Keith Wagner, MD, on Online Skin Disease Hoaxes
The internet offers many benefits for patients with skin diseases, such as connecting them with support groups, resources, and information on managing their condition. However, misinformation is common and widespread. One risk for patients when searching online is running into images of fake skin diseases, such as the lotus disease (Figures 1 and 2). These images are not only disturbing and play with feelings of disgust but can also be very distressing for patients unaware that these are altered photographs.
Keith Wagner, MD, with the department of dermatology at the University of Texas Medical Branch in Galveston, TX, and his colleagues examined online skin disease hoaxes. He discussed their findings with The Dermatologist and the importance of providers knowing that fake skin diseases exist in order to reassure patients who may have come across these images that they are not real.
The Dermatologist: Why did you and your team decide to study online skin disease hoaxes?
Dr Wagner: I was exposed to these hoaxes early at a young age. I first saw the lotus breast and lamprey fingers while I was browsing message boards at age 16 and 17. I thought they were pretty disturbing. Some people on the forums claimed that they were real, while others argued they were not real. After searching for information about them, I was able to confirm that neither image represented a real disease or injury. While in college, I continued to sporadically see new skin disease hoaxes circulating online.
Almost a decade after my initial exposure, I was in medical school and was interested in dermatology. I mentioned the hoaxes to several dermatologists during my rotations and I was shocked to find out that nobody I spoke to was aware of what was happening online. I combed the internet looking for a scholarly publication discussing the hoaxes, but that too came up with nothing. I realized that we had a unique opportunity to present something new to the dermatology community and reached out to my soon-to-be co-authors, Julie A. Croley, MD, and Janice M. Wilson, MD, for their help and opinions. Fortunately, they agreed that the project was worthwhile, and the rest is history!
Figures 1 and 2: Images of lotus disease circulated online. Photos courtesy of The Online Skin Disease Hoax Archive.
The Dermatologist: What are the most common skin disease hoaxes found online and where are people finding them?
Dr Wagner: The most well-known hoaxes were the lotus breast and the lamprey fingers. These are the oldest hoax images we have on record—both of which have been circulating online for more than a decade. Most people encounter these images on image boards, forums, and social media.
The Dermatologist: What are the challenges and dangers of individuals posing as patients with skin disease?
Dr Wagner: We all know many patients are digging online for information about their cutaneous symptoms. It is easy to imagine someone who is trying to find accurate information about their condition and may stumble onto some sort of skin health blog or message board where these images are posted. If the patient accepts that these images represent real end-disease states, it could be very mentally distressing and could shape the patient’s view of their disease and prognosis. Furthermore, many of the hoax images take advantage of trypophobia, the disgust of clustered holes or bumps, which one study found caused greater distress to those who actually suffer from real skin diseases.2
The Dermatologist: What are the key takeaways of your study?
Dr Wagner: The biggest take away is to recognize that if a patient is concerned about something they saw online, it could have been one of these images or another fake. It is worthwhile to know that this phenomenon occurs, so at least the dermatologist will not be caught totally off-guard by what a patient is talking about and can use the information to further establish trust and expertise.
We do not know 100% that these images are affecting people’s perceptions of skin diseases or causing increased morbidity, though it is a possibility. Besides our work, there is essentially no other information about this kind of online hoax.
The Dermatologist: How can dermatologists educate patients to recognize hoaxes?
Dr Wagner: Our research did not demonstrate any protective factors, besides lots of time spent online and being younger. However, all of this information was self-reported and anonymous, so more research is needed.
We have an educational website: www.SkinHoax.com, which is the Online Skin Disease Hoax Archive. There we collect and update all of the information we can find about the nine currently known hoaxes and add new ones as they emerge. It is a great starting point for anyone who wants to learn more about online skin disease hoaxes.
1. Wagner KD, Croley JA, Wilson JM. Online skin disease hoaxes: Widespread and credible to viewers [published online June 22, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.06.036
2. Yamada Y, Sasaki K. Involuntary protection against dermatosis: A preliminary observation on trypophobia. BMC Res Notes. 2017;10:658. doi:10.1186/s13104-017-2953-6