Medicalizing aesthetics or beautifying illness? Exploring the absence of diagnosis and the centrality of patient autonomy in dermatology

The moment of diagnosis is often regarded as a cornerstone of clinical practice and patienthood. It has mainly been viewed as preceding, and hence profoundly shaping, patients’ constructions of health and illness. However, amidst a rise in patient autonomy, the significance of a diagnosis as the starting point for care and patient identity is diminishing. This shift is particularly evident in dermatology due to its visual nature, the prevalence of alternative experts (e.g., cosmetologists, skincare gurus), and the intersection between its biomedical and cosmetic features. Against this backdrop, our study aims to reconsider the position of diagnosis in the dermatological context by raising the following questions: how is a dermatological condition socially constructed and therapeutically approached by patients, and what role does a diagnosis play? To address these questions, we thematically analyzed in-depth interviews with a heterogeneous sample of culturally diverse subjects diagnosed with seven distinct skin and hair conditions. Our findings reveal that the diagnostic moment is often absent in dermatological settings; instead, multiple agencies contribute to a dermatological diagnosis, with patients, rather than physicians, as the central agency. We situate our results within the broader context of increasing patient autonomy and lay expertise, noting that while the pursuit of “optimal” well-being is justified in the name of health, some skin and hair diseases are minimized, beautified, or embraced in the form of skin positivity. • The diagnostic moment is often absent in dermatological settings. • Multiple agencies contribute to the dermatological diagnostic process. • Patient autonomy drives the pursuit of well-being beyond pure health. • Dermatology’s biomedical-aesthetic features challenge traditional diagnostic models. • The role of alternative experts blurs the boundaries of dermatological practice.