Evening preference is associated with inflammatory skin diseases and poorer psychological health: evidence from the EPISONO study

Abstract Dermatological diseases (DD) are common and frequently accompanied by sleep and psychological impairments. The contribution of circadian variability to these outcomes remains unclear. This cross-sectional study investigated the individual and combined relationships of dermatitis, psoriasis, and vitiligo with sleep, chronotype, and psychosocial health using data from the 4th São Paulo Epidemiologic Sleep Study (EPISONO-2018). Of 769 participants aged 20–80 years, 721 had complete dermatological and sleep-timing data, including 83 individuals with DD and 638 without DD. Propensity score matching (PSM) balanced sociodemographic variables, yielding 83 individuals with DD and 84 matched controls. Sleep timing, chronotype (mid-sleep on free days corrected for sleep debt on workdays [MSF sc ] and diurnal preference assessed by the Morningness-Eveningness Questionnaire self-assessment [MEQ-SA]), social jetlag, and psychosocial measures (perceived stress, fatigue, anxiety, depression, and quality of life) were evaluated. In the unmatched sample, DD participants had lower MEQ-SA scores, fewer morning types, higher perceived stress, and poorer quality of life in the psychological domain than the non-DD group. Intermediate and evening preferences presented approximately 2-fold higher odds of DD, particularly dermatitis, whereas morning preference corresponded to nearly 50% lower odds. After PSM, DD was linked to more depressive symptoms and lower physical, psychological, and overall quality of life. An indirect association involving lower MEQ-SA scores was observed between DD and poorer psychological well-being, suggesting that diurnal preference may represent a correlate of the psychosocial burden of inflammatory skin diseases. These findings warrant further investigation of chronotype and chronotherapeutic approaches in dermatological settings.