Analysis of dermatology-related search engine trends during the COVID-19 pandemic: Implications for patient demand for outpatient services and telehealth
Authors: Anthony K. Guzman, John S. Barbieri
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: Amid the coronavirus disease 2019 (COVID-19) pandemic, dermatologists face the challenge of providing care while adhering to guidelines established by the Centers for Disease Control and Prevention. The American Academy of Dermatology has advised limiting nonessential in-person visits1Kwatra S.G. Sweren R.J. Grossberg A.L. Dermatology practices as vectors for COVID-19 transmission: a call for immediate cessation of nonemergent dermatology visits.J Am Acad Dermatol. 2020; 82: e179-e180Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar and provided guidance to accelerate telehealth services.2Lee I. Kovarik C. Tejasvi T. Pizarro M. Lipoff J.B. Telehealth: helping your patients and practice survive and thrive during the COVID-19 crisis with rapid quality implementation.J Am Acad Dermatol. 2020; 82: 1213-1214Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar However, little is known regarding how the dermatologic needs of patients have evolved during this public health crisis. The objective of this study was to use the Google Trends search volume index, a normalized value from 0 to 100, to examine patient interest in skin conditions and procedures during the COVID-19 pandemic. Google Trends search volume index data have been shown to describe patient interest in dermatologic issues.3Misitzis A. Weinstock M.A. Increased interest in sunless tanning versus tanning beds in the United States: a Google Trends analysis.J Am Acad Dermatol. 2019; 81: 1438-1439Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,4Reed D.D. Google search trends for tanning salons: temporal patterns indicate peak interest in mid spring.J Am Acad Dermatol. 2015; 73: 1055-1056Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar We divided common search queries into 3 categories: general dermatology conditions (ie, acne, eczema, seborrheic dermatitis, psoriasis, hair loss, rosacea, dry skin, hives, and atopic dermatitis), premalignant and cancerous conditions (ie, melanoma, squamous cell carcinoma, basal cell carcinoma, and actinic keratosis), and cosmetic procedures (ie, Botox, laser treatment, laser therapy, chemical peel, dermabrasion, lip filler, and fillers). The primary outcome was the mean search volume index during 3 intervals: prepandemic (April 28, 2019, to March 8, 2020), the onset of national stay-at-home orders (March 15, 2020, to March 29, 2020), and the ongoing social distancing period (April 5, 2020, to the present). The Centers for Disease Control and Prevention restricted public gatherings on March 15, 2020, and stay-at-home orders were rolled out between March 23, 2020, and March 30, 2020. Two-tailed unpaired t tests were used for continuous variable comparisons (GraphPad Prism 7, GraphPad, San Diego, CA). Significant decreases in search volume index were observed between the prepandemic period and the onset of stay-at-home orders for general dermatologic conditions (82.6 vs 71.9; P < .001), premalignant and cancerous conditions (77.6 vs 47.9; P < .001), and cosmetic procedures (71.8 vs 45.1; P < .001) (Table I). In contrast, only interest in general dermatologic conditions has returned to baseline during the ongoing social distancing period, whereas premalignant and cancerous conditions and cosmetic procedures showed persistently low search volume index (Table I and Fig 1).Table IComparison of mean search volume indices of general dermatologic conditions, precancerous and malignant conditions, and cosmetic procedures during key intervals throughout the COVID-19 pandemicApril 28, 2019, to March 8, 2020,March 15, 2020, to March 29, 2020April 5, 2020, to April 19, 2020Mean (SD)Mean (SD)P value∗Mean search volume indices from these periods were compared with the prepandemic search volume index (April 28, 2019, to March 8, 2020), using 2-tailed unpaired t tests.Mean (SD)P value∗Mean search volume indices from these periods were compared with the prepandemic search volume index (April 28, 2019, to March 8, 2020), using 2-tailed unpaired t tests.General dermatologic conditions82.6 (10.1)71.9 (6.6)<.00184.5 (8.2).31Precancerous and malignant conditions77.6 (11.0)47.9 (7.3)<.00150.3 (6.8)<.001Cosmetic procedures71.8 (12.5)45.1 (9.5)<.00149.8 (14.0)<.001SD, Standard deviation.∗ Mean search volume indices from these periods were compared with the prepandemic search volume index (April 28, 2019, to March 8, 2020), using 2-tailed unpaired t tests. Open table in a new tab SD, Standard deviation. Our findings suggest that public interest in dermatologic conditions and procedures has been influenced by the events of the pandemic. Although stay-at-home orders and the rapid spread of disease in mid-March reduced all categories of online searches, only general dermatologic conditions demonstrated a return to prepandemic levels of interest. It is possible that visits for these chronic, less urgent conditions—such as acne, rosacea, and seborrheic dermatitis—are more likely to be postponed or canceled amid the limitations of outpatient appointments and delays in teledermatology implementation. Consequently, with limited provider access, patients may turn to online resources, many of which exhibit bias and misinformation.5Guzman A.K. Wang R.H. Nazarian R.S. Barbieri J.S. Evaluation of YouTube as an educational resource for treatment options of common dermatologic conditions.Int J Dermatol. 2020; 59: e65-e67Crossref PubMed Scopus (16) Google Scholar In contrast, given premalignant and cancerous conditions' more urgent nature, their management may have been less disrupted by the COVID-19 pandemic. Alternatively, perhaps patients conducted online searches for information only after their diagnosis was introduced by a dermatologist; in this case, the increase in search volume index for general dermatologic conditions may be related to continued access during the pandemic through telehealth, whereas skin surgery and cosmetic procedures have been postponed. Future studies are warranted to explore the relationship between search volume index and patient behaviors, and to examine its potential role in developing predictive models to identify patient demand. The results of this study should be interpreted with caution because search volume index may not completely reflect patient needs and intention. As we continue to adapt our practice habits during the COVID-19 pandemic, these findings suggest areas of greatest demand, in which targeted development of telehealth offerings may provide significant benefit. Google searches in patient self-care increase during the COVID-19 lockdownJournal of the American Academy of DermatologyVol. 83Issue 5PreviewTo the Editor: The recently published article by Guzman and Barbieri1 provides useful insight into the dermatologic concerns of the public before and after entering periods of lockdown during COVID-19, recapitulating our own findings in the United Kingdom.2 However, a facet we believe the authors' analysis has overlooked is an increased interest in conditions patients can self-treat. In our UK population, we noticed an increase in searches for warts, acne, and laser hair removal after lockdown,2 terms that were also searched more frequently in the United States after lockdown (increases of 2%, 6%, and 12%, respectively). Full-Text PDF