Public Interest in Stress-Induced Dermatologic Conditions and Psychodermatologic Disorders Before, During, and After the COVID-19 Pandemic: Segmented Regression Analysis.

BACKGROUND: Psychological stress is known to exacerbate dermatologic conditions such as acne, eczema, and compulsive skin behaviors. The COVID-19 pandemic introduced a global stressor with widely experienced psychosocial effects and potential impacts on skin health. This study analyzes US public interest in stress-induced dermatologic conditions and psychodermatologic disorders to test for pandemic-associated shifts in 6 search terms.

OBJECTIVE: This study aimed to assess whether the onset and resolution of the COVID-19 pandemic were associated with changes in Google Search interest in psychodermatologic and stress-related skin conditions in the United States.

METHODS: Monthly relative search volume (RSV; 0-100 scale) for 6 terms ("skin picking," "trichotillomania," "stress rash," "eczema flare up," "dermatillomania," and "anxiety skin picking") was obtained from Google Trends for January 2018 through December 2024 (n=84 monthly observations per term); the 6 primary and 4 secondary exploratory terms were extracted in April 2025 and the 5 synonymic terms in July 2026, using the identical query window. A segmented regression model with break points at the World Health Organization's (WHO) pandemic timeline (March 2020 declaration; May 2023 end of concern) tested for level and slope changes at pandemic onset and post pandemic. Newey-West (heteroskedasticity and autocorrelation consistent) SEs corrected for residual autocorrelation, and joint F tests with Bonferroni and Benjamini-Hochberg (false discovery rate [FDR]) corrections assessed whether each period differed from the prior trend. A sensitivity analysis applied the identical model to 5 synonymic terms, each paired with 1 primary term, and to 4 unpaired, secondary, exploratory terms ("acne," "stress acne," "stress hives," and "hair loss from stress").

RESULTS: A total of 2 of the 6 terms showed a statistically significant pandemic-onset effect after correction: "dermatillomania" (level shift +15.20 RSV points; Bonferroni P=.007; FDR P=.007) and "anxiety skin picking" (slope change +0.70 RSV points/month; Bonferroni P=.02; FDR P=.01). "Stress rash," "skin picking," and "eczema flare up" reached significance under FDR correction only (P=.04, .04, and .03, respectively); "trichotillomania" showed no effect under either correction (FDR P=.08). "Anxiety skin picking," "trichotillomania," and "stress rash" showed postpandemic reversals robust to both corrections. The synonymic sensitivity analysis showed weaker, inconsistent support: only 1 of 5 pairs ("dermatillomania"/"excoriation disorder") showed partial agreement under FDR correction, while the remaining 4 diverged, indicating sensitivity to search-term phrasing. The secondary exploratory analysis found no pandemic-onset effects under either correction.

CONCLUSIONS: Public search interest in a subset of psychodermatologic conditions, specifically "dermatillomania" and "anxiety skin picking," showed statistically significant shifts temporally coinciding with COVID-19 pandemic onset. A sensitivity analysis using synonym terms did not consistently reproduce these findings, indicating sensitivity to both analytic choices and search-term phrasing. These results support further research into psychodermatology and illustrate how public search behavior can reflect societal stress, though causal interpretation is unwarranted from search-volume data alone.