Peter Lio, MD, FAAD: Navigating Dietary Triggers in Urticaria and Atopic Dermatitis

Oftentimes, diet and dermatologic conditions are closely intertwined.

At the 2024 American Academy of Dermatology Annual Meeting in San Diego, California, Peter Lio, MD, FAAD, presented a session on the intricacies of the topic, titled, "Dietary Triggers and Modifications of Common Dermatologic Conditions: An Evidence Based Approach."

Lio, a clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine and the Founding Director of the Chicago Integrative Eczema Center, spoke with Dermatology Times to discuss highlights and pearl from his session.

Transcript

Peter Lio, MD, FAAD: Hi, I'm Peter Lio. I'm a clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine and the Founding Director of the Chicago Integrative Eczema Center here in Chicago, Illinois.

I'm very excited about the American Academy of Dermatology meeting. As always, it is an extravaganza. There are so many great sessions with great people; so many awesome meetings, connections. So I am in store for a whirlwind, as usual, of meeting lots of folks and doing lots of great things. It's going to be fun, although exhausting.

One of the really exciting sessions was about the role of diet in different diseases. I got to talk a little bit about the role of diet in urticaria and atopic dermatitis. This comes up a lot, and it turns out that it is actually really confusing. There are many layers of this like an onion. It's frustrating, I think, because you want to have a sound bite to just say it either is or it isn't, [or] t's all or nothing, but it's almost never that easy. That's, I think, why when we really dig into anything that has controversy or complexity around it, you realize it's because it's not as simple as a one-liner or a 10-second sound bite.

I think the biggest issue is that there is no doubt that diet affects our health in our skin. 100%. We know that that's true. That's not on the table for discussion. But the question is: What is the level of effect that it's having for an individual? And sometimes, it's very little.

I have people who do extreme dietary changes, trying to figure this out; they'll cut out all sorts of foods, they'll keep food logs, they'll go on for months and months, sometimes will even be told, "You need to do it longer." I've had a patient who did it for over a year, and they were told again, they need to do it longer. They gave up they said, "Okay, I don't think I can change if I have to cut out all these foods for years." In a way, it's not living, right?

Oftentimes, I'll say if the answer to your problem were to live in a bubble, you might say that's not the answer we're looking for. I mean, it could be; somebody might want to live in a bubble, but other people want to go live in the world, so can we find other things? On the other hand, what we also find is that certain types of diets can directly drive things being an allergic type mechanism: for sure, certain foods, but other types of diets can just be pro-inflammatory.

This is really tricky, too, because we realized that a lot of times people make a big dietary change, and the classic thing people say is that, "I got a little better and it helped a little bit." Sometimes, I think it's because many of us, present company included, are not always eating the best; we're eating some more processed foods, some sugary foods. For some people, dairy is kind of pro-inflammatory, so by isolating these things, removing them from the diet, many times people say: "I feel better, and things are a little bit better." But figuring out what the root of the problem is not always that easy, so that's really what I explored in the session.

We talked about some of the testing and some of the pitfalls of the testing, because many patients come in with a pile of tests and say, "Well, look. Tell us what the answer is." And the truth is no, clearly, because if it did, you wouldn't be here, right? If it was as simple as saying, "Oh, it was gluten and dairy. I cut them and I was cured." Are there people like that? Yes, they're awesome. They're lucky; they're not coming to these sessions. They're not coming to their doctor, because they're figured out they're fixed, so the patients we're getting are obviously a little bit different. We really dug into that, which was really fun.

[Transcript has been edited for clarity.]