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Ask the Dermatologist: What are the Risks of Online Acne Treatment & Prescriptive Skin Care Service

by Joel Bain Herron, MD


With the onset of the pandemic, we found ourselves increasing the time we spent online, on-camera, both working and socially using apps like Zoom. Staring intently at yourself and others in online meetings for extended periods of time led to an increase in our awareness of skin issues and cosmetic concerns, and sent many people searching online for skincare and acne treatment solutions. Not surprisingly, there has been a surge in the availability of online dermatologic services providing virtual skin, acne treatment care, and prescriptive services.


How are skin and acne treatments prescribed online?


Commonly, the format may consist of going online to express your concerns, completing a questionnaire about your skin and skin care history, uploading a few photos of your skin, and consulting with a "skincare specialist.” Generally, this will be followed by shipping a few of their purported remedies to you via mail delivery.


There is no doubt these services could fulfill some unmet need or might extend some means of care for those that are unable to see a dermatologist or to afford a dermatologic visit. There are parts of the country where dermatologic care is less available, and these online services also will generally be less of an expense than an in-office physician appointment. But caveat emptor (buyer beware)!


Digital skincare versus in-person evaluation


With the pandemic, many dermatologists were forced into the world of online digital appointments. I can tell you from my personal experience as well as the experience of most dermatologists I have discussed this with, there is absolutely no substitute for evaluating a dermatologic condition in person.


You can much more accurately and confidently diagnose something when you're able to see it in person from various angles, with different lighting, and can actually feel or palpate it, if necessary. I dealt with small images taken from a distance, out of focus or fuzzy images, and poor lighting during virtual visits. For Northeast Dermatology, online appointments were something we had to endure in order to make the best of a bad situation. It’s definitely not our preferred method for evaluating and diagnosing skin conditions.


Who’s making your diagnosis online?


Another concern about online acne treatments and care of other conditions is the credentials of the "skin care specialist." A dermatologist has a medical degree, followed by an internship, and then an accredited residency in dermatology. Generally, includes at least eight years of higher education and training beyond a college degree.


The online "skin care specialist" may or may not have any significant medical training, but would still be able to recommend over-the-counter treatments. There’s a chance they could be a physician assistant or nurse practitioner, either of whom has prescriptive authority. Certainly, an appropriately trained physician assistant or nurse practitioner who has completed an adequate amount of intensive training under the close direction and supervision of a dermatologist can competently provide dermatologic services, but the amount of dermatologic-specific training and supervision of these online "specialists" is not always apparent.


Do you actually need acne treatment?


We’ve seen issues with these online services, including misdiagnosis. So many of these sites are set up to derive their revenue from sales of their products, and with acne treatment products making up the bulk of their products, acne tends to be over diagnosed. Other similar conditions such as rosacea or perioral dermatitis can have a similar appearance and be particularly hard to discriminate in photos. Some treatments for acne may not be appropriate for these conditions, and may even make them worse.


If you need acne treatment, can it be prescribed online?


It’s also important to note that not all acne treatments can be prescribed online. Some require blood work monitoring or an in-office urine pregnancy test. In particular, I am thinking about Accutane for the treatment of acne. A dermatologist has a limited window of opportunity in which to act in order to have the best chance at minimizing or avoiding the chances of acne scarring. Once scarring occurs, there is no medication that is going to eliminate it. There are surgical options that are available to address the scarring once apparent, but a delay in starting Accutane in an appropriate patient can have permanent consequences.


Money-motivation doesn’t equal excellent patient care


A few years ago, a pharmaceutical company set up an online site. Regardless of what condition or concern a patient seemed to have, the only treatment options offered were ones that were manufactured by that company. Of all the medications in existence, the "skincare specialist" employed by the pharmaceutical company apparently felt that particular company produced the best medication options for every condition. Once dermatologists became aware of this and complained, the pharmaceutical company shut down the site within a matter of days.


I’ve also seen sites that waive their evaluation fee or apply it toward the purchase of a product. I have to ask myself how financially incentivized they are to recommend medications from their limited arsenal, whether appropriate to treat the condition or not, if all of the revenue they derive is dependent on the sale of those medications.


Nothing equals in-person care


I don't mean to sound too skeptical or suspicious of these online dermatologic sites. I believe that in certain circumstances, they may provide valuable care to those who don't have access to or cannot afford proper dermatologic care.


However, in my experience, there is no substitute for an in-office evaluation with access to all available treatment options from a variety of sources.


If you seek acne treatment or care for another skin issue, please reach out to us today!