Is diet important?

During a recent bout of sickness and diarrhoea, my
daughter’s eczema almost disappeared. She ate hardly
anything during this time. Could this mean that her
eczema is related to the food she eats?
Unfortunately, this is not the likeliest explanation for the
improvement in your daughter’s eczema. Diet has not been shown
to be a major factor in causing eczema, despite many people’s view
to the contrary. You have to remember that eczema fluctuates in
severity all the time, often for reasons that we cannot explain. It
is always tempting to look at ‘what happened the day before’ as
the cause of a flare or an improvement, and doctors are no different
from you in wanting a simple explanation.
Any infections (including tummy upsets) can improve eczema
or cause a flare, presumably owing to the effect that they can have
on the body’s immune system or the fact that having a hightemperature may make the skin more itchy. It is equally likely that
your daughter’s sickness had no effect on her eczema but that it
was simply improving spontaneously at that time.
Could something in my son’s diet be causing his eczema?
Although you don’t say how old your son is, the answer is probably
that his diet is not having an effect. Diet may be important in the
initial triggering of eczema in infants with an inherited susceptibility,
but it seems to have little to do with keeping eczema going or
triggering it in older children. It is true that many parents, and
indeed some doctors, think that diet is very important in eczema,
but evidence from research studies over the past few years does
not support this view. Life would be a lot easier if diet did have a
major impact, but we have to believe the evidence from these well-
conducted studies. We have used special diets in the past, but they
are normally disappointing in terms of improving the eczema and
are difficult to stick to, especially for children of school age.
Our advice to you is that if there is a clear history of your son’s
eczema always worsening after eating a certain food, it is worth a
3-month trial of excluding that food – after taking advice from a
dietitian. If there is no improvement in his eczema after 3 months,
that food should be gradually reintroduced. It cannot be
overemphasised that all attempts at dietary manipulation should
be made under the control of a dietitian to ensure that there is
adequate calorie, protein, calcium and vitamin replacement. We
have seen children with malnutrition and even rickets from
unsupervised severe exclusion diets, and unfortunately they both
still had bad eczema.
Will altering my diet during breast-feeding stop my baby
from developing eczema? What else can I do to avoid
triggering the condition?
Eczema is an inherited condition, but it is also influenced by
environmental factors. We do not understand why it develops at a
certain age in any one individual. There are important trigger
factors, but little is known about them. It has been suggested thatthe early diet of a child, particularly an exposure to dairy products,
might be important in triggering eczema.
There is scant evidence to support the idea that if you changed
to a diet free from milk and eggs during breast-feeding, it might
provide some protection against your baby developing eczema,
especially if both you and the baby’s father have a history of the
condition. This view is still controversial, and we would not
recommend such a diet routinely. It would certainly need to be
done under the guidance of a dietitian.
Is breast-feeding better than bottle-feeding for helping to
prevent my baby getting eczema?
This is a bit controversial now! The old answer was that the
evidence seemed to suggest it was of benefit, although some
research studies failed to show any advantage. Recently, however,
a big study in New Zealand showed that breast-feeding was linked
to a greater chance of a baby getting eczema than bottle-feeding.
More research is needed before a definite answer can be given to
this simple question as it relates to eczema. Breast-feeding does,
however, have many other advantages, so we wouldn’t yet go
against the motto ‘breast is best’.
I want to continue breast-feeding my baby, but the eczema
on my nipples is making this very difficult. Have you any
advice that could help?
Breast-feeding with eczema on the nipple or areolar tissue round
it can be troublesome from time to time because this area can easily
become infected with thrush, making it cracked and sore. Ask your
doctor to examine your baby’s mouth as well as your breasts as
thrush may be present there too. There are topical creams that can
be prescribed to resolve the infection.
During treatment, breast-feeding from the affected side should
be temporarily stopped and expressing carried out instead, either
manually or with the aid of an electric or hand pump. Your baby
will be able to feed sufficiently from one breast only as the extra
demand will increase the milk supply. Any expressed milk may begiven to your baby or frozen for future use. As the skin heals, breast-
feeding can be resumed, but care must be taken that your baby is
well positioned and correctly attached on the breast at each feed
to minimise any trauma or friction to the nipple. Further assistance
with breast-feeding can be obtained from your local breast-feeding
counsellor.
My baby has developed eczema. Could it be something to
do with what I ate during pregnancy?
It sounds as though you are feeling guilty, as if your baby’s eczema
is your fault. There is no good evidence that what you eat during
pregnancy has any effect on the subsequent development of eczema
in a baby. Relax – it is not your ‘fault’.