Teledermatology companies are disrupting skin care, and a lot of consumers are OK with that.
Four years ago, while skimming her Instagram feed, Fawzia Khan happened upon an ad for Dear Brightly, an online platform that sells prescription retinoids, a derivative of vitamin A that’s used topically to fight acne and aging skin, and available through doctors.
After filling in a questionnaire and sending in some selfies, Ms. Khan, 43, a fashion consultant in Brooklyn, received her first 60-day supply in the mail — and was hooked.
“I’ve done a lot of research, and this is one of the best anti-aging ingredients you can get,” Ms. Khan said of her Dear Brightly Night Shift cream. (She is currently on a quarterly subscription priced at $99.)
“I definitely don’t look 43, and I think it’s definitely one of the reasons,” Ms. Khan said.
Until relatively recently, the only way to get prescription-grade medications for skin care and hair care — the gold standard when it comes to dealing with problems like hyperpigmentation and hair loss — was the old-fashioned way: by making an appointment with a dermatologist, getting a prescription and filling it at a pharmacy.
For many, that process came with the inconvenience of doctor visits and high co-pay fees (assuming the costs were covered by their insurance). Moreover, the medicine itself could be prohibitively expensive. A tube of Retin-A, for instance, can cost $100 to $200 at a pharmacy.
But now some of that inconvenience is gone, thanks in part to the pandemic, which helped relax regulations in some states, made consumers more comfortable with receiving medical care online and led more dermatologists to sign up for a work-from-home lifestyle.
Teledermatology platforms like Dear Brightly, Musely and Keeps, as well as general telehealth sites that offer dermatology services as part of their offerings — Hims & Hers and Nurx, for example — have seemingly exploded on social media, giving consumers the ability to “shop” for prescription-strength medications from the comfort of their couch.
Many of the companies make their own products, often mixing more than one Food and Drug Administration-approved generic drug or a key regulated drug with other unregulated but beneficial skin-care ingredients. They tout these mixtures as personalized medicine that can’t be rivaled by the average dermatologist, and the compounds can include ingredients like niacinamide, which helps to improve uneven skin tone and soften fine lines, and hydrating hyaluronic acid.
Roots by Genetic Arts, which opened for business this summer, collects DNA in addition to pictures and a questionnaire to determine the right medication for a customer. Hims & Hers works with pharmacies to create personalized formulations.
“It’s as good as if you are superrich and super-fancy,” said Andrew Dudum, the co-founder and chief executive of Hims & Hers, which says it has 1.4 million subscribers on its various platforms. “Our goal is to bring that to the everyday person at an affordable price.”
As could be expected, doctors are not necessarily as enthusiastic. Dr. Blair Rose, a dermatologist in Manhattan, reported that in a “handful” of instances patients had brought in compounds from an online platform that didn’t make sense, like tretinoin, a topical cream or gel often used to treat acne, mixed with benzoyl peroxide, which deactivates the tretinoin; she said she has also seen compounds that contain percentages of niacinamide that were too high and irritated patients’ skin. (None were from sites mentioned here.)
“It can’t be emphasized enough the importance of seeing a doctor in person,” Dr. Rose said — especially, she added, if people using these platforms aren’t seeing improvement in their condition. (Dr. Rose sells her own skin-care line, Skincare Junkie, online.)
Other doctors have continued to embrace the Zoom consultations that became common during the pandemic. Dr. Paul Jarrod Frank, a dermatologist with offices in the West Village and Upper East Side, said that he always saw patients online as part of his practice and that about 15 percent of his business now consists of online consultations with existing and new patients.
Dr. Frank said that he has recommended the Hims hair loss formulations to his male patients but worries about “the commercialization of health care,” when a doctor can write prescriptions only for the specific medications a company happens to sell.
What’s different about these platforms versus the telemedicine practiced by many doctors is that customers or patients usually don’t talk or video conference with their providers in real time. Instead the platforms offer asynchronous services that allow users to upload information and correspond with their doctors over their apps and websites.
A study published in Current Dermatology Reports in January noted that while patient satisfaction with asynchronous teledermatology is relatively high, there are limitations to the technology. Dr. Jun Lu, a professor of dermatology at the University of Connecticut and one of the study’s authors, said that platforms should collect detailed medical and medication history, provide instruction on how to take high-quality photos as well as offer detailed information on risk, benefits and potential side effects of treatment.
Dr. Lu also recommended that consumers look for credentials of providers and ask about quality of care. “Are you communicating with the same doctor” is a key question to ask, she said.
Pros and cons aside, a lot of money is up for grabs. According to IBISWorld, a market research firm, the dermatology market in the United States is expected to surpass $8.7 billion (nonsurgical medical treatments account for $5.4 billion of that) in 2023.
Teledermatology companies, almost all of which are founded by tech entrepreneurs — Musely is the fourth venture of Jack Jia, its founder and chief executive, and Amy Chiu, the chief executive of Dear Brightly, worked as a software engineer before cofounding her company — aren’t just disrupting health care, they’re tapping into a trend in the huge beauty business.
Larissa Jensen, the global beauty industry adviser at the research firm Circana, said the rise of these platforms is driven by consumers who are highly educated about ingredients and who have helped boost “clinical” skin care —- that is, brands started by dermatologists, aestheticians and other experts — over “natural” brands, formulated from naturally derived ingredients. From January to August 2023, according to Circana, sales of clinical skin-care products in prestige stores hit $1.8 billion.
“In 2020, natural brands were the No. 1,” Ms. Jensen said. “Why did that happen? Many of us were home. We were looking for things that worked.”
Vivid before-and-after images are the main selling point in the marketing campaigns of many of these brands. The ads for Musely, a platform that treats skin and hair concerns but specializes in addressing hyperpigmentation on the face and body, show significant transformations. (One stars the founder’s wife, who has melasma.)
Musely, a retooled version of an app called Trusper, has grown from 10,000 patients in 2019 to 600,000 patients today, the company said. It uses only board-certified dermatologists to write prescriptions, and charges $20 for a consultation and about $80 for a two-month supply of a prescription. (Some companies rely on a mix of dermatologists, physicians who are not dermatologists, and physician assistants to write prescriptions, depending on state regulations.)
Mr. Jia of Musely said that more doctors want to work for him than he has positions for. Why? Better pay and hours. Take Dr. Brandon Kirsch, the chief science officer of Musely and a prescribing dermatologist for the company, who also maintains his own private practice in Naples, Fla. Dr. Kirsch said he makes 70 percent of his income from Musely and 30 percent from his practice and likes the balance his work-from-home life now provides.
“I have a 4- and 2-year-old,” he said. “There’s nothing I’d rather do than be with my family.” He is unconcerned about any lack of prestige in working for a telehealth company.
“It’s kind of like online dating,” Dr. Kirsch said. “It had a stigma. But now it’s the norm.”