Chronic Skin Disease Linked to Wide Range of Addictive Behaviors in Pan-European Study

Addictive behaviors, including smoking, alcohol misuse, drug use, gambling, eating disorders, and internet addiction, are prevalent among adults with chronic inflammatory and immune-mediated skin diseases, according to a large, multicenter study spanning 20 countries. In the cross-sectional analysis of 3,585 adults treated in European tertiary care centers, more than 1 in 4 reported addictive smoking, nearly 1 in 3 met criteria for internet addiction, and clinically relevant rates of hazardous alcohol use, drug-related problems, and pathological gambling were observed across diagnostic groups.

The study was published online December 14 in the Journal of the European Academy of Dermatology and Venereology.

The European investigators reported that smoking emerged as the most common addictive behavior, affecting 25.7% of participants overall and nearly half (48.6%) of those with hidradenitis suppurativa (HS). Internet addiction, defined as mild/moderate or severe, was reported by 29.7% of the cohort, with the highest prevalence among participants with alopecia areata (AA) and atopic dermatitis (AD). Across conditions, higher impairment in dermatology-specific quality of life, measured by the Dermatology Life Quality Index (DLQI), consistently correlated with increased odds of several addictive behaviors.

Systemic Diseases with Psychological Burden

Chronic skin diseases such as psoriasis (PSO), AD, HS, alopecia areata, urticaria, and vitiligo are increasingly recognized as systemic disorders associated with substantial psychological burden.2 Prior studies have linked these conditions to depression, anxiety, social stigma, and reduced quality of life, factors that may promote maladaptive coping strategies.3,4 The authors point to the significant progress in understanding the pathophysiology of skin diseases that has supported development of numerous effective therapies. Less well understood and poorly addressed, however, is the unseen psychological toll, "particularly in relation to mental health," they wrote.

Although smaller studies and condition-specific analyses have suggested elevated addiction risk in dermatology populations, there is a dearth of comprehensive, multinational data across multiple skin diseases. The investigators sought to address this gap by estimating the prevalence and patterns of addictive behaviors across a broad spectrum of chronic skin diseases and by identifying demographic, clinical, and regional factors associated with addiction risk.

Study Background

Eligible adult participants had 1 of 6 chronic skin diseases and were recruited from dermatology departments in 20 European countries between July 2023 and July 2024. Participants completed a standardized questionnaire assessing sociodemographic characteristics, disease severity, quality of life, and addictive behaviors. Validated screening tools were used for each domain, including the AUDIT for alcohol use, DUDIT for drug use, Internet Addiction Test, and Lie-Bet Questionnaire for gambling. Smoking was defined as daily tobacco use.

Multivariate logistic regression analyses examined associations between addictive behaviors and demographic variables, disease type, DLQI scores, and European region.

Additional Findings

The cohort had a median age of 43.0 years and approximately half (51.1%) were women. The majority had psoriasis (44.7%), followed by AD (24.9%), HS (10.7%), urticaria (10.4%), vitiligo (4.9%) and AA (4.4%). Median disease duration was 14years, with a mean subjective severity score of 6.0 and DLQI of 6.0, according to the study results.

The authors found that several addictive behaviors showed condition- and region-specific patterns. For example, pathological gambling was uncommon overall (4.5%) but occurred more frequently in participants with AA (8.2%) and vitiligo (7.5%). Alcohol misuse, including hazardous drinking and dependence, did not differ significantly by skin disease.

Looking specifically at the 30% of participants identified as having internet addiction, the highest prevalence was observed in adult with AA and AD, authors wrote. Younger age, male sex, single relationship status, and higher DLQI scores were found independently associated with increased risk for the behavior, while older age and higher self-rated happiness appeared to be protective.

Regional variation included the highest prevalence of gambling in Eastern Europe, hazardous alcohol use in Northern Europe, and internet addiction in Western and Southern Europe. Analyses showed that disease duration and subjective severity showed weaker associations than dermatology-specific quality-of-life impairment.

Among the study's limitations the authors acknowledged the absence of a control group and that participants were drawn exclusively from tertiary , limiting generalizability and causal inference. Addiction behaviors were self-reported, raising the possibility of underreporting. Response rates could not be determined, and the cross-sectional design precludes assessment of temporal relationships.

Clinical Implications, Future Research

"Despite these limitations, this large, multicentre study offers valuable insights into the complex relationship between skin diseases and addiction across Europe," the researchers wrote. They added that the broad assessment of multiple addictive behaviours underscores "the importance of integrating addiction screening and management into dermatological care, especially for patients with high DLQI scores or those in regions with elevated rates of smoking and gambling."

They emphasized further that the smoking prevalence reported exceeds that in the general European population, an observation that carries particular clinical relevance for HS and psoriasis, conditions where smoking may exacerbate inflammation and reduce treatment efficacy.

The consistent association between higher DLQI scores and addiction risk suggests that impaired quality of life may contribute to maladaptive coping rather than disease severity alone.

"Future studies using population-based approaches and appropriate comparison groups are essential to confirm these patterns and inform targeted interventions," the researchers concluded.

References

1. Addiction and chronic skin diseases: A Pan-European study on
   prevalence, associations and patient impact. JEADV. Published online December 14, 2025. doi:10.1111/jdv.70245

2. Daugaard C, Iversen L, Hjuler KF. Comorbidity in adult psoriasis:
   considerations for the clinician. Psoriasis. 2022;12:139–50.
   doi:10.2147/PTT.S328572

3. Thyssen JP, Halling AS, Schmid-Grendelmeier P, Guttman-Yassky E,
   Silverberg JI. Comorbidities of atopic dermatitis—what does the evi-
   dence say? J Allergy Clin Immunol. 2023;151(5):1155–62. doi:10.1016/j.jaci.2022.12.002

4. Ezzedine K, Soliman AM, Li C, Camp HS, Pandya AG. Comorbidity
   burden among patients with vitiligo in the United States: a large-
   scale retrospective claims database analysis. Dermatol Ther.
   2023;13(10):2265–77. doi:10.1007/s13555-023-01001-2