Reddit Discourse on Eczema: Quantitative Analysis of Misinformation, Engagement, and Alignment With 2025 American Academy of Dermatology Guidelines

Aopic dermatitis (AD) is a chronic inflammatory disease with significant psychosocial burden.¹ Patients increasingly seek dermatological information and guidance on Reddit, a platform with over 70 million daily active users, which hosts disease-specific communities such as r/eczema.²,³ These forums provide validation and peer support but may amplify misinformation.⁴ The 2025 American Academy of Dermatology (AAD) atopic dermatitis guidelines offer a timely, evidence-based benchmark against which to evaluate this discourse.

The authors conducted a cross-sectional analysis of the top posts from the r/eczema subreddit between May 25, 2024, and May 25, 2025. Of 210 posts screened, 123 met the inclusion criteria (English language, relevant to AD diagnosis; excluding off-topic and spam posts). Posts were thematically coded and scored using two frameworks: (1) a Guideline Alignment and Bias Scoring (GABS; a score from 0–5, a higher score indicated greater misinformation/bias. Criteria assessed included; testability, credibility, AAD contradiction, pseudoscientific claim, and basis of claim), and (2) AAD alignment (A score from 1–5, a higher score representing stronger guideline concordance).⁵ Two independent raters scored posts; inter-rater reliability was high (κ = 0.81). Readability was assessed with the Flesch–Kincaid index. Pearson correlations evaluated associations among GABS, AAD alignment, engagement, and readability.

The most frequent themes were treatment success (n = 29), flare triggers (n = 25), and alternative remedies (n = 16). Alternative remedies (mean AAD = 2.69; mean GABS = 1.94) and misinformation/doubt (mean AAD = 2.20; mean GABS = 3.20) were the least AAD guideline-concordant. Empowerment and peer education (mean AAD = 4.70; mean GABS = 0.60) and flare triggers (mean AAD = 4.60; mean GABS = 0.80) demonstrated the highest concordance (Table 1). Overall, a higher GABS score strongly correlated with lower AAD alignment (r = −0.77, P<0.001), a pattern more pronounced at the theme-specific level (r = −0.92, P<0.001). Engagement metrics further reinforced this pattern: upvote percentage correlated positively with AAD alignment (r = 0.34, P<0.001) and negatively with GABS (r = −0.37, P<0.001), while comment count correlated with Reddit score (r = 0.50, P<0.001) (Figure 1). Readability was not significantly associated with information quality within both GABS and AAD alignment.

These results demonstrate that while Reddit discourse contains substantial misinformation, community engagement tends to favor posts aligned with dermatology guidelines. Dermatologists should be aware of these online dynamics, as they reveal barriers and narratives not easily captured in clinic settings. Proactive engagement through patient education, counseling that acknowledges alternative treatment narratives, and partnerships with digital health communities may help mitigate misinformation and support adherence to evidence-based management.

Study limitations include restriction to a single subreddit, lack of demographic information, and a cross-sectional design. Nevertheless, these findings demonstrate that social media captures patient perspectives not easily measured in clinic-based studies. Platforms may offer dermatologists valuable insights into barriers to care, adherence challenges, and lived experiences of disease.

Reddit discourse exhibits a complex interplay with medical guidelines. Higher GABS scores strongly correlated with lower AAD alignment, particularly in themes such as alternative remedies and misinformation. One post described frustration with the medical system, accusing dermatologists of profiting from the disease rather than seeking a cure. This sentiment