Skin of Color in Dermatology: Analysis of Content and Engagement on TikTok

July 2022 | Volume 21 | Issue 7 | 718 | Copyright © July 2022


Published online June 27, 2022

Madelaine Fritsche BSa, Tonya S. King PhDb, Lauren Claire Hollins MDa

aPenn State Hershey Medical Center, Department of Dermatology, Hershey, PA
bPenn State University College of Medicine, Department of Public Health Sciences, Hershey, PA

Abstract
Importance: There is an existing disparity in the ability for patients with skin of color to access reliable, evidence-based care via social media.
Objectives: To analyze the intention, creators, and engagement of skin of color content posted on TikTok.
Design: Cross-sectional epidemiologic study analyzing the content of 43 search terms related to skin of color.
Setting: Population-based.
Participants: The accounts linked to the top 3 posts associated with each search term when sorted by both relevance and number of likes based on the TikTok algorithm.
Exposures: N/A. Main Outcome Measures: The number of views, likes, comments, and shares.
Results: Dermatologists fall behind other TikTok creators with regard to producing popular skin of color content on TikTok.
Conclusion and Results: Dermatologists have the opportunity to help combat the spread of misinformation by generating educational posts and making reliable content more available for skin of color patients.

J Drugs Dermatol. 2022;21(7):718-722. doi:10.36849/JDD.6784

INTRODUCTION

Racial and ethnic diversity in healthcare has been shown to reflect positively upon access to care, patient outcomes, and patient experiences.1,2 However, there is a staggering lack of diversity within the field of dermatology despite the progression toward a more diverse population in the United States. Only 3% of all US dermatologists are black compared to 12.8% in the general population, and only 4.2% of dermatologists are Hispanic compared with 16.3% in the US population.3 This gap continues to grow, limiting the quality of healthcare experiences amongst patients with skin of color. Furthermore, studies have shown a significant deficit in reference photos of dermatological conditions on non-white skin in academic textbooks and a significant disparity of dermatologic publications related to skin of color.4,5 With the profound lack of diversity among several avenues of patient care in dermatology, skin of color patients may be discouraged from seeking care from board-certified dermatologists and may turn to more accessible routes including online platforms and social media.

Social media is frequently used by patients to seek advice related to dermatologic concerns, but it is underutilized among clinicians. In a study assessing the use of online platforms among patients seeking dermatologic care, 379 (82.4%) of 460 patients reported searching the internet for medical information, 301 (65.4%) of which reported specifically using social media platforms.6 Social media and the internet bear significant potential in patient education and the dispersion of evidence-based information. However, given the transfer of information distribution from the clinician to laypersons, the risk of misinformation poses danger as well. For example, in a study assessing the influence of social media use on acne treatment, 45% of 130 patients reported consulting social media for acne treatment advice, however, only 31% of participants consulting social media made changes aligned with AAD clinical guidelines.7 This risk is even greater in skin of color patients given that most dermatologic content on social media is targeted toward white or light skin, and when applied to skin of color, can be harmful. Furthermore, in a study assessing content of Instagram posts directly related to skin of color, board-certified dermatologists generated only 12% of top posts, whereas individuals not certified in dermatology produced 88% of top posts.8 The disparity in reliable skin of color content on social media limits the ability of skin of color patients to access evidence-based dermatologic care.

TikTok, like other social media platforms, poses a similar risk to skin of color patients through the spread of misinformation and lack of evidence-based information. However, no studies have been performed to analyze its content related to skin of color. The purpose of this study was to identify top TikTok