RESULTS
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.
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.
DISCUSSION
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.
