Historically, many have focused on the idea that food allergies drive atopic dermatitis. It seems to make good sense that things we eat can greatly influence the skin. Accordingly, many patients undergo very strict diets, some successful to be sure, but many without much improvement. Sadly, those who do not improve with dietary changes rarely get much attention on the internet and often feel isolated and left behind.
Avoiding triggers such as allergens and irritants is critical as well, but without a good skin barrier, it can become an impossible task. It is akin, perhaps, to a house that is on fire. Even though we’d like to understand what caused the fire in the first place, once the fire is burning, it is critical to put it out and protect the rest of the home. It might not look pretty, but you need to keep animals, bugs, and intruders out of the home, while protecting all that is precious to you on the inside. Thus, we often rely on anti-inflammatory agents to put out that initial fire, but we must also fireproof the structure for the future. Thus, we try to lean heavily on protecting and rebuilding the skin barrier with moisturizers and natural oils.
Food allergies and eczema remain significant challenges: they truly are multifactorial and do not have one easy answer, but the are deeply related, one way or another.