Hidradenitis suppurativa (HS) and melanoma were associated with an increased risk for completed suicide, while the evidence for an association with other skin diseases was “limited and inconsistent,” according to the results of a recently published systematic review and meta-analysis.

B. Hrvatin Stancic, MD, of the Dermatovenerology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia, and colleagues, conducted a systematic review and meta-analysis of studies through 2023. Eligible studies included at least 10 adult patients with dermatologic conditions and specifically assessed completed suicide; 37 studies were included in the systematic review, and 13 skin conditions were identified. The meta-analysis included 17 studies (four US studies) encompassing over 3.8 million patients with dermatologic conditions and over 33 million controls, and 13 skin conditions were identified.

Dermatologic diseases have been associated with increased psychological burden and linked to suicidality, the authors wrote in the paper, published in the January 2026 issue of the Journal of the European Academy of Dermatology and Venereology. But suicidality is a broad term, ranging from ideation to suicidal behavior and/or completed suicide, and the conclusions of these previous reviews “vary greatly,” they added.

They investigated whether individuals with skin disorders were at higher risk of death by suicide specifically, and the risk associated with the different disorders, using a random-effects model to account for inter-study variability and the Newcastle-Ottawa Scale to assess the quality of observational studies. Each skin disorder was analyzed separately.

‘Vicious Cycle’

For psoriasis, the meta-analysis included five cohort studies and one case-control study, of which five found no increase in completed suicide risk in patients with psoriasis, and one found an increased risk. The pooled data found no increase in completed suicide risk (odds ratio [OR], 1.42; 95% CI, 0.76-2.68).

For dermatitis (including atopic dermatitis, eczema, and contact dermatitis), five studies were included in the meta-analysis. Pooled data did not find an increased suicide risk (OR, 1.54; 95% CI, 0.57-4.17).

The researchers identified 12 studies that investigated the association between various types of skin cancer and suicide. These included four studies of melanoma that were included in the meta-analysis. There was an association in patients with melanoma (standardized mortality rate [SMR], 2.89; 95% CI, 1.97-3.81), with the first year following diagnosis identified as the highest-risk period.

For nonmelanoma skin cancer, two studies were included; women showed an increased risk for completed suicide compared with the control group (SMR, 1.30; 95% CI, 1.12-1.49). Stratification by gender found nonsignificant results for men. 

Of the five studies that evaluated completed suicide in patients with HS, two were included in the meta-analysis and pointed to an almost threefold increase in completed suicide risk among patients with HS compared with controls (OR, 2.86; 95% CI, 1.56-5.24).

Four studies investigated other dermatologic conditions: No increased suicide risk was reported in the study that examined prurigo nodularis. Acne was linked to an increased suicide risk in women, but the finding did not reach statistical significance. One inpatient study found alopecia areata to be associated with suicide as well as self-inflicted injury.

Noting that the data on skin disease and completed suicides “is limited,” the authors concluded that “HS and melanoma are the only skin diseases with consistent evidence of an association, albeit in a limited number of studies.” For other skin diseases, they added, “The literature is both limited and inconsistent.”

A limitation of the studies highlighted by the authors is that they used different inclusion criteria and collected data from patients using many types of sources (hospitals, general practitioners, and national databases), introducing a potential risk for selection bias.

In an accompanying editorial, Emanuele Scala, PhD, and Francesca Scampogna, PhD, of the Istituto Dermopatico Dell'immacolata, Rome, Italy, recommended that dermatologists “should be mindful that skin diseases can significantly impact ­health-related quality of life (QoL), affecting social interactions, emotional wellbeing, and psychological health.”

HS, in particular, they noted, “is associated with the highest comorbidity burden and the lowest QoL among skin conditions” and is one of the most painful conditions treated by dermatologists. Pain and mental health disorders have a “bidirectional relationship,” each exacerbating the other and creating a “vicious cycle,” they wrote. 

Bidirectional Signaling

Commenting on the study for Medscape Medical News, Ladan Mostaghimi, MD, professor emeritus, Department of Dermatology, University of Wisconsin-Madison, and director of the Wisconsin Psychocutaneous Clinic in Madison, said the take-home message of these findings applies across the gamut of skin diseases, because they carry a risk for mood disorders (depression and anxiety) as well as increased suicidal thoughts and behavior. 

She described the greater vulnerability to suicidality in people with dermatologic conditions as “multifactorial.”

Dermatologic diseases “due to their visibility and in some cases their symptoms, such as chronic itch, cause higher psychosocial distress, and there is an increased risk of depression and anxiety in these patients,” Mostaghimi said. Additionally, the “skin-brain axis adds biological mechanisms to the mix; for example, inflammatory cytokines may play a role in this increase in vulnerability.”

Mohammad Jafferany, MD, professor of psychodermatology, psychiatry, and behavioral sciences, Covenant HealthCare College of Medicine, Central Michigan University, Saginaw, Michigan, added that “inflammatory skin diseases share neuroimmune pathways with mood disorders, including cytokine-mediated effects on neurotransmission.” These cytokines — such as TNF-alpha, interleukin (IL)-1, IL-6, and IL-17 — alter serotonin and dopamine neurotransmission, affecting glutamate signaling and hypothalamic-pituitary-adrenal axis dysregulation, he told Medscape Medical News. Altered cortisol rhythms and stress reactivity increase the risk for depression, anxiety, and emotional dysregulation, and this “bidirectional neurocutaneous signaling” reduces emotional resilience and increases vulnerability to suicide, he added.

Sleep disruption from chronic itch and pain “further amplifies risk,” added Jafferany, president of the Association for Psychocutaneous Medicine of North America.

Integrated Care

The interaction of biological and psychosocial processes “underscores the need for integrated dermatologic and mental health care,” Jafferany said. Mostaghimi agreed, adding that dermatologists should utilize screening tools, such as the 9-item Patient Health Questionnaire-9, to screen for mood disorders.

After identifying patients with depression and anxiety, dermatologists can ask about suicidal thoughts and should have a process in place to offer appropriate treatment to vulnerable patients. “For example, if a patient’s answer is positive to passive or active thoughts of suicide in the depression questionnaires or direct questioning, then the Columbia Suicide Severity Rating Scale (C-SSRS) is a good screening tool for further assessing the suicide risk,” she said.

Patients who screen negative on the C-SSRS should be referred for outpatient treatment and require a safety plan while awaiting treatment, she advised. Patients who screen positive should be referred to the emergency department or be hospitalized and receive inpatient mental health treatment. The Suicide and Crisis Lifeline (988) is also a “good resource for emergencies.”

Jafferany emphasized that dermatologists should “recognize suicide risk as an integral component of disease burden rather than a secondary psychiatric issue.” He added that “heightened vigilance is warranted during disease flares, treatment failure, severe symptoms, sleep disruption, or social withdrawal.”

The research received no funding. Stancic reported receiving honoraria for lectures and consultancies from Viatris, AbbVie, Novartis, and Eli Lilly, andsupport for attending meetings from Janssen and AbbVie. The other study authors’ disclosures are listed on the original paper. Scala, Scampogna, and Mostaghimi disclosed no relevant financial relationships. Jafferany reported receiving consulting from Boehringer Ingelheim and L’Oreal.

Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as “Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom” (the memoir of two brave Afghan sisters who told her their story).