As in many states, Utah residents have long wait times to see a dermatologist, but a consumer-oriented telehealth platform — which will use AI to diagnose and prescribe treatment — is promising to easily connect Utah patients to topical acne medications.

Utah patients wait an average of 61 days, and 11 rural counties in the state have no dermatologists, according to New York City-based Nolla Health , which developed the app used in the program. In addition, the company said that 100,000 or more state residents live with active acne at any given time, but that only about 10% ever see a dermatologist. Nolla notes that routine acne care is a leading reason for dermatology visits, especially among young women, so giving patients the option to use its app will free appointment slots for urgent and complex cases.

“We are attempting to deal with the easy and very routine cases so that the more complex cases get filtered to the appropriate oversight,” Zaid Fadul, MD, chief medical advisor for Nolla Health, told Medscape Medical News. Fadul, a board-certified family medicine physician, is the main clinical reviewer of the AI-written prescriptions.

Dermatologists who spoke with Medscape Medical News, however, are skeptical the service will be a boon to consumers or that it will do anything to address access issues and also expressed concerns about clinician oversight of the AI process. 

Nolla is the fourth telehealth company to receive permission from Utah to prescribe medications using AI. All the companies have agreed to a staged approach, whereby physicians review an initial number of prescriptions. After reaching that threshold, the AI will autonomously prescribe, with retroactive review by a clinician.

The plan to eventually reduce physician oversight concerns the American Academy of Dermatology (AAD). That “increases the risk that reviewers defer to AI output instead of applying independent clinical judgment,” AAD president Murad Alam, MD, said in a statement to Medscape Medical News.

Alam, who is a professor of dermatology, otolaryngology, and surgery at Northwestern University in Chicago, said there were other “troubling aspects” to Nolla Health’s program, including a lack of prospective trials demonstrating effectiveness and safety and inadequate transparency of the algorithm and the data used to train it, including whether the data represents patients of all skin tones.

AI can be a helpful tool but “should not be used to independently diagnose or treat dermatologic conditions,” said Alam.

Skepticism About Innovation, Access

With Nolla Health’s limited scope, “it’s unclear to me that they’re offering anything truly novel,” said John Barbieri, MD, MBA, associate professor of dermatology at Harvard Medical School in Boston.

“While this is an interesting concept with potential to improve cost and access, if it remains limited to only this small selection of topical therapies, it may ultimately increase costs compared to what is already available OTC [over-the-counter] or through other direct-to-consumer platforms,” Barbieri, director of the advanced acne and rosacea therapeutics clinic at Brigham and Women’s Hospital in Boston, told Medscape Medical News.

Laura Ferris, MD, PhD, professor and chair of dermatology at the University of North Carolina School of Medicine in Chapel Hill, said that while Nolla’s AI prescribing does seem novel, she would like to see validation studies showing that the technology results in better tolerability or better adherence to a drug or that doses could be escalated more quickly or slowly.

Nolla Health likely started with acne because it’s a diagnosis that most consumers can make on their own, Ferris told Medscape Medical News.

Indeed, the company said it chose acne due to its prevalence, visual nature, standardized severity grading, and “reliance on first-line topical therapies with long-standing safety profiles.”

Ferris said she was concerned that topicals alone might not be enough in some cases, and that patients might not get appropriate treatment if they never see a dermatologist. “We do have a lot more advanced therapies that are way more effective and that can prevent scarring,” she said.

She also was dubious about the stated goal of increasing access. Treating acne with topicals is not necessarily an unmet need, Ferris said. And if those patients come to see her for that relatively minor complaint, she can counsel on options, dispel fears about systemic medications, and “cut through the myths,” she said.

For dermatologists, the goal is not to “only have the most complicated patients,” said Ferris, who is also a co-host of the Derms on Drugs podcast.

“I’m not sure this is going to improve access to care because people can already get these things very easily through a variety of ways,” said Barbieri.

But Tim Patton, DO, assistant professor of dermatology at the University of Pittsburgh Medical Center in Pittsburgh, said on an October 9 episode of the podcast Derms on Drugs, where Nolla’s venture in Utah was discussed, that he liked the idea of patients with acne who just need topicals being seen via a platform such as Nolla’s. Making those patients come for a visit or just because they need a refill of tretinoin is “silly,” he said. “It’s wasting the patient’s time,” and “it’s wasting their money,” if they have a copay for the visit, said Patton.

AI Prescribing After First 100 Patients

The company said its Nolla Derm app, which launched in the US in 2025, has been downloaded more than 175,000 times, and that it has been used been by “thousands” of patients in 43 other states.

In Utah, patients will pay $4.99 a month for the app-based program, which is a discount from the $9.99 monthly fee charged to other users.

The user first completes a structured medical intake covering acne history, symptoms, prior treatments, and other relevant health information and then submits photos following what the company says is a standardized multi-angle capture sequence. Images that are taken in low lighting or poor conditions are immediately rejected, and the user is prompted to take new photos.

Fadul said diagnosing acne is “easy for AI” and that Nolla’s algorithm has 96% concordance with dermatologists on both diagnosis and treatment.

For the first 100 Utah patients, Fadul and another primary care colleague will review and approve the prescription before it is sent to a pharmacy by the AI. For the next 500 patients, the prescription will be submitted directly by the AI to a pharmacy, and Fadul retrospectively reviews all cases at least weekly. For the subsequent 750 patients, the AI prescribes, and the physicians review 10% of the prescriptions monthly.

Patients can receive refills after they complete 28 face scans and another intake questionnaire, typically a month or two after the first prescription. The re-intake covers side effects, treatment improvements observed, patient motivation, and amount of medication remaining.

Patients who have severe acne, are pregnant or plan to become pregnant, are breastfeeding, have a weakened immune system, or have had a reaction to a listed medication will not receive a prescription. And patients will self-report adverse reactions and have the option to contact a physician 24 hours a day, 7 days a week, through the app. Fadul or his colleague will respond, not a chatbot.

Only five medications will be prescribed: adapalene (0.1%); azelaic acid (15%); benzoyl peroxide (5%); clindamycin (1%) plus benzoyl peroxide (5%); and tretinoin (0.025% and 0.05%). No oral medications, systemic hormonal therapies, or isotretinoin will be prescribed.

These are “relatively low-risk medications,” said Ferris, noting that even though tretinoin should theoretically not be prescribed during pregnancy, a topical presented very low risk. 

Liability and Prior Authorization Questions

Even so, Alam said he questioned who would have responsibility if a patient had a severe reaction or bad outcome.

Ferris also said she wondered how liability would be assessed if there was a delay in diagnosis of skin cancer or tuberous sclerosis.

Fadul told Medscape Medical News that “every prescription is under my name and my license, so I’m the final sign-off on all these prescriptions,” and Nolla also holds an insurance policy that covers his liability.

Utah has given Nolla Health a fair amount of regulatory leeway; it will not bring an enforcement action for unlicensed or unprofessional conduct, as long as the AI is issuing topical acne prescriptions under the agreed protocol, according to the contract with the state. The same protection covers physicians working with Nolla Health.

Barbieri wondered whether Nolla would assist with prior authorizations, which “are nearly universal for acne medications,” he said.

But Fadul said that most of the medications being prescribed are “typically covered without prior authorization” and that if a plan does not cover a medication, patients are referred to discount sites, where generics might cost less than a patient’s copay.

If prior authorization is required for Utah patients, the clinical team at Fadul’s company, Bespoke Concierge MD, will handle them on a case-by-case basis, he said.

Barbieri disclosed that he has received consulting fees from Alosa Health, Galderma, Honeydew Care, Kenvue, Sagimet Biosciences, Sanofi Pasteur, and TWi Biotechnology. Ferris reported having no relevant disclosures. Fadul disclosed that he is a paid contractor for Nolla Health, has a small ownership stake in the company, and is the CEO of Bespoke Concierge MD.

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in many health and science publications, including Smithsonian.com. You can find her on X at @aliciaault and on Bluesky at @aliciaault.bsky.social.