Dermatology Websites Are Writing About Acne and Skin Cancer at Reading Levels Patients Cannot Reach

A new analysis published in Archives of Dermatological Research has turned a spotlight on one of the quietest failures in modern medicine: the gap between what dermatology practices publish online and what their patients can actually read. In a research letter led by Nada Hentati of Case Western Reserve University School of Medicine, with colleagues Kaden M. Thomas, Bryan T. Carroll and Jeremy S. Bordeaux, the team assessed the readability of patient education materials posted on dermatology practice websites, focusing on two of the most searched skin conditions in the world, acne and skin cancer. Their conclusion adds to a growing body of evidence that the written health information patients encounter every day is pitched far above the reading level of the average American adult.

The stakes are higher than they might first appear. Acne is one of the most common reasons people turn to the internet for skin advice, and studies of search behavior have documented enormous public interest in the condition, with millions of queries flowing through platforms such as Google every year. Skin cancer, meanwhile, remains the most frequently diagnosed malignancy in many populations, and prevention depends heavily on people understanding sun protection, self-examination and when to seek professional evaluation. When the text that carries this guidance is written in dense, technical prose, the practical effect is that the people who most need the information are the least likely to absorb it.

Readability research rests on a simple premise: written material should match the reading ability of its intended audience. In the United States, the widely cited benchmark is that health information should be understandable at roughly a sixth-grade reading level or below, a standard endorsed by major public health bodies because national literacy surveys consistently show that a large share of adults read at or near that level. The researchers anchored their work in this framework, drawing on federal data from the U.S. Program for the International Assessment of Adult Competencies, which maps adult literacy and numeracy skills down to the state and county level. That dataset allowed the team to connect the difficulty of online dermatology materials to the actual literacy landscape of the communities the websites serve.

To quantify difficulty, the study used established readability formulas, the standard instruments of this field. Formulas such as the Flesch-Kincaid Grade Level and its relatives estimate the years of education a reader needs to comprehend a passage, based on measurable features of the text, most commonly sentence length and word length or syllable count. A passage scoring at a twelfth-grade level, for example, is judged as demanding the reading skill of a high school senior. These metrics are imperfect proxies for comprehension, since they ignore layout, jargon and visual design, but they are reproducible, transparent and widely used to audit health communication, which makes them the de facto yardstick for judging whether patient materials meet accessibility standards.

The target of the audit was the patient education section of dermatology practice websites, the pages clinics publish to explain conditions and treatments to the public. These pages occupy a peculiar position in the health information ecosystem. They are not peer-reviewed articles, but they carry the authority of a medical practice, and patients often treat them as trustworthy summaries of professional consensus. For acne, practice websites compete with a flood of social media content, influencer routines and product marketing; for skin cancer, they sit alongside official guidance from bodies such as the U.S. Preventive Services Task Force, whose 2023 recommendation statement on skin cancer screening shaped much of the public conversation around detection. In both cases, the practice website is often the first professional voice a worried patient hears.

The findings fit an uncomfortable pattern that dermatology researchers have been documenting for years. A 2023 call to action in the same journal, authored by Hernandez and colleagues, assessed online patient education materials across dermatology and found them routinely written at levels well above the recommended threshold, and a 2025 study by Bower and colleagues, which included several of the same investigators, reached similar conclusions for skin cancer prevention materials aimed at organ transplant recipients, a population whose elevated skin cancer risk makes clear communication especially critical. The new research letter extends this line of inquiry to the websites of individual dermatology practices and pairs the readability analysis with a geographic literacy correlation, an approach that asks not just whether the text is too hard in the abstract, but whether it is too hard for the specific populations living near the practices that publish it.

That geographic dimension is what gives the study its sharpest edge. Adult literacy is not evenly distributed across the United States; the PIAAC skills map reveals wide county-to-county variation in prose literacy, numeracy and problem-solving in technology-rich environments. A dermatology practice in a county where a substantial fraction of adults read below a high school level is serving a population for whom even moderately complex text becomes a barrier. If the education materials on that practice’s website are written at a college reading level, the practical consequence is a form of information gatekeeping: the page exists, it ranks in search results, it is technically available to everyone, and yet a large share of the local population cannot extract its meaning. Health disparities of this kind are invisible in the way that clinic wait times are not, but they shape outcomes just as surely, particularly for prevention-driven fields like dermatology where early recognition of a changing mole or consistent use of acne therapy depends on the patient understanding written instructions.

The mechanisms that push patient materials toward impenetrability are well understood, and they are worth spelling out because they explain why this problem persists despite decades of warnings. Medical writing drifts toward precision, and precision in medicine often means Latin-derived terminology, passive constructions and long compound sentences. A sentence that says a lesion may exhibit atypical features and warrant histopathologic evaluation is accurate, but it demands more of the reader than one that says a mole that looks unusual should be checked by a doctor. Readability formulas punish exactly these habits: polysyllabic clinical vocabulary inflates the word-length component, and the tendency to pack qualifications into single sentences inflates the sentence-length component. Add the legal and institutional instinct to hedge every claim, and the result is text that satisfies clinicians, lawyers and search engines while defeating the lay reader.

Fixing the problem is not primarily a matter of dumbing content down, researchers in health literacy emphasize, but of restructuring it. Plain-language guidelines recommend short sentences, everyday vocabulary, the active voice, and the front-loading of the single most important message, with technical terms introduced only when necessary and immediately defined. Numerical information, such as the actual risk of a melanoma recurrence or the expected timeline for an acne treatment to show results, benefits from concrete framing rather than percentages alone. The authors of the research letter, in line with the earlier calls to action in the field, effectively position readability auditing as a quality-control step that practices should apply to their own websites the way they audit clinical protocols: systematically, periodically and with a published standard as the benchmark.

The broader lesson of the study reaches beyond dermatology. The internet has made medical information universally available, but availability is not the same as accessibility, and the two diverge precisely at the level of reading skill. As patients increasingly arrive at clinics having already read, or failed to read, what their doctors’ websites say, the readability of those pages becomes part of the clinical encounter itself. A practice whose education materials can be understood by a sixth grader extends its reach to nearly the whole community; one whose materials demand a college education quietly filters out the patients who may need guidance most. The Case Western Reserve team’s audit of acne and skin cancer content is a small study in form, a research letter rather than a landmark trial, but it documents a failure that is easy to measure, easy to fix and, until practices take it seriously, easy to keep ignoring.

Subject of Research: Readability of online patient education materials for acne and skin cancer on dermatology practice websites

Article Title: Assessment of the readability of patient education materials on dermatology practice websites: a focus on acne and skin cancer

Article References: Hentati, N., Thomas, K. M., Carroll, B. T., & Bordeaux, J. S. (2026). Assessment of the readability of patient education materials on dermatology practice websites: a focus on acne and skin cancer. Archives of Dermatological Research, 318(1), Article 498. https://doi.org/10.1007/s00403-026-04940-w

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04940-w

Keywords: dermatology, readability, health literacy, patient education, acne, skin cancer, websites, health communication, PIAAC, plain language, health disparities, medical writing