Addiction in chronic inflammatory skin diseases: A systematic review of prevalence, impact and screening practices

BACKGROUND: Chronic inflammatory skin diseases are frequently associated with addictive behaviours, which may affect disease course, mental health and treatment outcomes. Yet, existing data remain fragmented across addiction types and dermatologic conditions. OBJECTIVES: To systematically review the prevalence of substance-related and behavioural addictions in adults with selected skin diseases and to evaluate the methodological quality of the available evidence. METHODS: A systematic search of PubMed and Embase was conducted through April 2025. Eligible studies included observational designs investigating adult populations with alopecia areata, atopic dermatitis, hidradenitis suppurativa, psoriasis, urticaria or vitiligo and reporting outcomes related to alcohol, nicotine substance use or behavioural addictions (e.g. internet or gambling). Methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Thirty-eight studies were included and psoriasis, atopic dermatitis and hidradenitis suppurativa were the most frequently investigated diseases. Alcohol addiction (prevalence up to 50%) and nicotine abuse (up to 40%) were the most common addictions, followed by substance use disorder and behavioural addictions (e.g. internet addiction up to 38%). Addictions were associated with greater disease severity, reduced treatment response and higher comorbidity burden. Two-thirds of studies met > 90% of STROBE criteria, but heterogeneity in design, assessment tools and reporting limited comparability. CONCLUSIONS: Addictive behaviours are common among patients with chronic skin diseases and may influence clinical outcomes. Systematic screening, particularly for underrecognized behavioural addictions, and age- and sex-stratified care approaches, should be integrated into dermatological practice.