How Online-Informed Patients Are Changing Dermatology Visits

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