Dietary Supplements for Established Atopic Eczema

Research Letter

1Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States

2Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Denver, CO, United States

3Dermatology Service, Department of Veterans Affairs Medical Center, Denver, CO, United States

Corresponding Author:

Madeline J Adelman, MD

Department of Dermatology

University of Colorado Anschutz Medical Campus

13001 E 17th Pl

Aurora, CO, 80045

United States

Phone: 1 303 724 5000


Atopic eczema (AE) is a chronic inflammatory skin condition, affecting 5% to 20% of people worldwide [1]. While there are many available treatment options that help improve AE, patients for whom these treatments did not work, or who fear side effects, may look to nutritional supplements as “natural” solutions. Nutritional supplements represent a vast, growing industry, globally valued at over US $150 billion in 2021. Nutritional supplements are manufactured pills, powders, or liquids, meant to provide nutrients in addition to conventional food. Supplements are classified by the Food and Drug Administration as foods rather than drugs; therefore, they are not required to prove efficacy or safety prior to entering the market. Given the growing popularity of supplements, physicians must be knowledgeable about supplement ingredients when counseling patients. A 2012 Cochrane review, “Dietary supplements for established atopic eczema” [1], offers a comprehensive review of evidence regarding popular dietary supplements used in AE. Here, we discuss the findings of this Cochrane review and of relevant subsequent publications. Of note, although food allergies often coexist in patients with AE, supplements were studied for their effects on AE and not as treatments for food allergies.

The review [1] extracted data and assessed the quality of 11 randomized controlled trials, with a total of 596 participants, investigating therapeutic interventions of fish oil, zinc, selenium, vitamin D, vitamin E, vitamin B6, sea buckthorn oil, hempseed oil, and sunflower oil, versus placebo. Participants had physician-diagnosed AE, with 8 studies using the Hanifin and/or Rajka criteria; the other 3 studies did not state a diagnostic method. The authors evaluated evidence of symptom improvement in the short term, reduced number of flares in the long term, and a reduced need for treatment in the long term.

Overall, there was scarce evidence supporting the use of supplements for treating AE. However, given that many of the included studies were either underpowered or of low quality, evidence was insufficient to claim all supplements are completely ineffective. Nevertheless, the authors advised against further research without a stronger rationale—to the exclusion of fish oil, for which pooled data from 2 small studies suggest it may improve subjective daily quality of life in people with AE [1]. Further research on fish oil is warranted, with preliminary evidence suggesting it may down-regulate inflammation. A 2018 animal study demonstrated that n-3 polyunsaturated fatty acids depressed inflammasome activation, with a resultant reduction in inflammatory cytokine release and overall inflammatory response, as well as marked attenuation of atopic skin lesions [2]. Additionally, a 2018 cross-sectional survey found that 35% of patients who added fish oil to their diet reported an improvement in their AE symptoms [3].

In a 2018 review of probiotics, vitamins, oils, and traditional Ayurvedic agents, there was insufficient evidence to recommend any oral supplements as treatment, with the exclusion of probiotics [4]. Meta-analyses of probiotics have produced conflicting results; variable patient populations, probiotic strains, dosing, and duration of therapy among studies limit the pooling of data for a meta-analysis. Additional large-scale clinical trials are necessary to fully understand the benefits of probiotics for AEs, elucidate optimal strains, and determine which patient populations would achieve the greatest benefit.

Overall, this review highlights the limited evidence that exists for the use of nutritional supplements in AE. At present, the most effective “natural” modality for AE is topical emollients [5]. Future randomized controlled trials of promising dietary supplements should include patient-reported outcomes to fully assess the impact of nutritional modifications.

Conflicts of Interest

RPD is a joint coordinating editor for Cochrane Skin, editor-in-chief of JMIR Dermatology, a dermatology section editor for UpToDate, a social media editor for the Journal of the American Academy of Dermatology, and a podcast editor for the Journal of Investigative Dermatology (JID). He is a coordinating editor representative on Cochrane Council. TES is an editorial board member-at-large for JMIR Dermatology.

RPD receives editorial stipends (JMIR Dermatology, JID), royalties (UpToDate), and expense reimbursement from Cochrane Skin. TES receives fellowship funding from Pfizer and the National Institutes of Health. MJA receives fellowship funding from the Pfizer Global Medical Grant (65894351 and 58858477) Dermatology Fellowship 2022 (principal investigator: RPD)

Editorial Notice

The views expressed in this paper are those of the author(s) and in no way represent the Cochrane Library or Wiley.

This article is based on a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2012, Issue 2, DOI: 10.1002/14651858.CD005205 (see for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.

  1. Bath-Hextall FJ, Jenkinson C, Humphreys R, Williams HC. Dietary supplements for established atopic eczema. Cochrane Database Syst Rev 2012 Feb 15(2):CD005205. [CrossRef] [Medline]
  2. Jang HY, Koo JH, Lee SM, Park BH. Atopic dermatitis-like skin lesions are suppressed in fat-1 transgenic mice through the inhibition of inflammasomes. Exp Mol Med 2018 Jun 13;50(6):1-9 [FREE Full text] [CrossRef] [Medline]
  3. Nosrati A, Afifi L, Danesh MJ, Lee K, Yan D, Beroukhim K, et al. Dietary modifications in atopic dermatitis: patient-reported outcomes. J Dermatolog Treat 2017 Sep;28(6):523-538 [FREE Full text] [CrossRef] [Medline]
  4. Fenner J, Silverberg NB. Oral supplements in atopic dermatitis. Clin Dermatol 2018 Sep;36(5):653-658. [CrossRef] [Medline]
  5. Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol 2014 Jul;71(1):116-132 [FREE Full text] [CrossRef] [Medline]

AE: atopic eczema

Edited by R Alhusayen; submitted 26.08.21; peer-reviewed by F Wallnöfer, J Lipoff, S Gulliver, F Kaliyadan; comments to author 21.03.22; revised version received 08.07.22; accepted 17.07.22; published 29.07.22


©Madeline J Adelman, Torunn E Sivesind, Robert P Dellavalle. Originally published in JMIR Dermatology (, 29.07.2022.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Dermatology Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.