New Study Reveals High Rates of Addiction Among Patients with Psoriasis and Other Conditions

The psychological distress and impaired quality of life associated with skin diseases such as psoriasis (PSO), atopic dermatitis (AD), and hidradenitis suppurativa (HS) may lead to negative mental health and, thus, poor coping strategies. These include addictive behaviors like smoking, alcohol use, drug use, gambling, and internet addiction.

“Behavioral and cognitive impairments associated with addiction—such as poor decision-making and reduced impulse control—further complicate the management of skin conditions requiring consistent treatment,” researchers noted.¹

While prior studies have suggested elevated addiction rates among dermatology patients, comprehensive multinational data across different skin diseases have been limited. A recent pan-European multicenter study has provided one of the most extensive assessments to date of addictive behaviors among patients with chronic skin diseases treated in tertiary dermatology centers.¹

Study Design

Investigators conducted a cross-sectional study across dermatology departments in 20 European countries between July 2023 and July 2024. Adult patients with PSO, AD, HS, alopecia areata (AA), urticaria, or vitiligo were recruited and completed a paper-based questionnaire. Data collection included sociodemographic characteristics, disease features, perceived disease severity, quality of life as measured by the Dermatology Life Quality Index (DLQI), and a broad range of addictive behaviors. Validated screening tools were used to assess smoking, alcohol use, drug use, pathological gambling, eating disorders, and internet addiction.

Results

A total of 3,585 patients were included in the final analysis. The median age was 43 years and 51.1% of the cohort were female. Psoriasis was the most common diagnosis, followed by AD and HS. Overall, addictive behaviors were frequent across this dermatologic population. Addictive smoking was reported by 25.7% of participants, exceeding rates reported in the general European population (19%).² Internet addiction was also prevalent, affecting nearly 30% of patients when mild to severe forms were combined. Hazardous or harmful alcohol use was observed in 8.8% of patients, alcohol dependence in 2.5%, drug-use-related problems in 5.3%, pathological gambling in 4.5%, and eating disorders in 1.8%.

Marked variation was observed across disease groups. Smoking prevalence was highest among patients with HS and psoriasis, conditions in which smoking is known to exacerbate inflammation and disease severity. Pathological gambling was most prevalent in patients with AA and vitiligo, while internet addiction was particularly common in AD and AA. In contrast, eating disorders were relatively uncommon across all disease groups.

Regional differences across Europe were also evident. Smoking prevalence was highest in Southern and Eastern Europe, while pathological gambling was most common in Eastern Europe. Hazardous alcohol consumption was most frequently reported in Northern Europe, whereas internet addiction was most prevalent in Western and Southern Europe.

Further Analysis

The multivariate analyses identified several sociodemographic and clinical factors associated with addictive behaviors. Male sex, younger age, single marital status, and higher DLQI scores were consistently associated with increased addiction risk across multiple domains. Higher DLQI scores were particularly notable, demonstrating a strong positive association with smoking, drug use, and internet addiction. This relationship suggests that impaired quality of life may be a key driver of maladaptive coping strategies in patients with chronic skin disease. Conversely, higher self-reported happiness was associated with lower addiction risk, indicating a potential protective effect of psychological well-being.

The study also demonstrated that disease severity as perceived by patients was less predictive of addiction risk than quality-of-life impairment, underscoring the importance of psychosocial assessment beyond objective disease measures. While disease duration showed modest associations with some addictive behaviors, it was not a dominant risk factor, suggesting that unmeasured psychosocial factors such as stigma, loneliness, or social support may further contribute to addiction vulnerability.

Conclusion

There are several limitations to consider. First, the study was conducted exclusively in tertiary dermatology centers, potentially biasing the sample toward patients with more severe or complex disease. Additionally, the absence of a control group, the cross-sectional design, and self-reported data may also limit these findings.

Despite these limitations, this large, multinational study provides important evidence that addictive behaviors are common among patients with chronic skin diseases across Europe and are closely linked to impaired quality of life. The findings support the integration of routine addiction screening and psychosocial support into dermatologic care, particularly for high-risk groups, such as patients with HS or PsO, and those with elevated DLQI scores. Future population-based studies with appropriate control groups are needed to further clarify causality and inform targeted, multidisciplinary interventions.

References

1. Ziehfreund S, Saak M, Schaal A, et al. Addiction and chronic skin diseases: A Pan-European study on prevalence, associations and patient impact. J Eur Acad Dermatol Venereol. Published online December 14, 2025. doi:10.1111/jdv.70245

2. Eurostat. Daily smokers of cigarettes by sex, age and educational attainment level. 2024. https://ec.europa.eu/eurostat/databrowser/view/hlth_ehis_sk3e__custom_13143640/default/table?lang=en&page=time:2019