DOI: 10.1111/pde.
14471
BRIEF REPORT
Acne and social media: A cross-sectional study of content
quality on TikTok
Abstract
Our objective was to assess the quality of acne-related
medical information present on TikTok, the world's fast-
est growing social media platform. We queried the TikTok
mobile application for videos tagged with “#acne” on May
1, 2020, and assessed the top 100 videos meeting inclu-
sion criteria for content quality using DISCERN, a validated
and reliable instrument for evaluating consumer health
information. The mean content quality rating of videos
was 2.03 (SD 0.47) which, according to the DISCERN in-
strument, indicates information with serious to potentially
important shortcomings. Dermatologists should be aware
that adolescents are using TikTok to gather acne-related
information, and should prioritize acne education in this
patient demographic due to the generally low content
quality of such information.
Social media platforms are becoming increasingly popular for sharing
dermatologic medical information.1 One such platform is TikTok, an
application for uploading short-form mobile videos and the fastest
growing social media platform in the world.2,3 In addition to being most
affected by acne,4 adolescents are quite active on TikTok, as 62% of US
teenagers report using TikTok at least once a month.5 Teenage TikTok
users often help to disseminate information on acne treatment, with
several of the most prominent users becoming “skinfluencers,” who
receive sponsorship in exchange for promotion of a brand's product.2
However, the quality of dermatologic information found on TikTok is
largely unknown. Our objective was to assess the quality of medical
information in the most popular TikTok videos related to acne.
We queried the TikTok mobile application for videos tagged with
“#acne” on May 1, 2020 (Figure 1). The 100 most popular videos
meeting inclusion criteria, as sorted by TikTok's proprietary search
algorithm, were considered in the final analysis. To characterize the
rate at which TikTok acne content evolves over time, we conducted
additional queries for the top 200 videos tagged with “#acne,” once
weekly from May 8, 2020, to June 5, 2020. Descriptive characteris-
tics were recorded for each video, including upload date, uploader
Pediatric Dermatology. 2020;00:1–3. wileyonlinelibrary.com/journal/pde© 2020 Wiley Periodicals LLC.     1
Pediatric
Dermatology
type, gender, physician specialty, and video category. Videos were
assessed for content quality by two independent reviewers using
DISCERN, a validated and reliable set of criteria (1-5 scale) for ap-
praising consumer health information (Table S1).6 We calculated
Pearson's correlation coefficient to test inter-rater reliability and
used Student's t test to compare mean DISCERN ratings between
physician and non-physician uploaders.
The top 100 videos tagged with “#acne” had a total of 13 470 501
likes and 64 775 comments over a 7.6 month time period (Table 1).
On average, 10.9% of a given week's top 200 “#acne” videos con-
sisted of new video content not included in any previous week.
Additionally, there were 1.4 billion views on videos tagged with
“#acne” at the start of our second query, and 400 million new views
were added to the hashtag over a one-month period (May 8, 2020
to June 5, 2020).
The mean content quality of videos was 2.03 (SD 0.47), with
a high level of inter-rater agreement (Pearson's correlation coeffi-
cient 0.78, P < .001). Nine videos were produced by United States
board-certified physicians, and these videos had a mean content
quality of 2.41 (SD 0.46), which was higher than the videos pro-
duced by non-physicians (P < .001). Analysis of the DISCERN crite-
ria dimensions suggested that major shortcomings common to both
physician and non-physician uploaders included failure to cite in-
formation sources, discuss treatment risks, and provide support for
shared decision-making.
Limitations of this study include the small sample size of phy-
sicians, uncertainty regarding whether additional non-physician
medical professionals were included in our sample, and lack of
video information (eg, view count, country of origin) beyond num-
ber of likes and comments. Given the high turnover rate of con-
tent (10.9% per week), and that information with a mean DISCERN
rating of 2 is considered to have serious to potentially important
shortcomings, 6 we suggest that patients view acne-related TikTok
videos with caution and consult evidence-based resources when-
ever possible. Conversely, we understand that social media can be
a powerful tool for advancing health literacy. Therefore, we also
recommend that healthcare professionals engaging on TikTok cre-
ate thorough and perhaps standardized educational videos regard-
ing acne, as well as correct any acne-related misinformation that
may be present.
|
 |
2       Pediatric BRIEF REPORT
Dermatology
F I G U R E 1   Flowchart displaying the
steps taken in conducting this cross-
sectional analysis

TA B L E 1   Characteristics of the top 100 most popular TikTok videosa on acne

Number (%) Mean DISCERN rating

Uploader type
Individual—non-physician 86 (86) 1.99
Individual—physician 9 (9) 2.41
Private company 4 (4) 1.86
Other 1 (1) 1.50
Gender
Female 74 (74) 2.07
Male 21 (21) 1.95
Other gender designation 5 (5) 1.79
Physician specialties
Dermatology 6 (67) 2.35
Plastic surgery 2 (22) 2.23
OB-GYN 1 (11) 2.77
Video categories
Treatment—product advertisement 34 (34) 1.89
Treatment—home remedy 13 (13) 2.17
Information relating to acne 20 (20) 2.06
Personal anecdote 26 (26) 2.02
Other 7 (7) 1.76
a
The earliest video upload date was September 13, 2019, and the latest video upload date was April 30, 2020.
BRIEF REPORT Pediatric |
      3
Dermatology
K E Y WO R D S REFERENCES
acne treatment, acne vulgaris, TikTok, TikTok and acne treatment 1. Sierro TJ, Young PM, Kassabian SK, Wu KK, Armstrong AW.
Dermatologists in social media: A study on top influencers, posts, and
user engagement. J Am Acad Dermatol. 2020;83(5):1452-1455.
David X. Zheng BA1
2. Flora L.TikTok’s skinfluencers emerge as Gen Z’s go-to source.
Anne Y. Ning BA1 https://www.glossy.co/beaut ​y/tikto​k s-skinf​l uenc​e rs-emerg​e -as-
Melissa A. Levoska MD2 gen-zs-go-to-sourc​e/. Accessed September 28, 2020
Laura Xiang BA1 3. Newton C.TikTok is having a monster 2020. http://www.theve​rge.
com/inter ​f ace/2020/6/10/21285​3 09/tikto​k-2020-user-numbe​r s-
Christina Wong MD2
reven​ue-smash​-hit-mea-culpa. Accessed June 12, 2020
Jeffrey F. Scott MD3 4. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol.
2013;168(3):474-485.
1 5. Piper Sandler Companies. Taking stock with teens: a collaborative
Department of Dermatology, Case Western Reserve University
consumer insights project. http://www.piper​sandl​er.com/2col.aspx-
School of Medicine, Cleveland, OH, USA
2
?id=6040. Accessed October 25, 2020
Department of Dermatology, University Hospitals Cleveland 6. Charnock D, Shepperd S, Needham G, Gann R. DISCERN: an in-
Medical Center, Case Western Reserve University, Cleveland, strument for judging the quality of written consumer health in-
OH, USA formation on treatment choices. J Epidemiol Community Health.
3
Department of Dermatology, Johns Hopkins University School 1999;53(2):105-111.

of Medicine, Baltimore, MD, USA

Correspondence
David X. Zheng, BA, University Hospitals Cleveland Medical
Center, 11100 Euclid Ave., Cleveland, OH 44106, USA.
Email: dxz281@case.edu
S U P P O R T I N G I N FO R M AT I O N
Additional supporting information may be found online in the
Supporting Information section.

ORCID
David X. Zheng  https://orcid.org/0000-0002-3351-023X