 David Cotter, MD, PhD

How Online-Informed Patients Are Changing Dermatology Visits

In recent years, the rise of the “online-informed” patient has transformed visits to 

 practices, with clinicians increasingly encountering patients who greet them armed with TikTok skincare advice, Reddit-informed treatment data, AI-generated differential diagnoses, and screenshots from ChatGPT inquiries. In this feature, interviews between 4 leaders in dermatology and 

highlight this trend as being simultaneously empowering to patients and potentially hazardous.

David Cotter, MD, PhD, assistant clinical professor at the University of Nevada, spoke with 

 in 1 such interview, describing the phenomenon as a double-edged sword. Cotter noted digitally informed individuals often arrive more prepared to discuss disease states and treatment options. He described access to online tools as encouraging earlier intervention, particularly for conditions such as skin cancer or acne, where delays in care may hurt patient outcomes. Cotter pointed to teledermatology and online educational content as especially valuable among those without access to specialists.

However, Cotter also warned against inaccurate online information, noting its ability to lead patients astray, particularly when individuals rely on unverified influencers or AI tools lacking training. He described seeing patients delay appropriate care following treating autoimmune skin disease as fungal infections based on online recommendations. Cotter also raised concerns over increasingly aggressive self-treatment trends, ranging from excessive tween skincare routines involving multiple active ingredients to do-it-yourself cosmetic filler injections promoted on social media platforms and Reddit forums. In Cotter’s view, dermatologists must lean into the digital era by understanding the online content patients consume.

Raj Chovatiya, MD, PhD, clinical associate professor of medicine at Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology + Immunology Research in Chicago, Illinois, similarly highlighted online self-education as an inevitable development, noting the widespread availability of search engines and large language models (LLMs) making patient self-research a permanent fixture. Chovatiya noted these tools may help patients recognize symptoms and connect with appropriate specialists, but only when they understand their limitations.

Chovatiya described dermatology’s visual nature as amplifying the impact of social media, especially for stigmatized diseases such as hidradenitis suppurativa (HS). He did acknowledge online communities can reduce shame and encourage earlier care-seeking, though they may also expose patients primarily to severe disease presentations that generate unnecessary fear. Chovatiya recalled a patient of his who extensively self-treated what she believed were refractory warts after consulting AI tools, only to later discover she had chronic inflammatory eczema. By the time she presented to clinic, her skin barrier had been significantly damaged by chemical peels and other at-home interventions.

Kathryn Celeste Durham, MD, a board-certified dermatologist practicing in Fort Worth, Texas, at US Dermatology Partners, echoed that ambivalence. With 20 years of clinical experience, Durham said patient self-education is broadly positive, as she values patients feeling empowered and informed about their conditions, but described mounting frustration when AI tools generate diagnoses that contradict her own clinical assessment.

Durham identified skin cancer as the area of greatest concern, explaining that diagnosing lesions involves far more than visual pattern recognition. Texture, feel, history, and chronology all factor into clinical judgment in ways that images and symptom checkers cannot replicate. She described seborrheic keratoses as a frequent driver of patient anxiety amplified by online searches, where broad symptom matching commonly steers individuals toward worst-case conclusions. She also described some patients’ resistance to standard surgical treatment for confirmed cancers in favor of holistic alternatives discovered online.

Durham pointed to perioficial dermatitis as a case study in how well-intentioned self-research can worsen outcomes. Because the condition can resemble both acne and eczema at different stages, patients frequently self-treat with topical steroids sourced from prior prescriptions or online recommendations, an approach potentially exacerbating the condition and complicating clinical management.

On the positive end, Durham described a significant rise in numbers of patients with acne who arrive already familiar with such products as retinoids and tretinoin, a development she attributed largely to online skincare communities. Durham also said targeted digital advertising has meaningfully expanded awareness of biologic treatments for psoriasis and other conditions, particularly among younger patients who do not engage with traditional broadcast media. She noted that growing disease awareness has translated into more patients actively seeking diagnoses and treatment.

When patients arrive with social media screenshots or online forum discussions, Durham urged acknowledgment over dismissal, suggesting the need for clinicians to validate patients’ attempts to engage with their own care before gently redirecting toward a more accurate diagnosis or treatment plan.

Peter Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine and founding director of the Chicago Integrative Eczema Center, described the current AI era as a significant acceleration of the patient self-research trend that began with widespread internet access. While he acknowledged AI systems can produce misinformation and occasionally dangerous confabulations, Lio noted his own cautious optimism as that patients are arriving more educated and engaged.

Lio additionally argued against clinicians feeling threatened by informed patients, framing education in this or any manner as central to medical care rather than a challenge to clinical authority. In his practice, he welcomes patients who bring in influencer videos, research papers, or chatbot outputs, as these materials allow for higher-level conversations earlier in the treatment process. He cautioned, however, that oversimplified online narratives can create unrealistic expectations.

Durham expressed cautious optimism about the trajectory of AI-assisted patient research, noting tools like ChatGPT, when implemented appropriately, can provide a useful on-ramp to professional care. On the inquiry of whether cliniciasns should build their own digital presence to counter unverified health content, Durham acknowledged the growing necessity while flagging its issues. She framed the challenge as a matter of balance: dermatologists need a presence in the digital space where their patients are increasingly turning for health information, but the profession’s primary obligation remains availability and care in the clinic.

Overall, the experts painted a complicated picture of the benefits and drawbacks of the online-informed patient. The 4 leaders in the field made their views regarding better-informed questions and increased access clear, along with their opinions of the potential negative aspects of misinformation and delayed diagnoses. Their statements help to paint a picture of the cross-section of the clinician viewpoints surrounding the ubiquity of access to information through Internet and AI use.

Chovatiya, Lio, Durham, and Cotter had no relevant disclosures of note.

Livingston R. AI Tools Improve Patient Knowledge of and Confidence in Optometric Information. HCPLive. June 26, 2025. Accessed May 18, 2026. 

https://www.hcplive.com/view/ai-tools-improve-patient-knowledge-of-and-confidence-in-optometric-information

Sayres R and Liu Y. Patient Awareness of Dermatologic Conditions Using AI, With Rory Sayres, PhD, and Yun Liu, PhD. HCPLive. April 23, 2026. Accessed May 18, 2026. 

https://www.hcplive.com/view/patient-awareness-dermatologic-conditions-using-ai-rory-sayres-phd-yun-liu-phd

Stein Gold L, Zirwas M, Lio P, et al. Assessing Severity of Atopic Dermatitis. HCPLive. April 30, 2023. Accessed May 18, 2026. 

https://www.hcplive.com/view/assessing-severity-of-atopic-dermatitis

Videos

As dermatology patients enter clinical visits with information from social media, online forums, and AI inquiries, clinicians are juggling new concerns.

Positive Results Identified for Risankizumab and Other Psoriasis Drugs, With David Cotter, MD, PhD

, David Cotter, MD, PhD, assistant clinical professor at the University of Nevada, shared his perspective on new data and recent developments in psoriasis management highlighted during the 

2026 American Academy of Dermatology (AAD) Annual Meeting

 on the floor of the 2026 AAD meeting, Cotter offered an enthusiastic and candid tour of what he sees as the most clinically meaningful developments in psoriasis currently, from new site-specific data on established biologics to a landmark oral treatment approval he anticipates could change prescribing habits significantly.

“We have a number of new molecules that are going to be entering soon, and we have some updated data from some of our old favorite molecules, some things that are particularly exciting and have dedicated studies looking at high impact sites,” Cotter expressed.

Among the findings that stood out most to Cotter, new data on risankizumab (Skyrizi) aimed specifically at high-impact sites, including scalp and genital psoriasis, were spotlighted. The availability of dedicated endpoints for these notoriously difficult areas has already shifted his practice, Cotter noted, pointing out that his own initiation of risankizumab more frequently for patients with genital involvement as the new results emerged.

Additionally, Cotter highlighted a recent label update for guselkumab (Tremfya) supporting its ability to inhibit radiographic progression in psoriatic arthritis (PsA), a development he believes shifts the calculation when selecting a first-line agent for patients managing both skin and joint disease.

On the question of head-to-head comparative data, Cotter pointed to 5 head-to-head trials on risankizumab against different mechanisms of action, including such drugs as apremilast and deucravacitinib. These data have resulted in risankizumab being his default biologic for plaque psoriasis.

In the PsA space, Cotter flagged bimekizumab as potentially the strongest option overall, citing topline data from the BE BOLD trial demonstrating superiority over risankizumab in attainment of rapid joint disease control. Turning to oral therapies, Cotter also noted the approval of icotrokinra (Icotyde) for moderate to severe plaque psoriasis down to age 12 as significant. He called it a game changer both therapeutically and regulatorily, noting its launch-day pediatric approval signals a great deal about the drug's safety profile and the rigor with which it was studied.

Disclosures: Cotter has previously reported serving as a consultant, speaker, and/or investigator for AbbVie, Alumis, Arcutis, Boehringer Ingelheim, Bristol Myers Squibb, Castle, Dermavant/Organon, DermTech, Eli Lilly, Galderma, Johnson and Johnson, Journey, KOWA, Pfizer, Regeneron, and Sanofi, UCB.

Magnolo N, Soung J, Sivamani RK, et al. Risankizumab vs deucravacitinib in adults with moderate plaque psoriasis: week 16 subgroup results from the IMMpactful study. Poster presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO. Poster DV-017716.

Johnson and Johnson. FDA approves ICOTYDE (icotrokinra), the first and only targeted oral peptide IL-23 receptor antagonist, for the treatment of moderate-to-severe plaque psoriasis. Press release. Published March 18, 2026. Accessed March 18, 2026. 

https://www.jnj.com/media-center/press-releases

This interview with David Cotter, MD, PhD, highlights recent findings and new data in the psoriasis treatment space highlighted at AAD 2026.

AAD Updates on Psoriasis Management and Pipeline, With David Cotter, MD, PhD

Final reflections from physicians Stein Gold, Soung, and Cotter, emphasizing multidisciplinary, patient-focused advances in psoriasis and PsA care.

Closing Thoughts on the Impact of IL-23s in Psoriasis and Psoriatic Arthritis

, despite the expanding therapeutic landscape. Linda Stein Gold, MD, and her colleagues analyze patient- and provider-reported data from the 

 surveys, revealing that many patients remain dissatisfied with current therapies and that oral agents are overwhelmingly preferred over injectables. The experts discuss how patient lifestyle, comorbidities, and psychosocial burden influence shared decision-making and treatment adherence. They also interpret the 

International Psoriasis Council’s (IPC)

 and explore its implications for reducing “topical churn” and advancing systemic therapy earlier in the disease course.

 and its potential to close current gaps in care. The panel provides an in-depth review of the 

 clinical development program, summarizing the 

 trials, which demonstrated superior efficacy versus deucravacitinib at both 16 and 24 weeks, with favorable safety and tolerability. They also discuss new 

 showing sustained clearance and no new safety signals in adults and adolescents. The faculty reflect on ICO’s implications for adolescent psoriasis and how early, aggressive oral intervention may help prevent progression to psoriatic arthritis, marking a significant milestone in the evolution of oral IL-23–targeted therapy.

The final portion of the series shifts focus to 

managing active psoriatic arthritis (PsA)

. The experts discuss new findings from the 

 demonstrated the first clear evidence of IL-23–mediated inhibition of structural joint damage, reinforcing the rationale for early biologic use in high-risk patients. They compare APEX to prior IL-23 studies, discuss implications for therapy sequencing, and highlight other emerging data from 

 studies. In closing, Stein Gold and colleagues emphasize a forward-looking approach that integrates personalized therapy selection, early detection of PsA, and cross-specialty collaboration to elevate standards of psoriasis care

Highlights from Fall Clinical 2025, including emerging IL-23 and real-world data shaping the next phase of psoriasis research.

David Cotter, MD, PhD

Articles