Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

 scores are positively correlated with multiple types of addiction behavior, new data suggest, potentially suggesting maladaptive coping may result from diminished quality of life.

These data, suggesting such behaviors as smoking cigarettes, alcoholism, and Internet addiction may be linked with certain skin diseases, were authored by investigators such as Stefanie Ziehfreund, MSc, of the Technical University of Munich (TUM) School of Medicine and Health. Ziehfreund et al wrote

“This study investigates the prevalence and patterns of addictive behaviours among patients with chronic skin diseases in tertiary dermatology centres across 20 European countries,” the investigators wrote.

 “By analyzing addictions alongside demographic, regional, and disease-specific factors, it aims to deepen understanding of addiction comorbidities in dermatology and support the integration of addiction screening and management into patient-centred care.”

A cross-sectional, multicentre design was implemented by the investigators and was carried out within dermatology clinics located in 20 European countries. The team recruited adults with a dermatologist-confirmed diagnosis of psoriasis alopecia areata, atopic dermatitis, hidradenitis suppurativa (HS), urticaria, or vitiligo consecutively between July 2023 - July 2024. Depending on local organizational and ethical considerations, those taking part were enrolled either during routine outpatient appointments or spoken with at the time of follow-up visits.

Individuals were not identified in advance through electronic medical records or registries. Eligibility was determined at the time of enrolment based on a verified clinical diagnosis by a dermatologist, a strategy intended to ensure diagnostic reliability and reduce selection bias. All participants completed the same structured questionnaire, administered either online or in paper format, in their native language.

Eligible participants were required to be at least 18 years of age and have one of the six specified chronic inflammatory or autoimmune skin conditions. Individuals were excluded if they were unable to complete the questionnaire because of language barriers or if they had more than one of the dermatologic diseases under study.

The questionnaire captured information on sociodemographic characteristics, disease-related factors, and a range of addictive behaviours, including tobacco use, alcohol consumption, illicit drug use, gambling, problematic internet use, and eating disorders.

All variables were summarised using descriptive statistics, including medians with interquartile ranges as well as absolute and relative frequencies. The prevalence of addictive behaviours was estimated using established cut-off thresholds and reported across both European regions and individual skin diseases. In addition to descriptive analyses, multivariable logistic regression models were applied to explore factors associated with addictive behaviours.

The final study population consisted of 3,585 individuals, with a median age of 43 years, and women accounted for 51.1% of participants. Overall, a substantial proportion reported at least one addictive behaviour, with smoking observed in 25.7% of participants, pathological gambling in 4.5%, hazardous alcohol use in 8.8%, alcohol dependence in 2.5%, drug use disorders in 5.3%, eating disorders in 1.8%, and internet addiction in 29.7%.

Tobacco use was particularly frequent among those with psoriasis and hidradenitis suppurativa, affecting 48.6% of patients in these groups, while gambling behaviours were most prevalent among individuals with alopecia areata and vitiligo, at 8.2%. Addictive behaviours were significantly associated with male sex, younger age, being single, higher scores on the Dermatology Life Quality Index, and differences across European regions.

Taken together, these findings highlight the importance of systematically assessing addictive behaviours in patients with chronic dermatologic diseases and suggest that integrated, multidisciplinary management approaches may be beneficial. Nevertheless, interpretation of the results should be tempered by several limitations, including the lack of a control group, non–population-based recruitment, and a potential overrepresentation of patients with more severe disease.

Additional research in which investigators use population-based sampling strategies and appropriate comparison cohorts was described as necessary to validate the aforementioned observations as well as to guide the development of targeted therapeutic interventions.

“Patients with visible skin conditions like [atopic dermatitis] and vitiligo often face social stigma, exacerbating psychological distress and potentially promoting addictive behaviours,” they concluded.

 “Future research should focus on these psychosocial dimensions, particularly the roles of stigma and social support in addiction risk.”

Ziehfreund S, Saak M, Schaal A, Mazilu R, Mahé E, Hajj C, et al. Addiction and chronic skin diseases: A Pan-European study on prevalence, associations and patient impact. J Eur Acad Dermatol Venereol. 2025; 00: 1–14. 

Butt M, Rigby A, Chinchilli VM, et al. Associations of Internalized Skin Bias With Age, Adverse Psychopathology, and Health-Related Quality of Life Among Patients With Hidradenitis Suppurativa: A Cross-sectional Analysis. JAMA Dermatol. 2022 Apr 1;158(4):432-438. doi: 10.1001/jamadermatol.2022.0248. PMID: 35293961; PMCID: PMC8928088.

Articles

New research indicates a positive correlation between Dermatology Life Quality Index scores and various addiction behaviors, suggesting maladaptive coping mechanisms may arise from reduced quality of life in patients with chronic skin diseases. Conducted across 20 European countries, the study involved 3,585 adults with conditions like psoriasis and vitiligo. Findings revealed significant associations between addictive behaviors and factors such as male sex, younger age, and higher DLQI scores. The study underscores the need for integrated management approaches and further research to validate these observations and develop targeted interventions.

Investigators highlighted patterns of addictive behavior among those with chronic skin diseases in European tertiary dermatology centers.

Addictive Behaviors Linked with Chronic Skin Diseases Such as HS, Psoriasis

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