Fish Oil and Omega-3
Fish oil supplements provide the long-chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The theory, as Schäfer (Allergo J Int) explains it, is that omega-6 fatty acids such as arachidonic acid feed more inflammatory messengers than omega-3s. Taking omega-3 should therefore shift the body towards less inflammatory signalling in Atopic Dermatitis. This is the opposite approach to Evening Primrose Oil and Borage Oil, which add the omega-6 fatty acid Gamma-Linolenic Acid. The sources reviewed record no specific traditional use of fish oil for eczema. It is a common “inside-out” supplement that parents try alongside, or instead of, creams.
Fish Oil and Omega-3 [part-of] Herbal and Home Remedies for Eczema Fish Oil and Omega-3 [treats] Atopic Dermatitis Fish Oil and Omega-3 [relates] Gamma-Linolenic Acid Fish Oil and Omega-3 [relates] Evening Primrose Oil
Strength of evidence: weak. The 2012 Cochrane review of dietary supplements for established eczema (Bath-Hextall et al.; 11 RCTs, 596 participants) included two small fish oil trials. They “suggest a possible modest benefit, but many outcomes were explored”, and a “convincingly positive result from a much larger study with a publicly-registered protocol is needed”. Overall the review found “no convincing evidence” for any supplement. Schäfer’s review describes a 20-patient inpatient trial in which fish oil infusions beat soybean oil infusions, and some smaller positive RCTs, but notes that “the largest well-documented study did not show any difference between fish oil and placebo”. A small DHA-only RCT was also included in Cochrane without changing the conclusion. The 2014 American Academy of Dermatology guideline finds “inconsistent to no evidence” for fish oils (NCCIH), and the AAP says fish oil and similar supplements showed “no convincing evidence” of improving eczema.
Cochrane [contradicts] Fish Oil and Omega-3 American Academy of Dermatology [contradicts] Fish Oil and Omega-3
Newer paediatric trial. In a triple-blind RCT from Children’s Hospital Zagreb (Niseteo et al., Nutrients, 2024), 52 children with eczema took either a liquid supplement or a placebo for 4 months over autumn to spring. The supplement (Mega Kid) combined fish-oil omega-3, GLA from blackcurrant seed oil and vitamin D. In the active group, SCORAD fell from a median of 42 to 25, and topical steroid use fell from 30 to 10 mg a month, with better itch, sleep and family quality of life. The authors concluded the combination “could be considered a safe and effective intervention”. The trial was small and tested a three-ingredient product, so it cannot show which ingredient helped. It also has not been replicated.
Conflict: [Niseteo et al., Nutrients, 2024] says an omega-3 + GLA + vitamin D supplement significantly reduced SCORAD and steroid use in 52 children over 4 months. [Bath-Hextall et al., Cochrane, 2012; Schäfer (largest well-documented fish oil trial)] say there is no convincing evidence of benefit from fish oil, and that the largest trial showed no difference from placebo. Unresolved — add to open_questions.
Fish Oil and Omega-3 [relates] Vitamin D Fish Oil and Omega-3 [relates] Topical Corticosteroids
Prevention vs treatment. Fish oil is also studied in pregnancy and infancy to prevent eczema, which is a separate question from treating a toddler who already has it. The British Association of Dermatologists patient leaflet says there is “no clear proof” that taking fish oil during pregnancy lowers a child’s eczema risk.
British Association of Dermatologists [contradicts] Fish Oil and Omega-3
Toddler safety and what parents report. The AAP notes these supplements “appear to be safe”, and the Cochrane trials did not raise safety signals. Practical issues for 1–4-year-olds are taste, burping and stomach upset. Children with a confirmed fish Food Allergy should avoid fish-derived products. Some children’s combination products also contain vitamin D, so parents should add up the total dose (see Vitamin D). Parent reports are sparse and mostly from adults (evidence: anecdotal). In one r/eczema thread, a poster said fish oil seemed to make their skin drier, and another agreed the same happened with cod liver oil, while noting it might be coincidence. No toddler-specific forum reports were found. Fish oil should not replace Emollient Therapy or prescribed treatment.
Fish Oil and Omega-3 [relates] Food Allergy Fish Oil and Omega-3 [relates] Emollient Therapy
Connections
- Herbal and Home Remedies for Eczema — oral supplement; weak evidence, source: Cochrane 2012; AAP
- Cochrane — Bath-Hextall 2012, two small fish oil trials, not convincing, source: Cochrane 2012
- Evening Primrose Oil — omega-6 counterpart supplement, source: Schäfer
- Vitamin D — co-ingredient in paediatric combination product, source: Niseteo 2024
- American Academy of Dermatology — inconsistent-to-no evidence, source: NCCIH