Direct-to-Consumer Teledermatology Growth

A Review and Outlook for the Future

Varun Ranpariya, BA; Daniel Kats, MD; Jules B. Lipoff, MD

Cutis. 2022;109(4):211-217.

Abstract and Introduction

Abstract

The direct-to-consumer (DTC) telemedicine industry, including teledermatology, has seen rapid expansion in recent years, partly because of the COVID-19 pandemic. The shortage of dermatologists and the visual nature of dermatologic conditions attracted DTC companies to dermatology. As more patients continue to seek medical consultations and prescription medications from these for-profit companies, we must approach their growth with healthy skepticism. Shortcomings of DTC teledermatology include concerns about conflicts of interest (COIs), overdiagnosis, and overprescribing. Although DTC teledermatology is certainly here to stay, an appropriate understanding of this industry will allow dermatologists to advise patients and advocate for best practices.

Introduction

In recent years, direct-to-consumer (DTC) teledermatology platforms have gained popularity as telehealth business models, allowing patients to directly initiate visits with physicians and purchase medications from single platforms. A shortage of dermatologists, improved technology, drug patent expirations, and rising health care costs accelerated the growth of DTC dermatology.^[1] During the COVID-19 pandemic, teledermatology adoption surged due to the need to provide care while social distancing and minimizing viral exposure. These needs prompted additional federal funding and loosened regulatory provisions.^[2] As the userbase of these companies has grown, so have their valuations.^[3] Although the DTC model has attracted the attention of patients and investors, its rise provokes many questions about patients acting as consumers in health care. Indeed, DTC telemedicine offers greater autonomy and convenience for patients, but it may impact the quality of care and the nature of physician-patient relationships, perhaps making them more transactional.

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Table 1. Definitions of DTC Business Models in Health Care
DTC model	Primary service/product	Description	Examples
DTC pharmaceutical advertising	Advertisements	Advertisement of prescription drugs directly to patients	Television commercials, billboards
DTC health care retail	Nonprescription health care products	Sale of health care products directly to consumers via web-based platforms	Hearing aids, glasses, OTC drugs/supplements
DTC telemedicine	Telemedicine visits	Sale of telemedicine physician consultations directly to patients; allows patients to see a physician at their convenience; physicians can send prescriptions directly to patients' pharmacies; any physician can set up their own DTC service using other companies that provide the needed infrastructure	Amwell, Teladoc Health, Doxy.me, DermatologistOnCall, DirectDerm
DTC pharmaceutical telemedicine	Prescription drugs	Sale of custom branded prescription drugs directly to consumers via web-based platforms; provides telemedicine visits within the platform to facilitate and streamline the prescription and delivery of medications	Hims/Hers, Ro (Roman/Rory), Curology, Keeps, Nurx, Lemonaid Health, Apostrophe

Abbreviations: DTC, direct-to-consumer; OTC, over-the-counter.

Table 2. List of DTC Companies Offering Dermatology Care and Medication Sales
Company	Dermatology services	Other services	Modality	Drug delivery	Cost^a
Apostrophe	Acne, wrinkles, rosacea, eyelashes, hair loss	None	Asynchronous	Direct delivery	$20 consultation + medication fee (free consultation if medication prescribed)
Curology	Skin care	None	Asynchronous	Direct delivery	Cost of medication + additional consultations
Hims/Hers	Skin care, hair loss	Erectile dysfunction, propranolol, numerous others	Asynchronous	Direct delivery	Cost of medication
Keeps	Hair loss	None	Asynchronous	Direct delivery	Cost of medication + $5 annual consultation cost (initial visit free)
Lemonaid Health	Hair loss, acne, cold sores, dark spots	Sexual health, daily health (eg, allergies, stress relief, weight management)	Asynchronous or synchronous, depending on state laws	Direct delivery or prescription to local pharmacy	$25 consultation + medication fee or monthly subscription fee
Nurx	Acne, antiaging, rosacea, herpes	Sexual health, mental health	Asynchronous	Direct delivery	$15–$60 consultation + medication fee
Ro: Roman/Rory	Hair loss, skin care, eczema, dandruff, excessive sweating	Sexual health, daily health (eg, allergies, stress relief, weight management)	Asynchronous or synchronous, depending on state laws	Direct delivery or prescription to local pharmacy	Cost of medication