Addictive Behaviour Patterns in Adults With Chronic Inflammatory Skin Diseases: Evidence From a Pan-European Clinical Cohort

Evidence from a large multicountry European survey indicates that addictive and compulsive behaviours are frequent among adults with chronic inflammatory skin diseases, and are closely linked to impaired dermatology-related quality of life. These findings support the integration of behavioural health assessment into routine dermatological practice.

Chronic inflammatory skin diseases impose a persistent psychosocial burden that extends well beyond visible skin symptoms. Feelings of stigma, social withdrawal, sleep disturbance, and emotional distress are common, yet the broader behavioural consequences of long-term dermatological disease have received comparatively limited attention. Recent Pan-European data provide new insight into the prevalence and distribution of addictive behaviours in this patient population, highlighting an under-recognised dimension of dermatological care [1].

Study Design and Population Characteristics

The cross-sectional study analysed data from 3,585 adults receiving care at tertiary dermatology centres in 20 European countries [1]. Participants were diagnosed with one of several chronic skin conditions, including psoriasis, atopic dermatitis, hidradenitis suppurativa, alopecia areata, chronic urticaria, or vitiligo.

Data collection relied on a structured, standardised questionnaire capturing sociodemographic variables, disease characteristics, dermatology-specific quality of life, and a broad spectrum of addiction-related behaviours. These included tobacco use, alcohol consumption patterns, substance use disorders, gambling behaviours, disordered eating, and problematic internet use. Quality of life was assessed using the Dermatology Life Quality Index (DLQI), a validated tool widely used in clinical and research settings [2].

Behavioural Addictions and Substance Use: A High-Burden Profile

Across the cohort, addictive behaviours were common. Approximately one in four patients reported current smoking, while hazardous alcohol use and alcohol dependence were identified in a clinically relevant minority. Disorders related to illicit drug use and gambling were also observed, affecting a non-negligible proportion of participants [1].

Of particular note was the high prevalence of problematic internet use, reported by nearly one-third of respondents. This finding suggests that digital behavioural addictions may represent an emerging concern in patients coping with chronic dermatological conditions, especially in younger populations.

Patterns of addictive behaviour differed across disease groups. Smoking was disproportionately frequent among individuals with psoriasis and hidradenitis suppurativa, whereas gambling behaviours were more often reported in patients with alopecia areata and vitiligo. These differences likely reflect variation in disease visibility, symptom burden, social impact, and coping strategies rather than disease pathology alone.

Quality of Life as a Central Determinant

Multivariable analyses demonstrated a consistent association between higher DLQI scores and the presence of addictive behaviours, independent of diagnosis [1]. Male sex, younger age, single marital status, and regional factors were also associated with increased behavioural risk.

These findings reinforce the concept that reduced quality of life may act as a driver for maladaptive coping mechanisms, including substance use and behavioural addictions. Conversely, addictive behaviours may further exacerbate disease severity, treatment adherence, and psychosocial outcomes, suggesting a potentially self-reinforcing cycle.

Clinical Interpretation and Implications for Practice

While causal relationships cannot be established due to the cross-sectional design, the results underscore the importance of viewing chronic skin disease through a biopsychosocial lens. Dermatological care models that focus exclusively on cutaneous symptoms may fail to identify behavioural health risks that meaningfully affect long-term outcomes.

The absence of a population control group and the restriction to tertiary care settings limit the generalisability of the findings. Patients attending specialist centres may represent more severe or complex cases. Nonetheless, the scale and geographic breadth of the study provide robust evidence that addictive behaviours are common and clinically relevant in dermatology populations.

Routine screening for addictive and compulsive behaviours, particularly in patients with marked quality-of-life impairment, should be considered a component of comprehensive dermatological care. Access to appropriate psychological and behavioural support services may improve both mental wellbeing and dermatological outcomes.

Future research should prioritise population-based designs, longitudinal follow-up, and the inclusion of matched control groups to better clarify risk magnitude and causal pathways.

References

1. Ziehfreund S, et al. Addiction and chronic skin diseases: A Pan-European study on prevalence, associations and patient impact. J Eur Acad Dermatol Venereol. 2025. doi:10.1111/jdv.70245

2. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19(3):210–216. doi:10.1111/j.1365-2230.1994.tb01167.x

Author:

Professor Giorgi Pkhakadze, MD, MPH, PhD is Professor of Public Health at David Tvildiani Medical University and Chair of the Public Health Institute of Georgia (PHIG). He is the Chief Editor of the Georgian Medical Journal (GMJ.ge) and an internationally recognised public health expert with more than 25 years of experience in health systems strengthening, quality of care, and evidence-based medical communication across Georgia, Europe, and global health institutions.

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