<p>Paediatric dermatological procedures (i.e., venipuncture, skin-prick testing, and burn care) and chronic skin conditions (i.e., atopic dermatitis, psoriasis) often cause pain and anxiety in children. While topical anesthetics are commonly used, they may be delayed in onset and insufficient for anxiety relief. Non-pharmacological interventions (NPIs) may offer adjunctive benefit. This systematic review evaluates the effectiveness of non-pharmacological interventions in reducing pain and anxiety in children undergoing dermatologic procedures or with chronic skin conditions. A systematic review was conducted per PRISMA guidelines. MEDLINE and Cochrane databases were searched from inception to May 26, 2025. Studies were included if they assessed NPIs in children (≤ 18 years) undergoing dermatologic procedures or with chronic skin conditions, with pain and/or anxiety outcomes. Two reviewers independently screened and extracted data. Due to heterogeneity, a narrative synthesis was performed. Certainty of evidence was assessed using the Grading of Recommendations, Assessments, Developments, and Evaluations (GRADE) framework. Twenty-seven studies (<i>n</i> = 1899) met the inclusion criteria. Interventions included medical clowning, general distraction techniques, hypnosis, virtual reality, music therapy, and mind-body approaches. Most studies reported reductions in pain or anxiety compared to standard care. For needle-based procedures, music therapy, medical clowning, and virtualy reality, may be associated with reduced pain and anxiety (low certainty). For dermatologic-specific procedures (e.g., cryotherapy, skin-prick testing), distraction methods (e.g., cards, video) may be associated with reduced pain and anxiety (low certainty). NPIs may be effective in reducing procedural pain and anxiety in paediatric dermatology and should be considered as adjuncts to standard care.</p>