Coconut has a different risk profile depending on whether it is being eaten or applied to the skin. As a food allergen, true coconut allergy is rare — despite being classified as a tree nut by the US FDA, coconut is botanically a drupe (stone fruit), and people with peanut or tree nut allergies are not more likely to be allergic to coconut.

However, coconut-derived surfactants used in shampoos, body washes, and facial cleansers — particularly cocamidopropyl betaine (CAPB) — are a well-documented cause of contact dermatitis, significant enough that CAPB was named Allergen of the Year in 2004. This means the coconut products applied to the body rather than the coconut consumed as food are the more relevant concern for most people with eczema. Virgin coconut oil applied to eczema skin has shown anti-inflammatory benefits in clinical studies and is generally well tolerated.