Reshaping Dermatology: The Enduring Impact of COVID-19

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On March 11, 2020, the World Health Organization (WHO) declared the outbreak of SARS-CoV-2 and the associated disease (COVID-19) a global pandemic. Just a few days later, on March 15, states began to implement lockdown orders.¹ Although the pandemic officially ended on May 11, 2023, its reverberations continue to be felt across the entire field of medicine. As we mark the fifth anniversary of this once-in-a-lifetime event, it is evident that dermatology, a specialty heavily reliant on both physical examination and visual-textural context, has experienced profound and lasting changes. Three long-term effects on dermatology have emerged across academia and private practice.

Telehealth

The most significant shift during the pandemic was the rapid adoption of telemedicine. Historically, telemedicine was used for patients unable to attend in-person evaluations. However, as pandemic restrictions limited in-office visits, remote consultations quickly became the standard of care. During this period, 75% of dermatologists offered telehealth appointments, representing a 200% increase.² Telemedicine remains a convenient option for many patients but has also presented challenges. The difficulty in encouraging patients to return for in-office evaluations, particularly for procedures, has been notable. The inability to perform full skin exams and assess textural changes remotely remains a limitation, emphasizing that although technology offers efficiency, it cannot fully replace in-person care.

Although social media has been a part of the digital landscape since the late 1990s, its influence skyrocketed during the pandemic, becoming a primary source of communication, information, and entertainment. For the first time, social media platforms ranked as the top 3 digital resources individuals use for health-related decisions.³ Unfortunately, this democratization of information has blurred the lines between trained medical professionals and unqualified individuals dispensing medical advice.

Social Media

The term provider has become a catch-all phrase, often failing to distinguish between dermatologists and nonphysicians. Many patients are unaware that individuals offering skin care advice online may have little to no formal medical training. A recent American Society for Dermatologic Surgery (ASDS) survey revealed that over half of respondents stated a provider’s social media presence influenced their decision to schedule an appointment. Currently, 73% of individuals follow the social media accounts of their prospective providers, and 84% rely on online ratings and reviews to guide their choices. Alarmingly, 33% of respondents prioritized price over a provider’s qualifications, compared with just 21% who considered licensure or educational background the most important factor.³ This suggests that cost-saving measures may take precedence over practitioner expertise, posing significant patient risks.

Figure 1. Most Requested Procedures Following Clinics Re-Opening After Pandemic⁶

Nondermatologists offering cosmetic services frequently fail to discuss key dermatologic considerations, including Fitzpatrick skin types, anatomical variations, healing processes, and potential adverse events.⁴ Additionally, product origins and safety profiles are often undisclosed. The rise of social media influencers promoting unverified treatments has led to widespread misinformation, unrealistic expectations, and potential patient harm. This cyber-driven misrepresentation remains a challenge for the dermatology community.

Technology has influenced health care delivery and reshaped self-perception. The increased use of video calls, online meetings, and virtual platforms has led many individuals to scrutinize their appearance in ways they never had before. This phenomenon, the Zoom effect, resulted in heightened awareness of perceived imperfections, leading to increased demand for cosmetic procedures. Often referred to as Zoom gloom or Zoom doom, this shift became evident when dermatology practices reopened post pandemic.⁵ Survey findings showed a 52% increase in new patients seeking aesthetic treatments and an 80% increase in existing patients pursuing cosmetic enhancements. The most requested procedures included wrinkle relaxers (65%), soft tissue fillers (54%), and laser and light-based treatments (40%) (Figure 1).⁶

Figure 2. American Society for Dermatologic Surgery Survey Summary³

Despite the growing role of social media in influencing patients’ decisions, dermatologists remain the most trusted source for guidance on cosmetic procedures and skin care purchases—a distinction they have held since 2018.³ According to the ASDS survey, more than 70% of patients who consulted a dermatologist ultimately received treatment from an ASDS member. When selecting a provider, patients identified several key factors influencing their decision: price (33%), specialty (23%), before-and-after photos (23%), physician referral (22%), friend referral (22%), and level of licensure (21%) (Figure 2).³

As cosmetic dermatology flourishes in this postpandemic era, physicians must recognize the psychological and societal pressures shaping patient perceptions. This surge in demand may be lucrative, but it also raises concerns regarding body dysmorphic disorder (BDD), which is notably more prevalent among dermatology and aesthetic medicine patients than among the general population. Dermatologists must balance patient expectations with ethical practice, ensuring that treatment decisions prioritize mental and physical well-being.

Market Challenges

The pandemic also brought about significant operational challenges for dermatology practices. Many offices faced staffing shortages, furloughs, and financial strain. Some dermatologists, burdened by rising overhead costs and regulatory pressures, chose to sell their practices to venture capital firms, merge with larger groups, or retire early. Despite these difficulties, the crisis also provided opportunities for adaptation and growth. Many practices leveraged the downtime to reevaluate workflows, update technology, improve patient tracking systems, and reconnect with colleagues. Although the initial adjustments were painful, this period of reflection and restructuring has led to greater long-term stability in the field.

Looking Ahead

As the saying goes, “Those who fail to learn from history are condemned to repeat it.” The COVID-19 pandemic was a trial by fire, testing the resilience of the dermatology community. However, it demonstrated our ability to innovate, overcome obstacles, and advance patient care. As we move forward, we must remain vigilant against misinformation, uphold ethical standards in the evolving cosmetic landscape, and advocate for evidence-based dermatologic care.

The traditional fifth-anniversary gift is wood—a symbol of strength and endurance. As we mark 5 years since the pandemic began, let us “knock on wood” that we have learned from our past, that we are better prepared for future challenges, and that we can continue safeguarding the integrity of dermatologic practice. This pandemic presented unparalleled difficulties, but it also reaffirmed the dedication of physicians to their patients. True to the Hippocratic Oath, we continue to meet the ever-changing needs of those we serve, ensuring that the lessons of this crisis pave the way for a more informed and resilient future.

Seth L. Matarasso, MD, is a board-certified dermatologist and clinical professor of dermatology at the University of California San Francisco School of Medicine.

Jake Nusynowitz is a doctor of medicine candidate at Florida International University Herbert Wertheim College of Medicine in Miami and a dermatology research fellow at Massachusetts General Hospital.

References

1. CDC museum COVID-19 timeline. CDC. Updated July 8, 2024. Accessed February 4, 2025. https://www.cdc.gov/ museum/timeline/covid19.html
2. Yeboah CB, Harvey N, Krishnan R, Lipoff JB. The impact of COVID-19 on teledermatology: a review. Dermatol Clin. 2021;39(4):599-608. doi:10.1016/j.det.2021.05.007
3. New survey results showcase dermatologists as the primary influencer for patients’ cosmetic procedures and skin care decisions. News release. American Society for Dermatologic Surgery. September 25, 2023. Accessed February 4, 2025. https://www.asds.net/skin-experts/news-room/press-releases/new-survey-results-showcase-dermatologists-as-the-primary-influencer-for-patients-cosmetic-procedures-and-skin-care-decisions
4. Rossi AM, Wilson B, Hibler BP, Drake LA. Nonphysician practice of cosmetic dermatology: a patient and physician perspective of outcomes and adverse events. Dermatol Surg. 2019;45(4):588-597. doi:10.1097/DSS.0000000000001829
5. Pikoos TD, Buzwell S, Sharp G, Rossell SL. The Zoom effect: exploring the impact of video calling on appearance dissatisfaction and interest in aesthetic treatment during the COVID-19 pandemic. Aesthet Surg J. 2021;41(12):NP2066-NP2075. doi:10.1093/asj/sjab257
6. Discovering the pandemic’s impact on dermatology practices and patients. News release. American Society for Dermatologic Surgery. February 7, 2022. Accessed February 4, 2025. https://www.asds.net/skin-experts/news-room/press-releases/discovering-the-pandemics-impact-on-dermatology-practices-and-patients