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MS LAURA XIANG (Orcid ID : 0000-0002-0536-2858)

Article type : Letter to the Editor

TikTok, teens, and isotretinoin: Recommendations for identifying trending acne-related content
on the world’s most popular social media platform

D.X. Zheng,1 A.Y. Ning,1 M.A. Levoska,1 L. Xiang,1 C. Wong1 and J.F. Scott2

1 Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve
University, Cleveland, OH
2 Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD

Correspondence: David X. Zheng, BA

Email: dxz281@case.edu

Financial disclosure: The authors report no funding sources relevant to this work.
Conflict of interest: The authors report no conflicts of interest relevant to this work.

Dear Editor, We enjoyed reading Roche et al.’s recent article published in Clinical and Experimental
Dermatology, in which the authors discussed the potential for propagation of false, misleading, or
harmful dermatologic information on TikTok.1 In reply, Nikookam and Guckian provided an
interesting perspective regarding TikTok’s potential for education in dermatology.2 We continue the

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 conversation by establishing a framework with which dermatologists may engage with the TikTok
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app interface to identify popular dermatology-related content, as increased awareness of trending
social media may allow dermatologists to better understand patients’ perspectives.
In particular, Roche et al. characterize the large prevalence of acne-related content on TikTok.
For example, there were 334 million cumulative views on videos relating to Accutane at the time of
analysis (436.7 million as of March 29, 2021). In a previous study by our group,3 we corroborated
Roche et al.’s concerns regarding potentially misleading dermatologic information on TikTok by
finding that most acne-related TikTok videos had serious to potentially important content quality
shortcomings. As such, it may benefit dermatologists to increase awareness of trending TikTok
content in order to better understand patient attitudes regarding acne treatments such as isotretinoin.
We provide practical recommendations below.
First, trending content can be identified using the hashtag search feature. Querying content
with a hashtag (key word or phrase prefaced with the “#” symbol) yields not only the most popular
TikTok videos incorporating that hashtag, but also other popular hashtags relating to the search term.
For example, searching for “#acne” reveals that “#acnetreatment” and “#acneskin” are also frequently
used hashtags in acne-related TikTok videos (Table 1). Knowing other popular hashtags related to a
search term of interest may provide dermatologists a more nuanced understanding of trending acne-
related content.
Second, dermatologists active on TikTok may take advantage of its proprietary algorithm to
shape the content appearing on their “For You Page.”4 TikTok’s algorithm is unique relative to other
social media platforms in that it presents users a continuous stream of videos curated to their previous
engagement preferences (e.g. views, likes), as opposed to users consuming content only from
accounts they follow and in chronological order. Therefore, dermatologists interested in better
understanding acne-related TikTok trends may consider following popular accounts that share acne-
related information or viewing/liking/commenting on videos demonstrating viral social media
skincare trends.5 Such engagement would likely encourage the TikTok algorithm to present more
trending acne-related content to the user in the future.
Overall, it is important for dermatologists to meet patients where they are at and understand
how patients may perceive acne treatments or other dermatologic information based on their portrayal

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 on social media platforms. This may allow dermatologists to preempt the low-quality medical
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information currently available on TikTok and the disproportionate emphasis on discussing positive
outcomes (at the expense of discussing side effects or consultation with a board-certified
dermatologist) when educating and treating their patients.2,3 Given the increasing influence of social
media on our lives, we encourage dermatologists to stay up-to-date on related trends in order to better
understand patients’ perspectives and ultimately provide more patient-centered care.

References
1. Roche L, Nic Dhonncha E, Murphy M. TikTok and dermatology: promises and pearls. Clin
Exp Dermatol. 2020.
2. Nikookam Y, Guckian J. TikTok and dermatology: lessons for medical education. Clin Exp
Dermatol. 2021.
3. Zheng DX, Ning AY, Levoska MA, Xiang L, Wong C, Scott JF. Acne and social media: A
cross-sectional study of content quality on TikTok. Pediatr Dermatol. 2021;38(1):336-338.
4. Zheng DX, Mulligan KM, Scott JF. TikTok and dermatology: An opportunity for public
health engagement. J Am Acad Dermatol. 2021.
5. Zheng DX, Xiang L, Scott JF. The bandwagon effect: A double-edged sword for influencing
teenage acne outcomes. Pediatr Dermatol. 2021.

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 Table 1. Top 10 acne-related hashtags on TikTok as of March 29, 2021
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Hashtag Cumulative views
#acne 8.2 billion
#acnetreatment 1.1 billion
#acneskin 807.8 million
#acnefighter 477.3 million
#acnecheck 448.5 million
#acnescars 312.7 million
#acneskincare 234.2 million
#acneremoval 227.8 million
#acnetips 172.0 million
#acnehelp 155.7 million

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