Raj Chovatiya, 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.

Credit: Rosalind Franklin University Chicago Medical School

 discussing a new consensus framework published in 

, Raj Chovatiya, MD, PhD, of Rosalind Franklin University Chicago Medical School, spoke in greater depth on the value of integrating both clinician-reported signs and patient-reported symptoms when looking at disease control in those living with atopic dermatitis.

Chovatiya described the framework’s development as having been driven by recognition of atopic dermatitis as not defined solely by visible inflammation, but also by the experiences of patients, particularly symptoms such as pruritus, or itch, which often contribute substantially to disease burden and quality-of-life impairment.

According to Chovatiya, the initiative intentionally avoided creating definitions focused exclusively on either objective clinical findings or subjective symptom reports. The following Q&A interview summary highlights his responses to inquiries in the second half of his interview with 

I know the framework separates clinician reported signs and patient reported symptoms. So how important is that distinction when assessing true disease control?

 You know, you really can't have one without the other in this disease state that is so much driven by not only what you see, but what the patient experiences. And this is something that we kind of knew coming into the exercise, that we did not want to try to come up with definitions that really looked at just a symptom or just a sign. So our goal was truly to combine both, and that's the reason why you'll see in these different categories. We're looking at a couple of different ways that you could report the overall lesional burden, but it was an important component of this too, given that it's the predominant symptom that our patients experience with this disease state. So you really can't have them dissociated. They really need to be thought of around the same time.

In your view, how could these consensus definitions potentially impact clinical research, particularly in terms of comparing efficacy across drugs or supporting regulatory decisions?

 You kind of answered that question a little bit in that question itself, given the fact that I think this is absolutely vital for thinking about how we might position new therapies that are coming to market, how we might query the true potential of a therapy to maybe even have remission for our patients. Then, we really need to think about how we design our endpoints around studies, and this is going to probably impact the entire regulatory pathway in terms of what type of claim we might make for a treatment with a patient. I think if we can sort of communicate this language and implement some of these signs and symptoms cut offs into the way we design studies, we'll be able to really communicate the potential of a drug and its possible effect a lot simpler.

Do you see the framework moving the field closer to a treat-to-target approach in atopic dermatitis, and what challenges might remain in implementing that strategy globally?

 We've seen a lot of different bites of this apple over a few years, there's been a couple of different rounds of treat to target strategies. There's been sort of the ahead recommendations, really trying to combine pros and clinician reported outcomes. We're seeing some of these definitions here for this low disease, very low disease, and on drug and off drug, control and remission that's incorporating both signs and symptoms. I think that maybe the biggest takeaway here is that we are beginning to see that there is a push for getting individuals to think about not only clinician assessments, but patient report.

I think that's vital. And I think also this idea that, you know, day to day practice sometimes it's really hard to have such strict numbers and multiple scores. It's just not the way practice in the US, at least is done. I think keeping a couple of general, vague cut offs in line for how we talk about how our patients are doing is really the most important point to take out of this. So rather than moving to get a new framework, I think it probably at least allows us to communicate patient status and also therapeutic success a little more straightforwardly.

Chovatiya previously reported serving as an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Argenx, ASLAN Pharmaceuticals, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, Eli Lilly and Company, FIDE, Formation Bio, Galderma, Genentech, GSK, Incyte, LEO Pharma, L’Oréal, Nektar Therapeutics, Novartis, Opsidio, Pfizer Inc., Regeneron, RAPT, Sanofi, Sitryx, and UCB.

Merola JF, Childs BA, Bartley BR, et al. International Eczema Council Definitions of Low Disease Activity and Remission in Atopic Dermatitis: A Consensus Statement. JAMA Dermatol. Published online April 15, 2026. 

Smith T. International Eczema Council Releases Definitions of Remission, Low Disease Activity. HCPLive. April 29, 2026. Accessed May 11, 2026. 

https://www.hcplive.com/view/international-eczema-council-releases-definitions-remission-low-disease-activity

Articles

Integrating clinician-reported signs with patient-reported symptoms is essential to defining atopic dermatitis disease control, given the frequent disconnect between visible inflammation and lived burden, particularly pruritus. A new consensus framework was developed to avoid sign-only or symptom-only definitions and to enable shared, standardized language around low disease activity, very low disease activity, control, and remission, both on-therapy and off-therapy. Aligning endpoints with these cutoffs could streamline trial interpretation, facilitate cross-drug comparisons, and clarify potential regulatory claims, while remaining practical for routine care.

In this segment of his interview, Chovatiya speaks about how new consensus definitions on atopic dermatitis disease activity could impact clinical trials.

Impacts of Consensus Disease Activity Definitions for Eczema, With Raj Chovatiya, MD, PhD

Discussing New International Eczema Council Definitions of Disease Activity, With Raj Chovatiya, MD, PHD

, Raj Chovatiya, MD, PhD, of Rosalind Franklin University of Medicine and Science, highlighted the growing importance of standardized disease activity definitions in atopic dermatitis and their potential to reshape both clinical care and research.

During his discussion, Chovatiya noted, although there have been recent major therapeutic advances, the dermatology space has lacked clear, universally accepted benchmarks for what would signify the presence of meaningful disease control. As a result, this poses a notable challenge for clinicians, trial investigators, and regulators alike.

“Frankly, you've probably done a number of these interviews over the past couple of years where people use these terms about disease control or disease remission and and there really hasn't been a really standardized approach to defining these concepts,” Chovatiya noted.

Chovatiya spoke about this initiative, headed by the International Eczema Council, as an effort to establish globally relevant definitions for lower levels of disease activity (LDA), for very low disease activity (vLDA), and for disease remission via the use of a structured, consensus-driven process. Drawing on both clinician-reported outcomes, such as Eczema Area and Severity Index (EASI) and validated Investigator Global Assessment (vIGA), and patient-reported measures like itch scores, he noted the framework reflects a more comprehensive view of disease burden.

Chovatiya furthermore pointed to the incorporation of both objective signs and subjective symptoms as being essential, noting pruritus issues and various quality-of-life impacts often impact patient experiences heavily, even when visible inflammation is limited. A key feature of the framework, according to Chovatiya, is its modular structure, which distinguishes between remission of signs, symptoms, and overall disease.

Chovatiya also noted this approach allows for greater nuance in the assessment of treatment response. It also acknowledges complete alignment between clinical findings and patient-reported outcomes as not always occurring. These new definitions also provide invaluable distinctions between on-treatment disease control and sustained remission following cessation of therapy.

Chovatiya described these standardized definitions as potentially allowing for more consistent comparisons across clinical studies and improving regulatory clarity, especially as newer targeted medications continue to raise expectations for treatment outcomes. He also suggested that the framework may support a broader shift toward treat-to-target strategies in atopic dermatitis, helping clinicians to set clearer goals and adjust treatments in a more systematic manner.

Smith T. International Eczema Council Releases Definitions of Remission, Low Disease Activity. HCPLive. April 29, 2026. Accessed May 6, 2026. 

In this interview, Chovatiya highlights several key takeaways regarding the latest definitions highlighted by the International Eczema Council.

Discussing International Eczema Council Definitions of Disease Activity, With Raj Chovatiya, MD, PHD

Cardiovascular and Cardiometabolic Risk in HS Demands Greater Clinical Attention, With Raj Chovatiya, MD, PhD

Patients with hidradenitis suppurativa (HS) face a broad spectrum of cardiovascular and cardiometabolic comorbidities, with risk elevations for multiple major outcomes that are consistent across study designs and geographic regions, according to a recent review and meta-analysis presented at the 

2026 American Academy of Dermatology (AAD) Annual Meeting

 held in Denver, Colorado, from March 27-31.

caught up with investigator 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, during the meeting, who argued that these findings should push dermatologists toward more systematic cardiovascular risk assessment in patients with HS.

The study was a PRISMA-guided systematic review and random-effects meta-analysis of studies identified through a search of PubMed, Embase, Scopus, CINAHL, and the Cochrane Library from inception through June 16, 2025. Twenty-five studies encompassing 373,689 patients with clinician-diagnosed HS were included. Random-effects meta-analyses were performed using the DerSimonian-Laird estimator, with between-study heterogeneity quantified using Cochran's Q, τ², and I².

Pooled prevalence estimates revealed a broad comorbidity profile across the included populations. Hypertension was the most prevalent condition, affecting 25.52% (95% CI, 20.88-30.45) of patients. Other pooled prevalence estimates included coronary artery disease at 4.2% (95% CI, 1.8-7.4), congestive heart failure at 1.9% (95% CI, 1.2-2.7), myocardial infarction at 1.9% (95% CI, 1.2-2.7), atrial fibrillation or flutter at 1.7% (95% CI, 1.0-2.6), cerebrovascular disease at 2.2% (95% CI, 1.2-3.3), and peripheral vascular disease at 2.2% (95% CI, 0.9-3.9).

The risk association analyses yielded findings Chovatiya described as the most clinically consequential output of the meta-analysis. HS was associated with a risk ratio (RR) of 1.85 (95% CI, 1.44-2.38) for heart failure, 1.75 (95% CI, 1.59-1.92) for coronary and ischemic heart disease, and 1.51 (95% CI, 1.22-1.88) for myocardial infarction. Risk of venous thromboembolism was also elevated, with an RR of 1.72 (95% CI, 1.45-2.05), as was all-cause mortality, with an RR of 1.86 (95% CI, 1.10-3.12). HS was additionally associated with a 52% increased odds of hypertension versus comparators (odds ratio, 1.52; 95% CI, 1.29-1.80). These associations were consistent across study designs and geographic regions. Chovatiya noted that while some pooled prevalence estimates were numerically similar to general population ranges, HS cohorts were disproportionately younger and female — populations in which this degree of cardiovascular risk is not typically expected — suggesting the clinical significance of these findings exceeds what raw prevalence numbers alone convey.

Chovatiya characterized the breadth of the comorbidity profile as the finding that most surprised him on reflection, noting that the aggregated published literature paints a picture of risk that extends across virtually every major cardiovascular outcome category. He framed the findings as supporting a shift toward routine cardiometabolic risk assessment and multidisciplinary preventive care in HS, while acknowledging that the most pressing unanswered question — whether timely targeted therapy modifies these outcomes — cannot be addressed by the existing retrospective observational evidence base. Most included studies lacked detailed reporting on HS severity, treatment exposure, and longitudinal risk factor trajectories, precluding causal inference. Prospective cohort studies and registry-based approaches capturing patients at or near disease onset will be needed to establish whether early intervention changes the cardiovascular trajectory in this population.

“I think what's really probably missing is, in addition to what I talked about [with] good prospective epidemiology, is trying to connect therapeutic intervention to some of these functional outcomes to see, indeed, if these are real risk factors, does timely intervention with targeted treatments make a difference,” Chovatiya said.

Mense SA, Hopkins T, Chovatiya R. Prevalence and risk of cardiovascular comorbidities and cardiometabolic factors in hidradenitis suppurativa: a systematic review and meta-analysis. Poster #76428. Presented at: AAD Annual Meeting; Denver, Colorado; March 27-31, 2026.

Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. 

. 2016;152(4):429-434. doi:10.1001/jamadermatol.2015.6264

HS is associated with up to a nearly 2-fold increased risk of heart failure, coronary artery disease, myocardial infarction, venous thromboembolism, and all-cause mortality.