Utilization of Internet and Social Media by Outpatient Dermatology Patients: A Prospective, Cross-sectional Study

J Clin Aesthet Dermatol. 2025;18(1):29–34.

by Autumn L. Saizan, MD; Simone N. Montgomery, MD, MPH; Li Ding, MD, MPH; Arielle Carolina Mora Hurtado, BS; and Nada Elbuluk, MD, MSc

Dr. Saizan is with the Department of Dermatology at Johns Hopkins University School of Medicine in Baltimore, Maryland. Drs. Montgomery and Elbuluk are with the Department of Dermatology at Keck School of Medicine at the University of Southern California in Los Angeles, California. Dr. Ding is with the Southern California Clinical and Translational Sciences Institute in Los Angeles, California. Ms. Hurtado is with the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin.

FUNDING: This work was supported by grant UL1TR001855 from the National Center for Advancing Translational Science (NCATS) of the U.S. National Institutes of Health. This program had no role in study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication. 

DISCLOSURES: Dr. Elbuluk has served as a consultant, advisory board member, and/or speaker for Avita, Scientis, Incyte, VisualDx, La Roche Posay, Beiersdorf, Unilever, Eli Lilly, Galderma, Pfizer, L’Oreal, McGraw Hill, Dior, Medscape, Abbvie, Takeda, Sanofi. She has received royalties from McGraw-Hill. She has stock options in VisualDx. The remaining authors have no disclosures to report.  

ABSTRACT: Background: Online health-related information (HRI) has expanded access to medical knowledge. While there are benefits to the increasing availability of online HRI, there may be limitations to the accuracy, quality of information, and utilization across patient demographics.

Methods: A survey was administered to dermatology outpatients at the Keck School of Medicine of the University of Southern California to examine the utilization of internet and social media for acquiring dermatology-related information (DRI).

Results: A total of 200 patients completed the survey. A majority (90%) indicated utilizing the internet to research information about their dermatological condition. Approximately 74 percent researched their dermatological condition before visiting the dermatologist, and 80 percent researched their condition after seeing a dermatologist. Younger patients (ages 18–25) were more likely to utilize online HRI before and after their visit. When stratified by income level, those with an income of less than $20,000 a year were more likely to search online for symptom management. Overwhelmingly, patients (99%) preferred to receive DRI from a dermatologist over internet or social media.

Limitations: A limitation of our study is the exclusion of individuals with dermatologic issues who do not seek in-person dermatologic care, which may contribute to selection bias.

Conclusion: There are differences across demographics in the utilization of the internet and social media for obtaining DRI. Understanding patients’ interactions with online HRI may allow providers and patients to work synergistically, leveraging online resources to support the dissemination of credible information and optimize patient outcomes.

Keywords: Outpatient dermatology, internet, social media, online health-related information, patient education

Introduction

As of 2023, it is estimated that approximately two-thirds of the world’s population has internet access.¹ The internet is an accessible resource for health-related information (HRI). Searching for medical information is the third most common use of the internet, with most patients referring to the internet before consulting their physician.^2,3 The internet allows patients to obtain vast types of medical information, including but not limited to diagnoses, symptoms, and treatments.⁴ Increased availability of accurate and readable medical information online may help promote digital health equity, bridge communication gaps between physicians and patients, and foster patients’ sense of control and responsibility for their health.^5,6 Additionally, the internet serves as a platform for global online health communities, where patients may find support, inspiration, and accountability.⁷ 

While there are several benefits to the availability of HRI online, there can be limitations to the accuracy and quality of information and its usability across various patient demographics. HRI online may be inaccurate, outdated, or lacking supportive evidence and references.^3,4 Such inaccuracies can negatively affect patient health, particularly when used in place of seeking professional care. Varying levels of health literacy among patients can make the internet a difficult space to navigate. Some patients lack the ability to search, obtain, and understand HRI online.⁶ Additionally, patients may have trouble finding information relevant to their condition, become overwhelmed by the breadth of information available, or become confused if conflicting information is found. For those without a confirmed diagnosis, it can lead to the assumption of incorrect diagnoses and unnecessary anxiety. Online dermatologic HRI can also have a negative impact on patients when it is utilized in lieu of seeing a board-certified dermatologist.^3,6 Previous reports suggest a discordance between patients and physicians regarding the reliability of online HRI.⁸

There is a paucity of literature on how patients balance online HRI with their dermatologist’s recommendations. This study evaluated the attitudes and practices of outpatient dermatology patients in utilizing the internet and social media to acquire dermatology-related information (DRI). This study assessed the sites and platforms most frequently used to obtain information, the type of information searched, and the influence of online HRI on the patient-physician relationship. Additionally, this study sought to determine whether patients considered their dermatologist the most reliable source of DRI and how patients responded to discordance between DRI gathered online and that provided by their dermatologist. 

Methods

Sample selection. This was a cross-sectional survey study conducted among dermatology outpatients at the Keck School of Medicine Downtown Dermatology Clinic in Los Angeles, California between January 2020 and November 2020. All patients 18 years of age and older were eligible. Patients were informed of the less-than-minimal risk associated with participation in the study and notified that no identifying patient information would be collected. Among eligible respondents, 200 agreed to participate. Consenting patients were given the survey to complete in person while waiting for their office visit. The survey consisted of 30 questions and took less than ten minutes to complete. All who completed the survey were offered a $5 gift card for their participation. This study received an exemption determination by the Institutional Review Board of the Keck School of Medicine at the University of Southern California. 

Data collection. Survey questions were adapted from questionnaires investigating internet use for health and medical information.^5,9 Questions were modified to fit the study objectives. Patients were given a paper survey to complete in the exam room prior to their appointment.

Demographic information collected included age, gender, race, ethnicity, education level, income level, marital status, dermatological diagnosis, duration of dermatological disease, and severity of dermatological disease. Education level was defined as secondary school or lower, associate or bachelor’s degree, or post-graduate or higher. Income level was stratified into four categories, (ie, <$20,000, $20,000–$44,999, $45,000–$99,999, and >$100,000).⁸ Duration of dermatological disease was defined as acute or chronic, and severity (mild, moderate, severe) of dermatological disease was based on the patient’s own self-perception of their disease. 

Questions also assessed internet and social media access, extent of use, platforms and websites utilized, type of information searched, perceptions of DRI online, level of satisfaction and trust with HRI online, and influence on the patient-physician relationship. 

Statistical analysis. Frequency and percentage were reported to summarize patient characteristics, internet and social media use and social economic status. Chi-square test and Exact test with Monte Carlo simulation, with N=1,000, was used for variables comparisons across groups, when appropriate. Significance level was less than or equal to 0.05, two-sided. Due to the exploration feature of the study, no adjustment for multiple comparison was conducted. All analyses were performed using SAS 9.4 (SAS Institute Inc., Cary, North Carolina).

Results

A total of 200 patients completed the survey (Table 1). Of those who indicated their gender, 64 percent (n=127/199) were female. The largest group of participants were between 26 to 36 years (42%, n=84/199). The majority of patients were White (49%, n=93/188), followed by Black/African American (21%, n=39/188). Among the 175 participants indicating their ethnicity, roughly 80 percent (n=140/175) self-identified as non-Hispanic. The majority of patients had a bachelor’s education or higher (87.9%, n=175/199). Over a third of patients (36.92%, n=72/195) reported an income level of >$100,000 followed by an income level of $45,999–99,999 reported by 31.79 percent (n=62/195) of patients. The five most common chief complaints among respondents included acne, skin check, rash, scalp and hair disorders, and pigmentary disorders. 

The majority of respondents (90%, n=180/199) reported utilizing the internet to research information about their dermatological condition. Roughly 74 percent (n=146/196) reported researching their condition before visiting a dermatologist, and 80 percent (n=156/196) reported researching after visiting a dermatologist. When stratified by age, those ages 18 to 25 had the highest percentage of respondents reporting researching their condition before (78%, n=39/50) and after (90%, n=45/50) a dermatology outpatient visit (p=0.02 and p=0.03 respectively). Of those 65 years or older, few (25%) reported using the internet or social media to diagnose, treat, or gather information about their condition prior to seeing a dermatologist (p=0.02). However, 88 percent reported researching their condition after seeing a dermatologist (p=0.03). 

The most common types of information sought were how to manage/improve symptoms (72%, n=141/197) followed by the underlying cause of their condition (63%, n=125/197) (Figure 1). Most individuals across all age groups, except those 65 years or older, used the internet for symptom management (p<0.0001). When stratified by gender, a higher percentage of female respondents reported searching how to improve/manage symptoms compared to their male counterparts (78%, n=97/125 versus 61%, n=43/71; p=0.01). There was also a higher proportion of female respondents reporting using the internet to search homeopathic treatment options compared to their male respondent counterparts (52%, n=65/125 versus 27%, n=19/71; p=0.0006). When stratified by income level, those making less than $20,000 a year had the highest percentage (91%) of respondents reporting searching online for symptom management (p=0.03).

The most used search engine among respondents was Google (93%, n=183/197) and the most used social media platform was Instagram (14%, n=27/198) (Figure 2). The most used websites were WebMD (65%, n=128/197) followed by hospital-associated websites (60%, n=118/197) (Figure 3). While most respondents did not use blogs or forums, those ages 18 to 25 and 26 to 39 reported using these sites more often than their counterparts ages 45 or older (p=0.0001). When stratified by gender, a higher percentage of female respondents using hospital-associated websites compared to male respondents (68%, n=85/125 versus 45%, n=32/72; p=0.002). When stratified by level of education, respondents with a post-graduate degree or higher had the highest percentage of individuals preferred using medical organization websites to search for information about their dermatological condition (33%, n=29/86; p= 0.06). Similarly, those with a post-graduate degree or higher also had the greatest percentage of individuals that preferred peer-reviewed research articles to access information about their dermatological condition (30%, n=26/86; p=0.02). 

Nearly 68 percent (n=134/198) of respondents denied using social media to research their dermatologic condition. When stratified by gender, there was a higher percentage of female respondents using social media compared to their male respondent counterparts (38%, n=48/127 versus 22%, n=16/72; p=0.01). Among social media platforms, Instagram was the most utilized. Roughly 18 percent (23/127) of female respondents reported using Instagram to research their dermatologic condition compared to 5.6 percent (n=4/72) of male respondents. Facebook and Twitter were used by few respondents. 

The most used criteria for website credibility was “website association with a hospital” (68%, n=133/199) followed by “website associated with an organization” (60%, n=118/197) (Figure 4). There was a higher percentage of female respondents listing “website association with a hospital” as a criterion for website credibility compared to their male respondent counterparts (74%, n=93/125 versus 56%, n=40/71, p=0.01).

Roughly 84 percent (n=165/197) of respondents believe DRI online to be “somewhat trustworthy” as opposed to “very trustworthy” or “not trustworthy at all.” Approximately one third of patients who searched DRI online state they “sometimes” apply the medical information they find without consulting a dermatologist (n=70/195, 36%). An estimated 40 percent (n=78/194) and 41 percent (n=79/194) of respondents respectively, reported “never” using or buying medications or herbal remedies for their dermatologic condition based on online recommendations. When stratified by gender, 50 percent (n=36/72) of men versus 33 percent (n=42/127) of women reporting “never” using/buying medications recommended online (p=0.03). With respect to herbal remedies, some women (38%, n=48/127) reported “sometimes” using/buying herbal remedies recommended online in contrast to most male participants (60%, 43/72) reporting “never” to this question (p=0.0001). 

An overwhelming majority of respondents preferred to receive their DRI from a dermatologist (99%, n=195/196) and trusted their dermatologist in providing accurate information (99%, n=197/200). Most are “very satisfied” with the information provided to them by their dermatologist (78%, n=151/194) and are “somewhat satisfied” with the information found online (75%, n=147/195). A majority (90%) of respondents stated they would follow their dermatologist’s recommendations should they differ from the information found online. Across all racial groups, most participants stated they were “very satisfied” with the explanations about their conditions and/or medications provided by their dermatologist (p=0.02).

Discussion

In this study, 90 percent of respondents reported using the internet to research HRI, with Google being the most utilized platform. Search engines are often a starting place for patients seeking HRI.⁴ Previous studies in the literature highlight the utility of using Google to identify patient interests and medical needs.⁹ Kaminski et al⁹ found seasonal and regional variations in Google search trends relating to cutaneous disease. In 2019, acne was searched on Google 3.2 million times per month.¹⁰ Such findings highlight the importance of search engine optimization for easy navigation to trusted HRI websites.⁴ Given that Google is the most widely used search engine globally, more studies investigating search trends dermatologic diseases are needed.⁹ 

When stratified by demographics, a higher percentage of younger individuals and women reported internet use for HRI. This is consistent with previous studies, which have noted younger age and female gender to be major predictors for seeking HRI online.^8,11,12 Compared to any other age group, those ages 18 to 25 had the highest percentage of respondents to report researching their condition before and after seeing their dermatologist. In a study by Kontos et al,¹¹ adults ages 18 to 34 were 3.5 times as likely and adults aged 35 to 49 were 2.5 times as likely as those 65 years or older to search for HRI online. Older generations may have increased difficulty navigating technology and the internet, which may contribute to these differences.¹¹ While few respondents ages 65 and older reported utilizing the internet to obtain dermatological information before seeing their dermatologist, a majority of older adults reported doing so after seeing their dermatologist. More research is needed to understand the utilization of HRI among older adults. 

In this study, we assessed the use of social media platforms for search of HRI, specifically Instagram, Facebook, and Twitter. Only 14 percent of respondents used Instagram and even fewer used Facebook or Twitter. Use of TikTok was not directly assessed though respondents had the option of including this under the “other” category. At the onset of this study, TikTok was not recognized as a major platform for dissemination of HRI, particularly with respect to dermatologic issues. It has since increased in popularity over the last few years particularly in the area of dermatology. Kassamali and Villa-Ruiz et al¹³ note that the number of views for the keyword “acne,” doubled from 3.0 to 6.7 billion over a five-month period in 2021. The largest audience for TikTok is adolescents (10–19 years old).¹⁴ The patient demographic of this study, with respect to age, may explain the limited use of social media to obtain HRI, as all respondents were 18 years or older. In this study, the majority of participants across all age groups denied using social media to search for DRI. With respect to gender, however, a higher percentage of women were more likely to use social media, particularly Instagram, compared to their male counterparts. More women reported searching how to manage/improve their symptoms and homeopathic treatment options. This is consistent with prior studies, which have highlighted a significant association between female gender and internet and social media use to search for HRI as well as implementation of dermatologic treatments recommended online.^15,16 Such findings may reflect the increasing influence of social media on health decisions. 

Park et al¹⁷ conducted a study characterizing the content of top dermatology-related posts on Instagram and found that the majority of posts were made by individuals lacking formal dermatologic education. This highlights the potential increased risk for misinformation from HRI on social media. AlGhamdi et al⁸ reported that roughly 60 percent of patients prefer a direct explanation from their doctor and many prefer to be guided by their physician on which websites to utilize. Twenty-five percent prefer websites provided by doctors while 8.5 percent prefer websites found during their own search.⁸ This suggests that dermatologists have an opportunity to guide patients to resources with accurate and credible HRI.⁸ Dermatologists can help also counter this issue by leveraging their own social media platforms to share DRI. 

Other factors considered predictors of increased internet use, in addition to age and gender, include higher income and higher education.^11,12 In this study, most respondents, regardless of income or education level, reported searching their dermatologic condition online. This may highlight the increasing accessibility of the internet irrespective of socioeconomic status (SES). While there were no significant differences in internet access and use, there were differences in the type of information searched and the resources used based on respondent income and education level. An overwhelming percentage, roughly 92 percent, of individuals making $20,000 a year or less and those with a high school education or less reported looking up how to manage or improve their symptoms, compared to the roughly 60 to 70 percent of respondents identified making more than $20,000 a year. This may indicate an increased reliance on online HRI amongst individuals of lower SES, as they are more likely to have barriers to healthcare access and dermatologic care. 

In terms of resources used, although overall fewer respondents reported using social media to search HRI, a higher percentage of respondents making $20,000 a year or less and those with a high school education or less reported using social media, particularly Instagram, to search for HRI. In a study by Kontos et al,¹¹ households with incomes less than $20,000 were two times more likely to use social media for HRI than households making $75,000 or more. SES can influence both healthcare access as well as digital health literacy.^11,18 “High connectivity” refers to those households with broadband access as well as a laptop, desktop, tablet, and/or mobile device.¹⁹ Sanders and Scanlon¹⁹ report that among households with an income of $150,000 or higher, 80 percent have “high connectivity,” compared to only 21 percent of households with an income of $25,000 or less. Previous reports note that lower-income individuals rely more heavily on their smartphones for internet access, and are thus, less likely to participate in certain online activities.¹⁹ In a study by Neter et al²⁰, those of higher SES had higher digital health literacy, as they were better able to search for, understand, and utilize HRI. These individuals were better able to take ownership of their health and cultivate an environment of shared-decision making with their provider. With respect to race/ethnicity, most respondents were non-Hispanic White. This has been reflected in prior studies, in which racial and ethnic minorities were less likely to use outpatient dermatologic services compared to their non-Hispanic White counterparts.²¹ Nevertheless, no significant differences in internet use or preferences were found. Most respondents from each racial or ethnic group reported being “very satisfied” with their dermatologist’s explanations, and only “somewhat satisfied” with the explanations found on the internet. 

Nearly 90 percent of respondents stated they would follow their dermatologist’s recommendations should they differ from those found online. Most reported they would never apply online medical information without first consulting their dermatologist. Such results suggest that individuals who seek dermatologic care recognize the limitations of online HRI information in terms of quality and credibility and that for them dermatologists remain the primary source of information for their dermatologic concerns. Similar findings were reported by AlGhamdi et al,⁴ in which 93 percent of patients considered their doctor their most reliable source of information, with 60 percent preferring a direct explanation from their physician and 95 percent reporting they did not trust all online HRI.⁴ 

Limitations. One limitation of this study includes a high false discovery rate secondary to intensive multiple hypotheses testing. A false discovery rate refers to the number of false positive results out of a set of tests considered significant.²² Another limitation is the possible exclusion of individuals with dermatologic issues who do not come to a dermatologist secondary to selection bias. Selection bias could also account for higher trust and satisfaction with dermatologists, as all survey respondents were at a dermatologist office at the time of survey completion.

Conclusion

In the age of advancing technology and continued widespread utilization of the internet and social media globally, understanding the role of these technologies in patient care is critical in optimizing patient comprehension and supporting the physician-patient relationship. This study showed that gender, age, and SES play a role in the utilization of online HRI. Patients are interested in understanding the cause of their conditions and how they can manage symptoms. Dermatologists can improve the patient-experience by providing handouts that include this information as well as directing patients to credible online resources. Numerous organizations including the American Academy of Dermatology, the Skin of Color Society, the American Society for Dermatologic Surgery, British Association of Dermatologists, and European Academy of Dermatology and Venerology have comprehensive, patient-friendly information on dermatologic conditions. With respect to social media, physicians may also consider leveraging their online presence to address the shift in patient needs, which includes more reliable and accessible educational material on various interactive platforms.²³ Through optimizing the use of HRI online, dermatologists can help enhance patients’ health literacy, improve patient rapport and health outcomes, and expand medical expertise outside of the outpatient setting. 

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