TikTok and dermatology: An opportunity for public health engagement

Abstract

To the Editor: We read with interest a recent publication by Villa-Ruiz et al1Villa-Ruiz C. Kassamali B. Mazori D.R. Min M. Cobos G. LaChance A. Overview of TikTok's most viewed dermatologic content and assessment of its reliability.J Am Acad Dermatol. 2020; https://doi.org/10.1016/j.jaad.2020.12.028Abstract Full Text Full Text PDF Scopus (15) Google Scholar on TikTok and dermatology. The authors characterized the content and assessed the reliability of the most popular dermatology videos on TikTok. Although the content creators of the most popular videos were most often patients, they found that board-certified dermatologists were the main source of educational videos and that these videos were 50% more likely to be reliable than educational videos created by other sources when compared based on the American Academy of Dermatology guidelines. Worldwide, TikTok has had over 1 billion monthly active users and 2 billion downloads in total since its launch in September 2016, making it the world's fastest growing social media platform (Table I).2Doyle B. TikTok Statistics - Updated October 2020. Wallaroo.https://wallaroomedia.com/blog/social-media/tiktok-statistics/Date accessed: December 29, 2020Google Scholar,3Zheng D.X. Ning A.Y. Levoska M.A. Xiang L. Wong C. Scott J.F. Acne and social media: a cross-sectional study of content quality on TikTok.Pediatr Dermatol. 2020; 38: 336-338Crossref PubMed Scopus (36) Google Scholar What makes TikTok unique compared to its peers (eg, Instagram), however, is that it uses a proprietary algorithm to perform never-ending streaming of curated short-form video content to its users via a “For You Page.” These videos are based on the users' previous engagement, views, and likes (as opposed to other social media platforms, where users primarily consume content in a chronological order and only from accounts they follow).4Explaining TikTok's Machine Learning Algorithm. Jumpstart Media.https://www.jumpstartmag.com/explaining-tiktoks-algorithm/Date accessed: December 29, 2020Google Scholar This algorithm creates a positive feedback loop in which popular content creators or viral trends are prioritized on the users' homepages, in turn providing the creators of these videos with an even larger audience. Understanding the results of the study by Villa-Ruiz et al necessarily entails contextualizing them in light of TikTok's proprietary algorithm.Table ITikTok statistics, updated as of January 1, 2021MetricQuantityTotal number of application downloads2.6 billionMonthly active users Worldwide1 billion United States100 million∗As of August 25, 2020, according to an official lawsuit filed by TikTok against the United States government on this date.Age breakdown of United States-based users (years) 10-1932.5% 20-2929.5% 30-3916.4% 40-4913.9% >507.1%Sex breakdown of United States-based users (years) Male40% Female60%Average daily minutes per user All users52 minutes Age 4-15 years80 minutesMarketing and advertising costs Brand takeover advertisement$20,000-$200,000 Hashtag challenge†Hashtag challenges are advertising schemes that have a tendency to go viral, in which brands ask TikTok users to perform a certain task and then tag them using a predetermined hashtag.>$100,000 Advertisement posted by a TikTok influencer with 2.5 million or more followers$600-$1000∗ As of August 25, 2020, according to an official lawsuit filed by TikTok against the United States government on this date.† Hashtag challenges are advertising schemes that have a tendency to go viral, in which brands ask TikTok users to perform a certain task and then tag them using a predetermined hashtag. Open table in a new tab For example, the content that typically goes viral on TikTok is often highly visual, comedic, or musical and may not adhere to the traditional format of educational content distributed by board-certified dermatologists. As demonstrated by the data in the study by Villa-Ruiz et al, the creators of the most popular videos are most commonly patients. Increasing the number of board-certified dermatologists active on TikTok may result in the dissemination of more reliable medical information, but without the quality of “virality,” or an already large following, their content is unlikely to receive much organic user engagement. Board-certified dermatologists may consider incorporating viral elements (eg, trending hashtags and background sounds) into their TikTok videos in an attempt to reach wider audiences.4Explaining TikTok's Machine Learning Algorithm. Jumpstart Media.https://www.jumpstartmag.com/explaining-tiktoks-algorithm/Date accessed: December 29, 2020Google Scholar Because of TikTok's broad reach among adolescents and young adults, demographics in which skin conditions are common,5De Vere Hunt I.J. Howard E. McPherson T. The impact of chronic skin disease in adolescence and the need for specialist adolescent services.Clin Exp Dermatol. 2020; 45: 5-9Crossref PubMed Scopus (10) Google Scholar dermatologists and public health advocates should consider leveraging TikTok to communicate important messages aimed at improving dermatologic health. For example, the American Academy of Dermatology can consider partnering with TikTok “skinfluencers” with large followings to share board-certified dermatologic information.3Zheng D.X. Ning A.Y. Levoska M.A. Xiang L. Wong C. Scott J.F. Acne and social media: a cross-sectional study of content quality on TikTok.Pediatr Dermatol. 2020; 38: 336-338Crossref PubMed Scopus (36) Google Scholar Alternatively, the American Academy of Dermatology can create an institutional TikTok account, obtain verified status to prove its authenticity, and then engage with TikTok users by publishing dermatology-related TikTok posts or interacting with content (eg, dispelling false or misleading claims) that has gone viral or has been posted by creators with large followings. Given the relative scarcity of highly popular board-certified dermatologists on TikTok, inaccurate dermatologic information or nonevidence-based treatments can be disseminated more easily. Increased presence of board-certified dermatologists on TikTok may be an appropriate first step; this should be followed by the creation of content that is enjoyable to watch and poised to be popular. None disclosed. Overview of TikTok's most viewed dermatologic content and assessment of its reliabilityJournal of the American Academy of DermatologyVol. 85Issue 1PreviewTo the Editor: Around 80% of people seek medical information online, and ≤45% report that social media influences their decisions to seek medical care.1,2 With >2 billion total downloads, TikTok is the world's fastest growing social media platform. This popular app allows users to create and share short videos on numerous topics, including health care. Previous studies have analyzed the dermatologic content posted on Instagram, Twitter, and YouTube.3 This study is the first to characterize the content, sources, and reliability of the most popular dermatology videos on TikTok. Full-Text PDF Characterizing top educational TikTok videos by dermatologists in response to “TikTok and dermatology: An opportunity for public health engagement”Journal of the American Academy of DermatologyVol. 85Issue 1PreviewTo the Editor: We thank Zheng et al1 for their interest in our manuscript, “Overview of TikTok's most viewed dermatologic content and assessment of its reliability.”2 We agree that TikTok holds great potential as a platform for disseminating educational information. To put this potential into perspective, the number of views for the hashtag #acne on TikTok more than doubled from 3.0 to 6.7 billion in just the past 5 months (Table I). As discussed by Zheng et al,1 to successfully utilize TikTok as an educational outlet, content creators should understand TikTok's target demographic and incorporate features associated with “virality” into their videos. Full-Text PDF