Acne Information on Instagram: Quality of Content & the Role of Dermatologists on Social Media
Common among adolescents and adults, acne vulgaris accounts for a significant portion of dermatology appointments.1 While there are a variety of safe, effective, and evidence-based treatments available, there are also numerous products for acne marketed on social media that are untested and/or show no benefit in treating acne vulgaris. Even for treatments with known efficacy, quality information can be difficult to locate on social media. A study of YouTube content regarding isotretinoin, a medication with strong evidence in treating acne vulgaris, found that videos were heterogeneous in terms of information quality, with the majority of videos in the poor to fair range.2 Only a minority of adults in this country are proficient in health literacy, suggesting that many patients may have difficulty differentiating sources with varying levels of information quality.3 In order to fully harness the potential of social media as a tool for educating our patients, we must first understand the current landscape of skin-related content available.
In this study, we sought to characterize the acne-related information present on one of the most popular social media platforms: Instagram. We searched for the “top” Instagram posts using the hashtag #acne and analyzed them based on their source and content. Posts were excluded if they were unrelated to acne, not in English, or duplicates. In April 2020, 900 top posts were assessed and 439 were included. Screenshots were obtained and stored for future reference. “Like” and “follower” accounts were compared with single factor ANOVA applied with the Microsoft Excel data analysis ToolPak.
Many top acne posts were generated by “influencers,” while dermatologists were responsible for only 17 posts, accounting for <4% of the included content (Table 1). While dermatologists, other providers, and influencers all had comparable numbers of followers (P=0.58), dermatologists had fewer average “likes” per photo: 250 compared to 764, with a trend toward significance (P=0.11). Retailers had significantly more followers than other groups (P=0.02). “Other providers” included Instagram users who used a professional credential to substantiate their recommendations. The most common other providers giving acne advice under a professional pretext were aestheticians, though the group was diverse and included nurses, pharmacists, dieticians, and dentists, among others.
Of the included posts, 232 promoted a commercial product, 82 centered around acne awareness and acceptance, 48 advertised services from a medical or beauty-industry provider, 35 promoted home remedies for acne, 31 recommended behavioral interventions, and 11 addressed the underlying etiology of acne vulgaris. 254 posts recommended at least one specific intervention, and 124 separate ingredients were proposed as potential acne treatments (Table 2). Among posts that made a specific recommendation, only 11% referenced a treatment with grade A evidence based on American Academy of Dermatology guidelines. 4 Furthermore, the recommendations tended to center around over the counter treatments with only rare mentions of physician-guided treatment for acne.
By its nature, Instagram is a social media platform with constantly evolving content and this study is limited as it represents only a snapshot in time. It is further limited by its assumption that the number of likes and followers is a proxy for influence. Further research is needed to determine whether patients weigh content differently based on its source and if/how exposure to this content leads to changes in behavior or attitudes. Nevertheless, there is a vast amount of acne-related content readily available to patients on this platform that has over 100 million US users. This study showed that the content is heterogeneous in message and quality, and dermatologists are responsible for a tiny fraction of it. Thus, there is a need for dermatologists to generate content and to support one another in promoting highquality evidence-based treatments for acne on Instagram.
The authors have no conflicts of interest to disclose.
1. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013;168(3):474-85. doi:10.1111/bjd.12149
2. Xiang L, Ravichandran S, Tamashunas N, Wan A, Mazmudar RS, Scott JF. YouTube as a source of dermatologic information on isotretinoin. J Am Acad Dermatol. 2020;83(2):653-655. doi:10.1016/j.jaad.2019.12.014
3. Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of Americaâ€™s adults: results from the 2003 National Assessment of adult literacy: National Center for Education Statistics. 2006.
4. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.e33. doi:10.1016/j.jaad.2015.12.037