Peter Lio, MD 

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.

Topical Steroid Withdrawal: Inside the Controversy Over TSW in Dermatology

Topical steroid withdrawal (TSW) is a controversial topic in the field of 

, precisely because it exposes the fault lines between patient experience and clinical consensus. Long discussed in patient communities found online, a wider acknowledgement of TSW has largely remained unseen.

TSW is often a contested diagnosis, recognized by some dermatologists as a distinct entity but dismissed by others as simply a severe or undertreated atopic dermatitis flare. Many patients who have recognized a distinction between a typical flare and a result of withdrawal from topical corticosteroids have highlighted distinct symptoms of this condition, including what is commonly referred to as ‘elephant skin.’

Additional features may be present, including sharp, “sleeve-like” demarcations at wrists and ankles, temperature dysregulation, chronic exfoliation, and neuropathic sensations described among patients reporting TSW may raise red flags for clinicians, particularly when seen alongside long-term, escalating steroid use. However, a stalemate between patient and dermatologist can arise in which patients insist steroids have impacted them, and clinicians describe their atopic dermatitis as merely uncontrolled.

In this video feature, 3 experts with recently published research on the topic of TSW were consulted on the controversy surrounding TSW, its lack of acceptance, and the ways for clinicians to recognize the condition. These experts included Peter A. Lio, MD, a clinical assistant professor of Dermatology & Pediatrics at Northwestern University Feinberg School of Medicine, Ian Myles, MD, MPH, the chief medical research officer of the US Public Health Service Commissioned Corps, and Anish Maskey, PhD, an assistant professor of Microbiology & Immunology at Touro College of Osteopathic Medicine, Montana.

The 3 dermatology experts converged on several key points in their separate interviews, noting the high efficacy of topical steroids and general safety for most patients. Additionally, prolonged and escalating use of topical corticosteroids without reassessment is a common risk factor of TSW. Lastly, they pointed to patient communities, especially those found online, as largely helpful and instrumental in highlighting TSW for clinicians who may not be aware of TSW’s distinction from eczema.

Throughout the feature, Lio, Miles, and Maskey agree on the path forward, lying not in polarization but in transparency, understanding, and new research taking patient-reported suffering seriously without discarding scientific rigor. While definitions remain imperfect, the experts agree about the existence of increasing acknowledgement of TSW and its impacts on patients. Bridging the gap between many patients’ beliefs and the views of wary physicians may be less about choosing sides than about restoring faith in the medical community’s commitment to patients while new evidence grows.

Check out the feature video posted above to discover more about the views of these 3 experts on this topic.

Lio P. Addressing Doubts About Topical Steroid Withdrawal (TSW), with Peter Lio, MD. HCPLive. June 10, 2025. Accessed December 12, 2025. 

https://www.hcplive.com/view/addressing-doubts-about-topical-steroid-withdrawal-tsw-peter-lio-md

Ahuja K, Lio P. Pediatric Topical Steroid Withdrawal Syndrome: What Is Known, What Is Unknown. Pediatr Dermatol. 2025 Mar-Apr;42(2):311-317. doi: 10.1111/pde.15799. Epub 2024 Nov 4. PMID: 39496222; PMCID: PMC11950796.

Shobnam N, Ratley G, Myles IA, et al. Topical Steroid Withdrawal Is a Targetable Excess of Mitochondrial NAD. J Invest Dermatol. 2025 Aug;145(8):1953-1968.e14. doi: 10.1016/j.jid.2024.11.026. Epub 2025 Mar 14. PMID: 40088241; PMCID: PMC12286752.

Maskey AR, Sasaki A, Li XM, et al. Breaking the cycle: a comprehensive exploration of topical steroid addiction and withdrawal. Front Allergy. 2025 Mar 31;6:1547923. doi: 10.3389/falgy.2025.1547923. PMID: 40230788; PMCID: PMC11994697.

Topical steroid withdrawal (TSW) remains a contentious issue in dermatology, with a divide between patient experiences and clinical consensus. Some dermatologists recognize TSW as distinct from atopic dermatitis flares, while others do not. Symptoms include "elephant skin," sharp demarcations, and neuropathic sensations. Experts agree on the efficacy of topical steroids but caution against prolonged use without reassessment. Patient communities play a crucial role in raising awareness. Bridging the gap between patient beliefs and clinical views requires transparency, understanding, and research that respects patient-reported experiences.

Topical steroid withdrawal remains a controversial topic in the dermatology field, given the lack of necessary data. 

 Topical Steroid Withdrawal: Inside the Controversy Over TSW in Dermatology

Discussing New Topical Drugs for Atopic Dermatitis in Younger Patients, With Peter Lio, MD

2025 Fall Clinical Dermatology Conference

 in Las Vegas, featuring Peter A. Lio, MD, a clinical professor of Dermatology at the Icahn School of Medicine at Mount Sinai and clinical assistant professor of Dermatology & Pediatrics at Northwestern University’s Feinberg School of Medicine.

In this interview at the Fall Clinical meeting, Lio discussed highlights from several of the sessions he co-presented during the conference.

First, Lio was asked about his session on the changing landscape of topical therapies in the field of 

“Topical therapy is so important to me, and it's near and dear to my heart,” Lio explained. “...I think that the money that a company can make from a topical is nowhere near what they can make from a systemic. So to me, it's kind of the ultimate honor for us when companies do it. And I'm so happy we have some really exciting new topicals in our armamentarium, particularly in the world of atopic dermatitis. We have a new topical phosphodiesterase 4 inhibitor that's just a couple of years old now.”

This drug, Lio noted, was topical roflumilast, and it received an indication down to age 2 years recently. Lio went on to discuss other topical medications of note.

“We’ve got topical ruxolitinib, and that is, of course, a topical JAK inhibitor,” Lio said. “That also very recently, in the past month or 2 here, has gotten approval down to age 2. We have topical tapinarof, which is the aryl hydrocarbon receptor agonist and is really awesome. Also approved down to age 2. So not only do we have new treatments for atopic dermatitis, but also in little kids, which is incredible. Most recently, we got a new topical in the class for JAK inhibitors, with topical delgocitinib…for chronic hand eczema.”

Lio went on to discuss some of the most notable takeaways from his portion of the conference session titled ‘30 Tips in 30 Minutes.’

“I think number 1 is going to be the writing out of an action plan,” Lio said. “I think this sort of defines my entire practice, [where] I print out for each individual patient exactly what I'd like them to do. That tells them what to do in the morning, what to do in the evening. It has an order of operations. It links to the products. So they really have all of that comprehensive stuff done. Not only is it for the patient, but it's also selfishly for me because if they call later, then sometimes I'm like.”

Lio went on to describe the second tip provided in his talk, which was a strategy for dealing with patients’ needle-phobia and procedure phobia.

“I have a whole bunch of kind of pearls within the pearl of doing everything you can to minimize the pain, the discomfort, and the anxiety around doing procedures from a blood draw to a biopsy to even just freezing a wart,” Lio said. “All of these things can cause a lot of trauma to the patients. And if especially for [kids], of course, we realize that if they are comfortable, if they are relaxed and on board, not only is that good for them…but it's good for us because we're much more likely to have a successful procedure. And there's even data to support that.”

Lio highlighted the benefits of habit reversal therapy, which he described as a way to give patients a ‘replacement behavior.’

“Instead of scratching at itchy skin, we might have them do something like make gentle circles or tap their fingers, or play with ‘worry beads’ or a fidget toy,” Lio explained. “It sounds kind of goofy, but it really can make a huge difference. It's not the whole story. It's not going to replace an oral JAK inhibitors or biologics. I'm not trying to make a claim like that, but it can be a really nice, supportive or adjunctive piece that addresses the mind body. And sometimes it can literally be the difference between treatment success and treatment failure. I need all the help I can get.”

To find out any additional information on these topics and others highlighted in Lio’s sessions, view the video above. For more on new research in dermatology, view the 

The quotes implemented in this interview summary were edited for clarity.

Relevant disclosures for Lio include AbbVie, Almirall, Arbonne, ASLAN Pharmaceuticals, Dermavant, Eli Lilly and Company, Galderma, Johnson & Johnson, L’Oreal, LEO Pharma, Pfizer, Regeneron/Sanofi Genzyme and others.

Stein Gold L, Frey C, Lio P, et al. The Changing Landscape of Topical Therapies. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

Elewski B, Alexis A, Lio P, et al. 30 Tips in 30 Minutes. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

Lio P. How To Get Involved in Clinical Trials. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

This Fall Clinical Dermatology Conference interview features Peter Lio, MD, discussing takeaways from several of his sessions at the meeting.

2025 Revolutionizing Atopic Dermatitis (RAD) Conference

, Peter Lio, MD, spoke about topical steroid withdrawal at the atopic dermatitis-focused meeting.

Lio, who works at Northwestern University's Feinberg School of Medicine as a clinical assistant professor of dermatology and pediatrics, touched on the topic following his shared session about topical steroid withdrawal and its relationship to atopic dermatitis. He was asked about some of the most notable takeaways.

Addressing Doubts About Topical Steroid Withdrawal (TSW), with Peter Lio, MD

“There were 3 of us presenting on stage, and we got to go through different aspects of it,” Lio explained. “First, my piece was all about how we identify it? What is it? Is it a real thing? I think in this particular setting, most people, at least as far as I could tell, seem to acknowledge it as a real entity and want to understand it better. But I know that that's not true. I meet clinicians who say, ‘I don't think it's a real entity’ or ‘I think it's not different than atopic dermatitis,’ but I tried to convey some of the symptoms that are different. Some of the signs that are different and, most importantly, even if you don't acknowledge it or accept it, I think we should still hear our patient out.”

Lio added that one should still adapt to the patient and their needs related to corticosteroids.

“I wrote because I was so frustrated a couple of years ago by someone who said there's nothing else besides steroids,” Lio explained. “I wrote an entire paper about the therapeutic ladder of how we can treat atopic dermatitis without steroids at all, and I think it's pretty compelling. So when anyone says there's nothing outside of this, I'm like, ‘Here's an entire paper about the whole thing.’ We talked about that, and then the other sessions were really interesting too, about how we counsel the patients, and what we specifically do to treat it. Then finally, how do we bring all of this together?”

Lio was then asked about the doubts some physicians have related to topical steroid withdrawal.

“I hope some people who are doubtful watch it, and I hope it changes their minds,” Lio explained. “It's a powerful thing to be able to change somebody's mind. I love those moments in life when my mind gets changed, it's very exciting…I think that people feel that way for a couple of reasons. Number 1, it is relatively new. This is a bit of a controversial statement, because you can find threads in the literature for at least 20 years, and even beyond that. So it's not that new, but it's not something in the conventional canon.”

Lio noted that mainstream dermatology textbooks largely do not discuss topical steroid withdrawal.

“Part 2 is that patients often come in telling us that they have this, and that is a big reversal for dermatology,” Lio said. “We are quite used to, and I would say it's almost universal. Patients come in, or even other clinicians, even really good clinicians, come in telling us, ‘I don't know what this is, whether it's a rash, a spot, or some bumps, I don't know.’ We tell them what it is…This is backwards. The patient comes and says, ‘I think I have TSW,’ and we're not built for that. We know a lot more than the patients do, so I feel like it's a weird reaction to be threatened, but I get it. It feels threatening, like they're kind of trying to usurp you.”

Despite this initial feeling, Lio expressed that essentially all of the patients who have told him in his practice that they have TSW, he has agreed with them.

“I can reassure them ‘I see you know, you may not know this, but I'm a TSW person and I've written about it,’” Lio explained. “I say ‘I see a lot of patients with it, so I'm going to tell you very honestly, at this point, I do not think you or your child has this. We're going to treat you. We can even treat you like you have it, if you like’...Usually when I say that, their shoulders drop, they relax, and they smile."

For more from Lio and other session presenter, view our 

The quotes used in this summary were edited for clarity.

This interview with Peter Lio, MD, at RAD 2025 provides several insights into the topic of topical steroid withdrawal versus atopic dermatitis and what the distinction may be.

Peter Lio, MD

Articles