Special dietary interventions are structured diet plans used for chronic health conditions including but not limited to diabetes, obesity, and cardiovascular disease, among other conditions. Special dietary interventions can include exclusion diets such as gluten-free diets and modification diets including Mediterranean diets. Other commonly included special dietary interventions are low-carbohydrate high-protein, paleolithic, vegetarian, ketogenic, and pescatarian diets.¹ These diets have been studied in the management or preventive treatment of certain dermatologic diseases including psoriasis, but literature on its assessment of eczema patients is very limited.²

Eczema, which is a common inflammatory and chronic skin condition, has been associated with decreased quality of life.^3,4 The ability to provide an alternative treatment option that may serve as an adjunct to current modalities of care or serve as the primary mode of treatment for patients is an innovative area of research. Dietary interventions may represent a valuable adjunctive strategy for skin disease management, with potential benefits for cardiovascular and metabolic health. While diet has been studied as described in regard to specific foods such as fruits, vegetables, and omega fatty acids, the use of special dietary intervention in the management of eczema is very limited.^5–8 Our present study is partially modeled after a similar dietary survey study on psoriasis patients.² In this study, 1,206 psoriasis patients who were members of the National Psoriasis Foundation were administered a 61-question survey about dietary habits, modifications, and attitudes/perceptions. Interestingly, this study found favorable skin responses after trying special diets such as Pagano (72.2%), vegan (70%), and Paleolithic (68.9%) diets. This same study also found that skin improvement was greatest after reducing alcohol (53.8%), gluten (53.4%), nightshades (52.1%), and after adding fish oil/omega-3 (44.6%), vegetables (42.5%), and oral vitamin D (41%). While this study assessed special dietary intervention use, it does not account for differences in patients opting to try versus not try special dietary intervention in the management of their skin disease. This data does not exist among psoriasis, eczema, hidradenitis suppurativa, among other dermatology patients. This present prospective survey conducted at a single academic medical center site adds to the body of literature by assessing differences in demographics, dietary factors, structural barriers, financial barriers, and attitudes between eczema patients adhering and not adhering to a special dietary intervention. Understanding these differences helps to tailor education and research efforts towards addressing social determinants of health when considering use of dietary intervention for skin disease management. As eczema is an inflammatory skin condition that is often multifactorial, chronic, but non-fatal, dietary intervention use may improve clinically relevant outcomes.

After approval from the institutional review board of the University of Pittsburgh Medical Center (STUDY 24050044), a prospective survey study was conducted at Falk Medical Building. Between July 2024 and August 2025, 80 eczema patients at a dermatology clinic at the University of Pittsburgh Medical Center were surveyed one time via the REDCap platform at the end of their visit, after obtaining informed consent via a consent form filled out prior to the survey. Data was stored de-identified and confidentially within REDCap. The survey, consisting of 44 questions, spanned over 5 broad categories including demographics/disease characteristics, general dietary information, special dietary intervention, barriers to dietary intervention, and perceptions regarding dietary intervention. Inclusion criteria included adult patients, 18 years or older, of all genders and races with a clinical diagnosis of eczema. Exclusion criteria included those who are unable to provide informed consent. Due to incomplete data and survey submission among several patients, 9 patients were excluded, with a total of 71 patients being included in the final analysis.

Patients were recruited at the dermatology clinic at the University of Pittsburgh Medical Center. At the end of the patient visit with one physician, for those with a clinical diagnosis of eczema, a member of the clinical care team informed the patient about the prospective survey study, reasons for collecting the data, and lack of financial incentive for completing the survey. Patients seeking to fill out the survey were then prompted to fill out the survey via REDCap along with an initial consent script on a tablet.

Upon completion of data collection, quantitative and categorical variable data was extracted from de-identified and confidential sheets within REDCap. Data collected within REDCap included (1) patient demographics and disease characteristics, (2) general dietary information including dietary additions and eliminations, (3) special dietary interventions, (4) financial, structural, and social barriers to dietary intervention, (5) and attitudes/perceptions regarding dietary intervention. Specific variables assessed include age, gender, race, severity of eczema, current residential environment, education level, income level, number of dependents, dietary additions, dietary eliminations, proximity to grocery store, number of dependents, and beliefs that dietary intervention may help with skin disease. The 71 survey responses were divided based on whether patients used or did not use a special dietary intervention such as gluten-free, paleolithic, vegetarian, Mediterranean, ketogenic, pescatarian, among other diets. Using the IBM SPSS v25 software program, chi-square tests and t-tests for independent samples were performed to compare categorical and quantitative data respectively between patients using (n = 24) and not using (n = 47) special dietary interventions. P-values were generated using these tests with a significance level of 0.05.

Of the 71 patients included in the study, 33.8% of patients (n = 24) used a special dietary intervention. Of the special diets tried, 10 tried a gluten-free diet, 9 tried a low-carbohydrate high-protein diet, 0 tried Paleolithic diet, 5 tried vegetarian diet, 8 tried Mediterranean diet, 4 tried ketogenic diet, and 4 tried pescatarian diet (Table I).

354714 Table I.

Of those initiating versus not initiating a special dietary intervention, patients who initiated were on average younger (36.06 years vs. 47.49 years; p = 0.013) and were more likely to have had a severe eczema flare more than one year ago (16.7% vs. 2.1%; p = 0.042). There were no significant differences in gender, race, severity of eczema, family history of eczema, estimated eczema body surface area, urban vs. rural residential environment, education level, income level, and number of dependents between those initiating versus not initiating a special dietary intervention (Table II).

354715 Table II.

In regard to dietary factors, those initiating versus not initiating a special dietary intervention were more likely to report soy (6.25% vs. 0%; p = 0.035), sugar (22.9% vs. 13.0%; p = 0.018), and gluten (14.6% vs. 0%; p < 0.001) as dietary triggers (Table III). Patients initiating versus not initiating special dietary interventions were more likely to try dietary additions such as vegetables (23.0% vs. 10.3%; p < 0.001), fruits (23.0% vs. 13.2%; p < 0.001), water (26.2% vs. 16.2%; p < 0.001), and fish (18.0% vs. 8.8%; p = 0.002) and less likely to have not tried any dietary additions (6.6% vs. 50%; p < 0.001). Furthermore, those initiating versus not initiating were also more likely to try dietary eliminations such as dairy (25.9% vs. 15.8%; p = 0.025) and gluten (29.6% vs. 0%; p < 0.001) and report that a dietary elimination improved symptoms (45.8% vs. 21.3%; p = 0.032). There were no significant differences in current dietary patterns (vegan, vegetarian, omnivore, etc), improvement in symptoms with supplements, and dietary intakes of sugar, whole grain, dairy, fruit, legumes, and vegetables between the two cohorts. In addition, there were no significant differences in any financial, structural, and social barriers between those initiating versus not initiating special dietary interventions (Table IV). These variables include proximity to grocery store, self-reported health literacy, difficulties associated with diet adherence (motivation, time, familial pressures, dining out, financial reasons, transportation, other access issues, knowledge), belief to have the knowledge to be healthy, family support at home, frequency of packing lunch at work, barriers to eating lunch (time, appetite, work, proximity, etc), average free time per week, average time per week spent on self-care, and average time per week spent on social media.

354716 Table III.

354717 Table IV.

In regard to attitudes and perceptions towards dietary intervention use as seen in Table V, those initiating versus not initiating special dietary interventions were more likely to believe that special dietary interventions may help with skin disease (70.8% vs. 42.6%; p = 0.024), that dietary intervention has a major effect with diet (20.8% vs. 4.3%; p = 0.040), and were less likely to believe that there is no effect of diet on skin disease management (4.2% vs. 36.2%; p = 0.003). Patients initiating versus not initiating a special dietary intervention were also more likely to prefer using lifestyle interventions to manage health concerns (83.3% vs. 46.8%; p = 0.003), believe that it is very important that physicians discuss the role of diet in managing eczema (79.2% vs. 55.3%; p = 0.048), and believe that if you adhere to a certain diet, that it will help associated symptoms not related to the skin (50% vs. 19.1%; p = 0.007). Patients initiating versus not initiating a special dietary intervention less frequently preferred to take medications as opposed to managing with lifestyle interventions (12.5% vs. 38.3%; p = 0.024). There were no significant differences between the two cohorts in regard to the belief that adding or eliminating a specific component of the diet may improve skin disease, in relation to the attitudes about diet within the social circle/community, in regard to motivation to take care of health, and in regard to whether patients have been asked about dietary interventions by a healthcare provider in the past.

354718 Table V.

Our findings suggest that dietary interventions are commonly explored by patients with eczema, particularly younger individuals, underscoring the importance of clinician awareness and patient counseling regarding dietary practices. Use of special dietary intervention was present in one third of the patients filling out the survey suggesting that is quite commonplace for patients to attempt dietary intervention use. This suggests that it may serve as a valuable tool in dermatologic care for eczema patients. Our prospective survey study provided comprehensive descriptive statistics including gender, age, race, eczema severity, dietary factors, attitudes/perceptions as well as financial, structural, and social barriers stratified by whether patients did or did not initiate special dietary intervention in order to establish associations.

It has been well reported that trends related to healthy dieting are more common among the younger generation, particularly in the light of the digital age. One 2024 systematic review found a promising role of digital intervention in promoting healthy food behaviors.⁹ In keeping with this, we report that patients using special dietary interventions were more commonly younger. Furthermore, our study found that patients using special dietary interventions more commonly had a severe eczema flare over one year ago. This corroborates a 2025 cross sectional study of 124 atopic dermatitis patients, where disease severity was assessed using the Eczema Area and Severity Index (EASI) and adherence to Mediterranean diet was assessed using the Prevention with Mediterranean Diet (PREDIMED) questionnaire. The study found that higher adherence to Mediterranean diet was associated with a lower disease severity (p < 0.0001).¹⁰

Our study also reported an association with certain behavioral patterns among the special dietary intervention cohort. Specifically, patients who used special dietary interventions were more likely to have dietary triggers such as soy, sugar, and gluten and were additionally more likely to try dietary additions such as vegetables, fruits, water, and fish. Interestingly, there were no dietary additions or triggers identified that were more common among the patient cohort that did not initiate a special dietary intervention for the management of eczema. Additionally, patients in the special dietary intervention cohort were also more likely to try dietary eliminations such as dairy and gluten and report an improvement in symptoms because of dietary eliminations. Like report of dietary triggers and dietary eliminations, there were no dietary eliminations that were more commonly tried among the cohort not initiating a special dietary intervention. These results suggest that patients’ understanding of dietary triggers, additions, and eliminations is associated with special dietary intervention use. This association may reflect more awareness of dietary patterns among special dietary intervention users, although this cannot be determined from the present study.

Notably, income level or number of dependents did not seem to play a role in whether special diets were initiated. Moreover, there were no differences in financial, structural, and social barriers between the two cohorts. This includes proximity to grocery stores, self-reported health literacy, difficulties associated with diet adherence such as motivation, time, familial pressures, transportation and more as seen in Table IV. Attitudes related to special dietary intervention were important as seen in Table V. Patients initiating special dietary interventions were also more likely to prefer lifestyle interventions over medications. Overall, this suggests that long-term behavioral patterns and motivations seem to play a larger role than lack of financial ability, time, or social support.

Limitations of the study include that the study is single site with a small sample size, making results less generalizable. There may also have been selection bias due to the self-selected nature of dietary intervention use. Patients choosing to initiate special dietary interventions may have differed systematically including interest in health engagement. Therefore, the observed associations should be interpreted as associative, rather than causative. Of note, our study excluded nine patients due to incomplete survey data. While data is limited, it is likely excluded patients were systemically different from included patients, leading to potential non-response bias. Lack of control data reduces ability to compare important patient variables to healthy controls. Overall, while sample size is limited from this single site study, among motivated patients, it may be worthwhile to discuss how dietary intervention plays a role in their skin disease management.

Overall, our study concluded that patients initiating special dietary interventions were younger, more likely to try dietary additions, eliminations, and triggers, and had more positive attitudes about dietary intervention. Patients using special dietary interventions more frequently reported improvement in eczema symptoms and differences in flare history; however, prospective studies evaluating clinical outcomes are needed. Our study suggests that perceptions and attitudes towards the efficacy of special dietary interventions play a bigger role than structural, social, and financial barriers. As the cohort of patients initiating special dietary intervention was younger, focusing on education early on to raise awareness about special dietary intervention use and its benefits in the younger population is warranted.

None.