The Year Without a Dermatologist

The title may have caught your eye, so let me explain. With the rapid rise of dermatology-focused telehealth companies prescribing isotretinoin, hair loss and melasma treatments, and other medications—along with a proliferation of home skin care products and devices marketed directly to consumers—many patients understandably question the need to see their friendly neighborhood board-certified dermatologist.

Obviously as a dermatologist, I admit I am perhaps biased. But my goal here is not to rain on this parade; the forecast only calls for a drizzle. There is both potential benefit and risk when patients circumvent traditional dermatologic care. In my efforts to deep dive into this topic, I consulted my trusty Gen Z medical assistant and future medical student, Shrea Kumar, to better understand what and why her fellow generational brethren do what they do to their hair and skin.

To See a Derm or Not to See a Derm—That Is the Question

As a clinician with a passion for a good bargain and one who legitimately enjoys helping patients save time and money, I am more than happy to advise patients on safe and effective home treatments and products. It was always a pet peeve of mine in residency and in practice when I saw a patient potentially get “duped” or “sold” a product, cosmetic service, etc, that was unnecessary or when a cheaper direct-to-consumer alternative was available. Is it obvious yet that I mostly specialize in medical dermatology? Although I am somewhat of a chemical peel guru. See: my groundbreaking inaugural article in this publication.

The Flip Side

Unfortunately, complications from online telehealth or social media–endorsed products are a weekly if not daily occurrence in my clinic. If I had a dime for every post–“glow-up” hyperpigmentation crisis or dubiously counseled telehealth prescription I’ve had to clean up, I’d have about 70 cents. Not enough to retire, but enough to feel validated. There is clearly no universally accepted recommendation on whether direct-to-consumer/patient skin care things are good, neutral, or bad. As an academic dermatologist, I find case-based examples useful to illustrate the risks.

Case Studies: When DIY Derm Goes Wrong

Acne attack

The high schooler who emulated the classic TikTok trend of “slugging” with the caking on of petroleum jelly all over the face, consequently resulting in an impressive acne flare

Eyelid eczema extravaganza

The college student who was prescribed tretinoin online and wasn’t counseled to avoid the periorbital skin, subsequently leading to a juicy case of eyelid irritant contact dermatitis

Microneedling mayhem

The adult patient who did a couple in-office microneedling sessions who wanted to save thousands of dollars by buying a “medical grade” microneedling pen off the dark web but lacked knowledge of sterile technique, prescription numbing cream, and appropriate procedural training

Chemical peel catastrophe

The aspiring influencer with Fitzpatrick skin type V who bought medical-grade, high-strength glycolic acid on eBay and gave herself a chemical peel, with resultant post inflammatory hypopigmentation

Hydroquinone horror story

The melasma patient who obtained prescription-strength hydroquinone via an online telehealth company and used it for 8 months straight without stopping due to not receiving proper counseling on the risks of exogenous ochronosis with continued use, ergo developing the slate-gray staining of the skin where the product was applied

iPledge plot twist

The busy female corporate executive with severe acne who started isotretinoin via an online telehealth company and claimed she was abstinent during the iPledge enrollment process became pregnant and did not receive the proper guidance on further actions

On Second Thought...

Well, it appears I have created a classic M. Night Shyamalan twist here. Turns out I was wrong: Direct-to-consumer skin care without consulting a dermatologist is never good. Call it bias. Call it wanting to still have patients to see. I call it being a responsible physician who looks out for his patients, their skin, and their wallets. Here’s to 2026.