TOPLINE:

In a cross-sectional study across 20 European countries, patients with chronic skin diseases showed high rates of addictive behaviours such as smoking, hazardous alcohol use, drug abuse, gambling disorder, and internet addiction. Men who were single with high Dermatology Life Quality Index (DLQI) scores were at high risk for worse outcomes.

METHODOLOGY:

• Researchers conducted a cross-sectional multicentre study across dermatology departments in 20 European countries and recruited 3585 adult patients (median age, 43 years; 51.1% women) with psoriasis (44.7%), atopic dermatitis (AD; 24.9%), hidradenitis suppurativa (HS; 10.7%), urticaria (10.4%), vitiligo (4.9%), and alopecia areata (AA; 4.4%) from July 2023 to July 2024.
• Patients completed standardised questionnaires via the Research Electronic Data Capture system, assessing sociodemographic parameters, disease severity, and disease-related quality of life (using DLQI scores); the median duration of disease was 14 years, with a subjective severity score of 6 and a DLQI score of 6.
• The prevalence of various addictive behaviours, including smoking, alcohol use, drug use, gambling, internet addiction, and eating disorders, across skin conditions and European regions was evaluated.

TAKEAWAY:

• Overall, addictive smoking affected 25.7% of patients — highest in those with HS and lowest in those with urticaria (48.6% vs 16.4%; P < .001). Pathological gambling occurred in 4.5% of patients, peaking in those with AA and lowest in those with AD (8.2% vs 3.6%; P = .012). Hazardous drinking and alcohol dependence affected 8.8% and 2.5%, respectively, with little variation by skin condition.
• Drug use (5.3%) and dependence (0.4%) were highest in those with AA and HS and lowest in those with vitiligo (drug use, 8.8% and 8.6% vs 2.9%; drug dependence, 0.4% and 0.5% vs 0.0%; P < .001). Internet addiction affected 29.7% of patients overall — highest in those with AA and lowest in those with psoriasis (29.6% vs 19.9%; P < .001). Eating disorders occurred in 1.8%, with no significant between-group differences.
• Addictive smoking, pathological gambling, and internet addiction differed significantly by region (P < .001 for all), being most prevalent in Southern, Eastern, and Western Europe, respectively. Hazardous drinking and alcohol dependence were highest in Northern and Western Europe, respectively; however, drug use-related problems and eating disorders showed only minor regional variations.
• Researchers identified significant associations between addiction and male sex, being single, and having high DLQI scores.

IN PRACTICE:

"In this multicentre tertiary care study across 20 European countries, addictive disorders were common among patients with chronic skin diseases," the authors wrote, adding that "the observed associations underline the relevance of routine screening for addictive behaviours in dermatological settings and the potential value of multidisciplinary care." "Future studies using population-based approaches and appropriate comparison groups are essential to confirm these patterns and inform targeted interventions," they concluded.

SOURCE:

This study was led by Stefanie Ziehfreund, Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany. It was published online on December 14, 2025, in the Journal of the European Academy of Dermatology & Venereology.

LIMITATIONS:

This was not a population-based study, and the sample might not represent the general population with skin diseases. The recruitment was conducted exclusively in tertiary dermatology centres, potentially biasing the sample towards patients with more severe conditions. The absence of a control group prevented the direct comparison with individuals without skin diseases and limited causal inference. Selection bias was possible as individuals with addictions may have avoided participation or underreported behaviours despite anonymity. The proportion of missing data was not recorded systematically, and the response rate could not be determined.

DISCLOSURES:

This study was funded by the European Academy of Dermatology and Venereology. Several authors reported receiving speaker honoraria and/or support for attending meetings and/or being a consultant and/or serving in advisory boards of Almirall, Janssen, LEO Pharma, AbbVie, Sanofi, and various other sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.