Food for Thought: What to Tell Patients Asking, “Is It Something I Ate?”

At the Masterclasses in Dermatology APP Institute, Rosemary Son, MPAS, PA-C, RDN, delivered a thoughtful and evidence-based session on the role of nutrition in chronic skin disease. Titled “Nutrition in Skin Disease,” the talk tackled everything from food myths to food deserts, empowering APPs with data to help patients make realistic choices.

“A ‘Western diet’ pattern is associated with chronic illnesses,” Son explained, citing its typical makeup of “pre-packaged food, refined grains, red meat, high sugar drinks… and high-fat dairy products.”

She contrasted this with the Mediterranean diet, which is “plant-based, minimally processed, with high-quality fats and lean protein from fish and poultry,” and associated with improved outcomes in psoriasis, hidradenitis suppurativa (HS), eczema, and even acne.

In psoriasis, diet alone is not enough. Son highlighted that “weight loss and a low-calorie diet have the best evidence” and “a gluten-free diet should only be used in those who test positive for serologic markers.”

Elimination diets for eczema? Not helpful. “More harm than good,” Son said, adding that there is “no benefit for elimination diets” and no long-term evidence to support them. However, “prevention of food allergy–associated eczema” is supported by exclusive breastfeeding and early introduction of foods at 4 to 6 months of age in high-risk children.

Evidence is limited in HS, but “weight loss, smoking cessation, and a Mediterranean-style diet may be beneficial adjuncts.” No significant benefit has been shown for exercise alone or any specific supplements.

For acne, there is fair-to-good evidence for probiotics and omega-3s, as well as emerging support for green tea extract and vitamin D. But as Son emphasized, “most studies are underpowered and heterogeneous,” so definitive recommendations are still evolving.

Probiotics show the most promise across multiple conditions, especially eczema and acne. Fish oil and curcumin (turmeric) show modest benefit in psoriasis, particularly when combined with standard therapy. But for HS, “evidence for any supplement is currently insufficient to support clinical recommendations.”

In a compelling conclusion, Son shifted gears to the politics of food access. “Food deserts are a modern, policy-driven phenomenon,” she noted, linking their rise to deregulation of the Robinson-Patman Act in the 1980s. The takeaway? Some food equity “could start with actually enforcing the laws from the 1930s.”

For APPs facing daily patient questions like “Should I cut out dairy?” or “Do I need to be gluten-free?” this session offered much-needed clarity and reminded everyone that nutrition can be a powerful, if imperfect, adjunct to dermatologic care.

Reference

Son R. Nutrition in skin disease. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.