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

Dermatology Life Quality Index (DLQI) scores are positively correlated with multiple types of addiction behavior, new data suggest, potentially suggesting maladaptive coping may result from diminished quality of life.1

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 noted their aim of estimating the prevalence and patterns of addictive behaviors among Europeans.

“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.1 “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.”

Design and Findings

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.

Identification of subjects did not occur in advance through electronic medical records or registries. Ziehfreund and colleagues determined patients' eligibility at the time of recruitment based on a verified clinical diagnosis by a dermatologist. This strategy was designed to ensure reliability of diagnostics and to diminish any chance of selection bias. All of those involved completed the same structured questionnaire, provided for them either online or in paper format, in each subject's native language.

Those deemed eligible to take part were required by the investigative team to be at least 18 years of age and have 1 of the 6 specified chronic inflammatory or autoimmune skin conditions mentioned. They were not included provided they were unable to fill out the study questionnaire as a result of language barriers. They would also be excluded if they had more than 1 of the dermatologic conditions under study.

Ziehfreund et al's questionnaire inquired about a variety of information on sociodemographic characteristics, a range of addictive behaviors, including tobacco use, alcohol consumption, illicit drug use, gambling, problematic internet use, and eating disorders, as well as disease-related factors. All of the study variables were summarized via descriptive statistics, including medians with interquartile ranges as well as absolute and relative frequencies.

The prevalence of addictive behaviours was estimated by the team through the use of established cut-off thresholds and reported across both European regions and individual skin conditions. Along with descriptive analyses, multivariable logistic regression models were implemented by Ziehfreund and coauthors to assess any factors linked with addictive behaviors. Their analysis's final study population consisted of 3585 individuals, with a median age of 43 years. Women accounted for 51.1% of participants.

Overall, a significant proportion reported were found by the investigators to have at least 1 addictive behavior. Specifically, Ziehfreund and colleagues noted smoking was observed in 25.7% of subjects, pathological gambling among 4.5%, hazardous alcohol use among 8.8%, dependence on alcohol among 2.5%, drug use disorders among 5.3%, eating disorders among 1.8%, and internet addiction among 29.7%.

Tobacco use, the investigators found, had been uniquely common among individuals with psoriasis and HS, impacting 48.6% of individuals in these specific subgroups. Additionally, gambling behaviors were noted by Ziehfreund et al as most prevalent among those living with vitiligo and alopecia areata, at 8.2%. Addictive behaviors were shown to have a significant link with younger age of patients, male sex, being single, higher scores on the DLQI, and differences across European regions.

Taken together, the investigators' data suggest the value of systematically assessing patients' addictive behaviors. Nevertheless, they also noted interpretation of the results should be tempered by several of the study's limitations, including non–population-based recruitment, the lack of a control group, and a potential overrepresentation of subjects 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.1,2 “Future research should focus on these psychosocial dimensions, particularly the roles of stigma and social support in addiction risk.”

References

1. 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. https://doi.org/10.1111/jdv.70245.

2. 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.