Unseen Impacts: Rural Adolescents’ Self-Perception and Mental Health in the Age of Dermatology-Related Social Media

Abstract

Background: 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. Materials and 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. Inclusion required current enrollment at school and at least one prior use of social media; exclusion criteria was no social media use. Responses were analyzed using descriptive statistics and chi-square tests. Results and discussion: Of 206 respondents, most were female (74%, n = 152) and under 18 years of age (84%, n = 175). Female students were significantly more likely than males to follow skincare influencers (36.8%, n = 56 vs. 8.5%, n = 4; p = 0.001, p < 0.05). Among those who viewed dermatology-related content, 37.8% (n = 56) reported only positive effects (e.g., increased confidence), 31.1% (n = 46) reported only negative effects (e.g., heightened self-criticism), and 4.1% (n = 6) reported both positive and negative effects. Notably, while 68.9% (n = 102) acknowledged some impact on self-image, only 22.6% (n = 35) perceived effects on their mental health, suggesting a disconnect between appearance concerns and emotional awareness. Nearly half (45%, n = 74) reported greater focus on perceived flaws, yet most (59%, n = 97) denied developing an unhealthy perspective on body image. Gender- and identity-based disparities were pronounced: female and non-binary students reported higher rates of negative self-perception compared to males. Despite these risks, over half (50.6%, n = 104) identified educational benefits, and 30.6% (n = 63) noted that dermatology content inspired interest in healthcare careers. Further, just over one-third of rural respondents (n = 75, 36.4%) reported discovering a new community or interest they would not otherwise have encountered, thereby reflecting a significant integration into the lives of rural, underserved populations. These findings underscore the dual nature of aesthetic media, both reinforcing body dissatisfaction and offering pathways for learning, community, and identity exploration. Conclusions: Dermatology-related social media exerts complex psychological effects on rural adolescents, amplifying self-image concerns while simultaneously providing educational value and career inspiration. Female and gender-diverse students appear particularly vulnerable, highlighting the need for adolescent-centered media literacy and inclusive, evidence-based dermatology messaging.