The Tricky Business of Being a TikTok Derm

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The three most followed physicians in the history of social media are People’s Sexiest Doctor Alive and two board-certified dermatologists. One of them is less than two years out of residency. Muneeb Shah, DO, is young, jocular, and has optic white teeth. He once told an interviewer he aspires to become “the Ryan Seacrest of dermatology.” With an audience of nearly 20 million, his TikTok following outnumbers Seacrest’s by more than 100 to 1.

The other dermatologist is a name you’ve probably heard before: Sandra Lee, MD, aka Dr. Pimple Popper, has 16.8 million TikTok followers, another 8 million on YouTube, and close to 5 million on Instagram. Skin is in her blood. Dr. Lee’s father was a dermatologist, and she’s married to one. She and her husband had been working at their private practice east of Los Angeles for nearly a decade before she had the idea to start posting extraction videos on her YouTube page, established in 2010. Things didn’t take off until she created an Instagram account in 2014. “I had no idea it would be such a draw,” she says, of the blackhead and milia extraction videos that have become an ASMR subcanon. Fans have recognized her on the street simply by the sound of her voice, and lately they recognize her from her own TV show.

Early on, Dr. Lee was cautiously optimistic about the potential of social media to amplify her practice and provide another revenue stream, but she also worried her colleagues would think she was trivializing the trade. Dermatologists are medical professionals trained to manage over 3,000 hair, skin, and nail diseases, and they comprise the human race’s first line of defense against one of the most common cancers. Some of them wished she’d chosen a name that reflects the breadth of their expertise.

Everyone has since come around, though, if only because something even more remarkable has now entered the room: a new breed of digitally native skin doctors and camera-ready talent, talking to camera in daily videos, filming Super Bowl campaigns, and, hopefully, seeing patients too.

“I've had patients show me a TikTok of someone doing a dance and supporting a product and ask, ‘Why aren't you doing this?’ I'm like, ‘Because I'm here seeing you.’”

In the marketing plans of skin-care companies, these professionals are called dermfluencers. To the general public, they are probably known as dermatologists, albeit ones who exist inside their phones, and whose presence in their lives is closer to that of an entertainer than an actual medical practitioner. But they do provide the public service of free-access skin-care programming dispensed by a board-certified physician. In most cases, anyway; some dermfluencers are residents or still in medical school, to say nothing of the posers and probable grifters. In fact, board-certified dermatologists contribute a paltry sliver of the skin-related content on social media, even though they are arguably those most qualified to provide it — we should feel lucky that they take time to convert their medical education into bite-size performances, and we eat it right up.

Sometimes, though, there is less reverence for the dermfluencer in the dermatologic community. At last year’s World Congress of Dermatology in Singapore, sideways glances were exchanged between some doctors — who had paid for their airfare, flown in coach, chaired committees and sessions, and made quick-turnaround trips so they could return to patients — and others who had attended on behalf of brands that paid for their airfare and accommodations. One dermatologist was walking to the back of the plane when they passed a group of residents they had not long ago instructed, all getting settled in first-class.

At the moment, the United States is suffering from a shortage of physicians in various specialities, including dermatology. One study found that the vast majority of counties in the US don’t have access to a single dermatologist, as the limited pool of young doctors increasingly flocks to urban markets. Part of this physician shortage can be attributed to burnout, but it’s also due to a “glitch” in the doctor pipeline. Caps on federally funded residencies imposed in the 1990s have failed to keep up with population growth or climbing enrollment in medical schools. Though the number of dermatology residencies in the US has increased in recent years, there are still fewer than 500 positions open nationwide every year — about the same amount of applicants to a single program.

One dermatologist was walking to the back of the plane when they passed a group of residents… all getting settled in first-class.

To some of the nation’s dermatologists, this context makes the dawn of dermfluencing seem perplexing at best, dangerous at worst. Eight years of medical school and training is a serious commitment to make in order to launch a career as an influencer, one that experts say has an average life expectancy of the same amount of time.

And then there is worry about the ever-closer financial relationship between young doctors and skin-care brands, as well as a perception that dermfluencers may be prioritizing partnerships over patients, some of whom have been waiting months for an appointment about a strange new mole. “We have an access issue in dermatology,” says Adam Friedman, MD, the chair of George Washington University’s dermatology department. “There aren’t enough of us. What does that mean when someone goes through those eight years [of education and training] and comes out and now they're not taking care of patients?”

Dermfluencing is a time-consuming endeavor — at its highest levels, it could be nearly all-consuming. “I've had patients show me a TikTok of someone doing a dance and supporting a product and ask, ‘Why aren't you doing this?’” says Dr. Friedman. “I'm like, ‘Because I'm here seeing you.’”

To bring your hustle online is a new American pastime; even beekeepers are doing it. But beekeepers aren’t medical doctors, no offense to them. We hold physicians to a higher standard than celebrity spokespeople (and beekeepers) because we trust doctors with our health. At the very least, we understand that their schooling probably took two or three times as long as the average professional’s, and we have a baseline respect for them. That respect can be tarnished, though, when we catch them doing skits about moisturizers for affiliate revenue.

At George Washington University, Dr. Friedman had a passionate dermatology resident named Angelo Landriscina, MD. “I always say, I never wanted to be a doctor, I only wanted to be a dermatologist,” Dr. Landriscina tells me. He started a blog during his residency where he wrote longform articles on a range of skin-deep topics including parabens and polycystic ovarian syndrome. Halfway through his residency, Dr. Landriscina asked Dr. Friedman if he could start an Instagram account promoting his blog. Dr. Friedman blessed him under one condition: no product recommendations — paid or unpaid.

The relationship between commerce and dermatology is not new. For decades, physicians have accepted money from skin-care companies to help them formulate better products, and in more recent years, they have helped market them too. Dermatologists have also created and sold their own skin products for the better part of the last century. Erno Laszlo started selling his formulas out of his institute in 1927, and Clinique was brought to us in 1968 by dermatologist Norman Orentreich. In the ’90s, Drs. Brandt and Perricone created skin-care brands; more recently, Drs. Lee and Alexiades and Idriss did the same.

In 2024, a dermatologist might be paid to recommend a specific product — in an interview, in a sponsored video, in the link-in bio — in a manner that is indistinguishable from an influencer. “I think the rise of the dermfluencer was really prompted by the pandemic,” Dr. Landriscina hypothesizes. He joined social media in early 2019 and rode it to great success (@dermangelo on Instagram and TikTok, 700,000 followers combined). But, he notes, this practice has been going on for decades, just not as publicly.

To bring your hustle online is a new American pastime; even beekeepers are doing it. But beekeepers aren’t medical doctors, no offense to them.

One dermatologist I speak with for this story shares a funny story with me: Doris Day, MD (@drdorisday on Instagram, 102,000 followers), recently met with a representative from a skin-care brand. Before long, their conversation drifted to social media. The rep told Dr. Day that her 12-year-old daughter voraciously watched dermatologists online. “She gets all of her information from TikTok,” Dr. Day says. “She maybe has one little pimple.”

That wasn’t the funny story, which was about how fewer people are confusing the doctor with the other Doris Day, and, ultimately, how our culture can change so slowly but so resolutely that we don’t know until it’s already happened. Once upon a time, a physician who started their own website or channel or page may have received sneers from contemporaries. “But the stigmas don’t last,” says Dr. Day. "Everything that used to be like, 'Eh?' is now like, 'Meh.’”

In the late ’90s, the day after attaining board certification, Dr. Day started a website to help advertise her services, and to maybe, just maybe, knock the elder Day, of Hollywood fame, off of her search-engine optimization perch. Within a few weeks, a skin-care brand had come across her page, and presented an opportunity. The brand wanted a dermatologist who could handle a few days of press interviews with a gaggle of magazine beauty editors — in Anguilla.

The brand paid Dr. Day $10,000. “I was like, ‘I get paid for this?’” Though the sum was less than what she would have made seeing patients, the opportunity proved invaluable. Those beauty editors called her for quotes in their skin-care features, and brands contracted with her for interviews or consulting work. The resulting cycles of exposure to the greater world of skin care — not only the dermatologists who study it, but the brands that control it, and the people who crave it — have conspired to make Dr. Day a physician of some renown. Except for the odd press trip or speaking engagement, Dr. Day says, she has always seen patients four days a week; on the fifth day, she teaches residents at Bellevue Hospital in New York City.

For some time now, there have been press junkets in Anguilla and media interviews for new-to-market creams. Short of selling their recommendations, doctors are paid to stand very close to a particular vitamin C serum and explain why vitamin C can make your skin glow. The notion that dermatologists might function as independent influencers — sharing a brand’s content or product with their own audience members, who have ostensibly gathered under the pretense of medical expertise — may be a new and prickly development, but it is not a spontaneous phenomenon.

The enterprising dermatologist from Dr. Day’s early years in practice was wise to stake out their own web address. The blog made it easier to find digital space, and became the outlet of choice for young doctors like Dr. Landriscina and Elyse Love, MD, who, during her dermatology residency at New York University circa 2015, began interviewing early-career physicians and sharing advice about applying to medical school. Dr. Love joined Instagram, but just as a means to promote her blog. In those early days of her residency, “it was embarrassing to have social media,” she recalls. By the end of her residency, though, people were asking her for advice on how to build their own audience. “I feel like the relationship between dermatology and social media changed very quickly,” says Dr. Love (@elyselovemd on Instagram, 39,000 followers).

At NYU, Dr. Love met Joyce Park, MD, a fellow resident dabbling in the social media arts. (Dr. Park, @teawithmd, now has about 170,000 followers on Instagram and almost 700,000 on TikTok.) Both graduated into residency with online audiences, though neither considers herself an influencer. “Nothing against them,” Dr. Love clarifies. “But I went to medical school, I did residency training. So I view my interaction with — I call them patients, brands call them consumers — I view that relationship very differently.” Today, Dr. Love says she sees patients four days a week at a private practice in Manhattan. She is also an adviser for the retailer BlueMercury, cohosts a podcast, and makes a handful of monthly posts, some of them sponsored, for her Instagram.

After her residency, Dr. Park worked at two different multispecialty hospital groups, where she was “constantly racing against the clock,” she says. “Patients were scheduled every 10 to 15 minutes for strictly one or two skin issues.” (Most practicing dermatologists have told us they see at least 30, sometimes up to 50, patients per day.) Dr. Park didn’t like having to tell them to make another appointment if they had a third question. In 2022, she opened her own telemedicine practice for patients in Washington and California. The Seattle-based Dr. Park estimates that she now sees between 4 and 16 patients per week. As a virtual dermatologist, she provides treatment for acne, rosacea, hyperpigmentation, and hair loss. She can prescribe medications but, for obvious reasons, cannot perform procedures. Dr. Park shares up to 10 TikTok videos per week, including some sponsored posts each month.

Dermatology training is unlikely to last if it’s not put in practice, says Dr. Lee, who is concerned about young dermatologists devoting a lot of their time and energy to dermfluence: “You have to be in practice, you have to apply the things that you've learned, or there's a window that you'll lose it much more quickly, especially early on.” Even though she saw patients six days a week for at least the first decade of her career, Dr. Lee says that there are certain surgical procedures she no longer performs today because she’s not doing them often enough. With a TV show, a skin-care line, and a social media content beast to tend to, she now sees patients only two days a week.

Dr. Lee is certainly not blind to the appeal of dermfluencing to the millennial generation, and she can’t say for sure what she would have done had social media existed when she was starting out. She recently posed the question to a private Facebook group of other dermatologists: Imagine you’re a resident who reaches their professional dermatology career with an Instagram following, and lo and behold, skin-care brands come knocking with $20,000 to $30,000 offers for a single sponsored post. Would you forgo joining, or starting, a practice full-time to pursue dermfluencing? The respondents, she says, were evenly trisected. The first third said no, because it’s bad for the profession; the second third said yes, because medical school is expensive and many graduate with near-crushing debt;* the last third (sounding like most of the dermatologists I’ve met) agreed that working with brands can be good, even great — by all means, try it, just don’t quit your day job.

* A note on numbers: A medical school degree costs around $235,000 on average, according to the Education Data Initiative. A dermatology resident earns an average $88,000 a year, according to Glassdoor. The annual salary of a seasoned dermatologist can climb past half a million dollars in some cities.

The compensation estimate in Dr. Lee’s Facebook post is not inaccurate, according to a source at a big-box beauty brand. A dermfluencer with a following of two million can get around $20,000 for a single branded post; one with under a million followers could cut a package deal, including Instagram posts and media interviews, for close to six figures. According to sources in PR and marketing, a dermatologist is likely to be paid more than a non-dermatologist influencer with the same following. One dermatologist in private practice spoke to me about another dermatologist in private practice with a seven-figure TikTok following who takes home a seven-figure yearly bonus from paid content. (I asked the DermToker’s publicist about that figure, but he declined to discuss.)

“We don’t just develop skin-care products with dermatologists, we bring dermatologists straight to people’s social media feeds,” says Adam Kornblum, senior vice president and the global head of digital for CeraVe, a brand that has been an early and enthusiastic adopter of dermfluencer marketing. This year CeraVe is even funding an additional spot in the residency program at George Washington University. Kornblum has a preference for the term “edutaining,” and the brand has a flair for pairing experts with entertainers — Kornblum cites a recent partnership between Dr. Muneeb Shah, DO, and the TikTok creator Zach King. Last month, Dr. Shah starred in a CeraVe video with the actor Michael Cera, part of a campaign leading up to its Super Bowl commercial.

Just two years ago, Dr. Shah was in the final months of his dermatology residency at Campbell University in North Carolina and would soon join a practice called Fora Dermatology, a couple hours west in Mooresville. Last year, Dr. Shah joined the staff at Hudson Dermatology and Laser Surgery, in Manhattan’s tony Hudson Yards. But he is best and most widely known for his digital platform on TikTok, @dermdoctor, where he issues daily edutainment to an audience of 18.2 million (with a few more million and change on YouTube and Instagram combined).

Dr. Shah began posting as a resident in 2020. He has described the purpose of his page as correcting the record in a timelier manner than, say, a newspaper or scientific journal. “Initially, in the past, you’d have this crazy thing happening on social media, and then the Wall Street Journal or the New York Times would put out an article saying, ‘This isn’t true, you shouldn’t do this.’ But the people that are consuming the misinformation on social media are not going to the New York Times to vet their information, right?” he told the Dermatology Times. “So we combat this misinformation when it’s happening on social media by debunking those videos in real time, which has been awesome.” A standard video might feature Dr. Shah issuing brief, energetic advice on acne cleansers; a partnered video might feature the same content, but would be delivered in front of a CeraVe background, and tagged beneath with #CeraVePartner.

Dr. Shah’s email is hosted by — DermCollective is the LLC that Shah established in 2020. More recently, Dr. Shah launched a consumer-facing site called Remedy Skin, a robust online skin encyclopedia and now also a skin-care brand — its first three products launched this week.

A few hours after I send Dr. Shah an interview request, I receive a reply with his phone number: “Call me anytime!” I reach Dr. Shah on a Friday evening, about an hour after most dermatology clinics on the East Coast have closed. “I’m just editing some videos right now,” he tells me.

“What reason would I have to stop them when it's educating the public and saving lives?”

Dr. Shah posts on TikTok every day, about as often on Instagram, and once a week on YouTube. Like so many others, he began posting in 2020, just for fun. He also, like a few others in 2020, rode TikTok’s sudden pandemic-driven popularity straight to stardom. “Being a doctor is a little bit unrelatable,” says Dr. Shah. “It feels almost paternalistic in some ways, the way that we can give advice. So I really try to reduce that friction and make it funny, make it relatable.”

It was his own residency program director, Dr. Shah says, who encouraged him to discuss dermatology on his social media channels. “He said, ‘In one video you could reach more people than you could in your entire career educating them on something that they wouldn’t know about. So you should really take this seriously.’” He also said: “Just be ethical and honest.”

I reach that program director, Jonathan Crane, DO, via email. “My approach towards residents educating the public has always been supportive,” he says, as long as those residents are forthright, and, of course, acing their tests. Dr. Crane doesn’t put any restrictions on his residents’ social media presence, even if — as in Dr. Shah’s case — skin-care or pharmaceutical companies come knocking with paid opportunities.

When asked by other program directors about his you-do-you social media policy, “I typically explain how well the resident is performing during their training,” Dr. Crane says. “What reason would I have to stop them when it's educating the public and saving lives?” He points out that Dr. Shah was honored with the Melanoma Research Foundation’s Influencer Award in 2021.

Though Dr. Shah began his career online as a resident, he cut a more authoritative figure with series like Dermatologist Reacts, featuring his split-screen reactions to viral videos, and the handle @dermdoctor. In 2020, after Dr. Shah made a video recommending an Inkey List product, the brand reached out with an offer for what would become his first paid advertisement. By the time Dr. Shah attained board certification, in 2022, his partner roster read like walking down a drugstore's skin-care aisle — CeraVe, Neutrogena, Olay. Dr. Shah declines to comment on how much he makes per sponsored post. “If I wasn't a doctor, I would,” he explains, but wonders whether it's unprofessional to share.

In response to critics who say that some dermfluencers don’t spend much time seeing patients, Dr. Shah says that, in his case, respectfully, they’re wrong. “For me, it's just not true,” he says when we connect in late February. He was recently in New York, he adds, where he was performing hair transplants at Hudson Dermatology.

He does travel often, but Dr. Shah says that New York City is his full-time residence. He will be seeing patients in Manhattan for a week in March, he tells me, and later updates that to two weeks, explaining that because of his travel schedule, appointments are usually not booked far in advance. He says he hopes to ramp up his availability this year.

“If I had to choose between content and dermatology, I would choose seeing patients every day,” says Dr. Shah. But he doesn’t look down on dermatologists who have opted out of patient practice in favor of social media work. “I think a lot of people that only do social media and don't see patients, it's probably because they found out they didn't really enjoy it,” he says. Maybe they have social anxiety, kids at home, fear of germs. “I almost feel like, who am I to judge?”

Doctors are not obligated to disclose how much time they spend in examination rooms or labs, let alone making videos for TikTok. And they only have a few obligations to disclose how much they are paid for promotional or consulting services. A 2010 law known as the Physician Payments Sunshine Act allows Americans access to a database that records payments between drug companies, physicians, and teaching hospitals. Querying any one of the three opens a ledger of payments for things like consulting, lodging and travel, honoraria.

But cosmetics are distinguished from drugs in the eyes of the Food and Drug Administration, and skin-care companies are not obligated to publicly disclose, say, how much they paid a dermatologist for partner content. For their part, doctors are beholden only to the same disclosure regulations that govern all influencers, put forth by the Federal Trade Commission: Use clear and concise disclosure language, like “sponsored” or “partner.”

A lack of comprehensive regulation and full transparency has driven some doctors to establish their own boundaries. When a major company asked one veteran dermatologist to be on an advisory board regarding a topic on which she had authored research, she was interested in the gig — until she found out that another member of the board was a dermatologist who made videos instead of seeing patients. The veteran dermatologist dropped out. “I'm not doing this advisory board, which is going to lead to a major publication,” they fumed. “I’m not giving the credibility to people who are not working.”

“I’m not giving the credibility to people who are not working.”

Skin-care companies are incentivized to work with dermatologists early on, even during residency. In these relationships, the trainee functions less like an expert and more like a host, and the brand has greater editorial control over the resulting paid content. Whether or not a dermatology resident is an eligible dermfluencer varies from program to program. At George Washington University, it is “completely forbidden” for a resident to “promote, support, recommend, or suggest the use of either prescription or over-the-counter products on social media,” according to the program’s two-page social media policy. Johns Hopkins Medicine permits employees, including residents, to engage in social media partnerships as long as they don’t invoke the Johns Hopkins Medicine brand. (We contacted 10 other prominent dermatology residency programs; most either declined to comment on their social media guidelines or did not respond.)

“Every institution is different, and whether or not the institution allows a resident to post content in association with that institution’s name often has many legal layers to it,” explains Sara Samimi, MD, the associate director of the University of Pennsylvania’s dermatology residency program. Penn advises against sponsored posts. But if a resident decides to do one, adds Dr. Samimi, “their account cannot be linked back to Penn in any way.” (None of the current resident-dermfluencers I reached out to wanted to talk, or did not respond to my inquiries.)

When we asked the American Academy of Dermatology (AAD) for a statement on guidelines for members regarding ethical social media practices and sponsored content, AAD president Terence Cronin Jr., MD, said, “We encourage members to include their credentials in their social media bio…. In addition, we advise discretion when recommending products and accepting paid partnerships with brands. Above all, the AAD aims to empower its members to effectively use their voice on social media as the leading experts in the skin, hair, and nails.”

A 2021 installment of the Ethics Journal Club, a portion of the broader Journal of the American Academy of Dermatology, tackled the issue of dermfluence when a resident wrote in wringing their hands about spon-con. The reply took a much harder line than Dr. Cronin: “Recommending products in return for compensation is unethical as it harms the physician-patient relationship and prioritizes your own personal monetary gain over patient well-being.” But not too hard: “If you do decide to advertise products on social media, we strongly recommend that you (1) refrain from making false or unsubstantiated claims and (2) disclose conflicts of interest for readers if they apply.”

“If you’re not regularly seeing patients, and you’re not putting into practice everything you learned, I don’t know if you can really call yourself a dermatologist.”

We're a society that is increasingly conditioned to spin our expertise into “engagement.” Birdwatchers do it, beekeepers do it, even educated tweens do it. Dr. Friedman, of George Washington University, has to admire the colleagues who’ve found a new path in paid spokesmanship. “If you've been able to figure out how to position yourself where a company will pay you $50,000 just to post about them? I respect the energy and the investment and the creativity,” he says.

Dr. Friedman also makes it clear that the current access issues in dermatology were brought about by other, larger forces, not doctors devoting time to social media. But he does have fears for the future of his field, and the patients it serves, if more young doctors let TikTok take away from treating patients. Dr. Lee/Pimple Popper agrees: “I see the draw,” she says. “But if you’re not regularly seeing patients, and you’re not putting into practice everything you learned, I don’t know if you can really call yourself a dermatologist.”

Dr. Landriscina, Dr. Friedman’s former resident, most recently saw patients at Ever/Body, a medspa chain with several locations in New York. He left last fall, and says he is currently in contract negotiations for a new position elsewhere. “By and large, we still have clinical duties,” says Dr. Landriscina. But he references the pre-dermfluence decades, when dermatologists not only taught, consulted, and advised but were paid by brands to attend trips and dinners. “One of the great things about our field is that the career is very flexible in a lot of ways,” he says. “You could make it exactly what you want it to be.”

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Originally Appeared on Allure