Bell, KatherynZayed MD, MPH, ElhamIreland PhD, EllenReyes PhD, Eric2025-09-112025-09-112025-09-13Bell K, Zayed E, Ireland E, et al. () Unseen Impacts: Rural Adolescents’ Self-Perception and Mental Health in the Age of Dermatology Social Media. Cureus (): e. doi:10.7759/cureus.https://hdl.handle.net/1805/50940Background: Adolescence represents a pivotal period in the development of self-image, with skin appearance playing a central role in self-confidence and peer acceptance. In rural communities with limited access to dermatologic care, adolescents frequently turn to social media platforms such as TikTok, Instagram, and YouTube for skin-related information. These platforms often promote idealized beauty standards and unverified treatments, potentially influencing self-perception and psychological well-being. To investigate these potential impacts, the objective of this survey-based cross-sectional study was to evaluate the psychological impact of dermatology-related social media exposure on self-image, emotional health, and professional aspirations among adolescents in a rural setting. Methods: A cross-sectional survey was administered to 206/294 high school students (response rate: 70.1%) in a rural Indiana community. The 19-item Qualtrics survey assessed demographics, social media use, exposure to dermatologic content, and self-reported psychological effects. Responses were analyzed using descriptive statistics and chi-square tests (R version 4.4.3). Institutional Review Board approval was obtained (IRB #25625), with written parental consent and student assent required for participation. Results: Frequent exposure to dermatologic social media content was significantly associated with increased dissatisfaction with personal skin appearance (p < 0.01). Among viewers, 35.9% reported increased focus on perceived flaws, 17.5% noted greater self-criticism, 17.5% experienced increased social comparison, and 16.5% reported decreased confidence in appearance. Despite these indicators of self-image disruption, over half of participants 47% (n = 97) denied any personal mental health impact, while simultaneously acknowledging that dermatologic content likely contributes to broader peer anxiety and negative self-image. This divergence suggests a cognitive-affective dissociation in emotional recognition. Still, students tend to recognize the duality of social media, with 50.6% (n = 80) acknowledging benefits and harms of such content on both themselves and their peers. Notably, 37.2% reported positive influences from the content (e.g., increased confidence, embracing unique features), and 30.6% expressed new interest in dermatology or related healthcare careers. Conclusions: Dermatology-related social media content exerts a multifaceted influence on rural adolescents, simultaneously fostering appearance-related distress and positive professional curiosity. The observed dissociation between body image concerns and acknowledgment of mental health effects may reflect under-recognition of distress or social stigma. These findings underscore the need for media literacy interventions, evidence-based dermatologic education tailored to rural youth, and clinician awareness of social media’s nuanced psychological impact in adolescent care.en-USAttribution 4.0 InternationalSocial MediaMental HealthInfluencerSkin InfluencerAdolescent healthArticle