Evidence-Based Evaluation of Non-Pharmacological Interventions in the Management of Atopic Dermatitis: A Comprehensive Review

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease marked by pruritus, xerosis, and recurrent eczematous lesions. Conventional treatments, including topical corticosteroids and calcineurin inhibitors, remain central to management but often present challenges such as incomplete disease control, adverse effects with long-term use, and low adherence due to corticophobia. As a result, interest has grown in non-pharmacological interventions that may serve as adjuncts or alternatives in the treatment of AD. This review evaluates current evidence for five such therapies: virgin coconut oil (VCO), sunflower oleodistillate (SOD), shea butter, probiotics, and vitamin D supplementation. Clinical trials and mechanistic studies support the use of VCO for its antibacterial, anti-inflammatory, and skin barrier-enhancing properties, demonstrating reductions in SCORAD scores and transepidermal water loss. SOD, via PPAR-α activation, improves lipid synthesis and skin hydration, while shea butter exerts anti-inflammatory effects comparable to low-potency corticosteroids. Vitamin D supplementation has shown systemic immunomodulatory effects and improvement in clinical scores in deficient populations. Conversely, while probiotics show theoretical benefit via gut-skin axis modulation, pooled analyses reveal inconsistent results and highlight the need for strain-specific evaluation. Despite their promise, these interventions face limitations such as small sample sizes, short durations, and heterogeneity in formulations. Still, their favorable safety profiles and patient acceptability position them as valuable tools in integrative AD management. Rigorous, large-scale studies are needed to confirm long-term safety, efficacy, and optimal clinical use.