PS23 The neurodermatological–behavioural interface: a scoping review of attention deficit/hyperactivity disorder associations with inflammatory dermatoses and body-focused repetitive behaviours

Abstract

Attention deficit/hyperactivity disorder (ADHD) is a common neuro­developmental condition marked by inattention and impulsivity, affecting emotional regulation and behavioural control. ADHD is increasingly observed to occur with dermatological disease, notably inflammatory dermatoses such as atopic dermatitis and body-focused repetitive behaviours (BFRBs) including excoriation disorder and trichotillomania. These skin conditions are traditionally managed under dermatology and psychodermatology; however, their convergence with ADHD suggests shared neurobiological, behavioural and psychosocial pathways. The ADHD–skin interface is under-recognized in dermatological practice. This scoping review maps existing evidence linking ADHD with dermatological manifestations, with the aim of reframing associated skin disease within a neurodevelopmental–behavioural context. Guided by the Joanna Briggs Institute framework, reported in accordance with PRISMA-ScR, we systematically searched PubMed and Ovid Medline for peer-reviewed studies published during 1980–2025. Eligible studies examined associations between ADHD and inflammatory dermatoses, BFRBs, pruritus, excoriation and related psychodermatological outcomes. The findings were organized into proposed mechanisms and clinical implications. Over 100 studies met the inclusion criteria after screening 954 initial results. Population-based meta-analyses and registry studies consistently demonstrate a 1.4–1.7-fold increased prevalence of ADHD among individuals with atopic dermatitis. Evidence from clinical cohorts indicates a high burden of ADHD traits in BFRBs, with up to one-third of patients with chronic excoriation disorder meeting diagnostic criteria for ADHD. Proposed mechanisms include sleep disruption from chronic pruritus impairing executive function, dopaminergic dysregulation underpinning repetitive skin-directed behaviours, and shared genetic or inflammatory vulnerability. ADHD is over-represented among patients with atopic dermatitis and BFRBs, with important implications for management and encouraging adherence. Dermatologists are encouraged to recognize underlying neuro­developmental conditions coexisting alongside skin disease. Consideration of ADHD screening within dermatological assessment, in refractory or behaviourally mediated disease, may support more effective multidisciplinary care. Future research would be needed to explore whether prompt ADHD interventions with subsequent improvement on behavioural control would also improve long-term skin outcomes.