INTRODUCTION
Forty-two percent of Americans search for health-related information on social media platforms, and forty-five percent of consumers report that social media health information influences their decision to seek care.1 However, online information is not always accurate, nor does it consistently come from credible sources.2,3 We aimed to characterize the content and sources of the top Dermatology posts on Instagram, the most popular photo-sharing platform with 800 million monthly active users.4
METHODS
We generated a list of the top 81 dermatologic diagnoses and procedures based on the National Ambulatory Medical Care Survey and the 2016 American Society for Dermatologic Surgery Survey of Dermatologic Procedures.5,6 Synonymous lay terms for these diagnoses and procedures were added. On September 17, 2017, these terms were queried as Instagram hashtags. Hashtags are keywords users can add to label their posts. JP and MC recorded the top 20 most common hashtags for medical and procedural dermatology (Table 1) and noted the total number of posts tagged with each hashtag. Instagram automatically selects “top 9” posts to highlight for each hashtag, based on the highest engagement level. Engagement is determined by a private Instagram algorithm incorporating the number of comments and likes of the photo, and the following-to-follower ratio of the poster, among other criteria.
TABLE 1.
Most Common Dermatologic Diagnoses | Most Common Dermatologic Procedures | ||
Acne | 1,852,029 | Botox | 1,847,196 |
Eczema | 406,904 | Laser | 1,398,163 |
Alopecia | 291,652 | Filler | 626,494 |
Hairloss | 287,587 | Juvederm | 398,056 |
Psoriasis | 227,413 | Restylane | 226,889 |
Pimples | 209,775 | Laser hair removal | 186,149 |
Rosacea | 78,502 | Dysport | 136,821 |
Cyst | 72,112 | Tattoo removal | 112,993 |
Rash | 68,833 | Coolsculpting | 108,295 |
Melanoma | 68,743 | Body contouring | 105,485 |
Skin cancer | 65,776 | Acne scars | 105,134 |
Hyperpigmentation | 47,027 | Melasma | 98,248 |
Atopic dermatitis | 5132 | Sun damage | 73,332 |
Seborrheic dermatitis | 2016 | Laser tattoo removal | 52,611 |
Contact dermatitis | 1833 | Dermalfillers | 130,429 |
Folliculitis | 820 | Kybella | 45,166 |
Tinea | 800 | Radiesse | 39,865 |
Benigntumor | 641 | Chemicalpeel | 76,009 |
Actinic keratosis | 504 | Radiofrequency | 37,393 |
Molluscum contagiosum | 259 | Ultherapy | 36,481 |
Total Medical Dermatology-Related | 3,722,970 | Total Procedural Dermatology-Related | 5,893,190 |
Board certified dermatologist | 716 | ||
Dermatologist | 166,150 | ||
Dermatology | 415,858 | ||
Total Hashtags Queried | 10,197,884 |
We analyzed the content of each “top 9” post. We excluded posts unrelated to dermatology, duplicates, and paid advertisements marked by “#ad” as required by the Federal Trade Commission. We assessed the credentials and occupation of users as reported on the Instagram account or linked website of the original poster. We used the American Board of Medical Specialties website (www.certificationmatters.org) to determine if physicians who posted were board-certified dermatologists. We classified posts into the following categories: education, self-promotion, non-paid product advertisement, and patient-posted. As Instagram data is publicly available, this study was exempt from the Institutional Review Board.
RESULTS
A total of 10,197,884 Instagram posts were tagged with the 43 hashtags queried for this study. Of these, 387 were considered “top posts” and 258 posts met inclusion criteria.
Ninety-one unique posters (35%) identified as working in the healthcare field, either as a physician (80% of total health-related posters), nurse or nurse practitioner (10%), dentist (4%), esthetician (3%), or physician assistant (3%) (Table 2). Self-identified physicians were responsible for 73 (28%) of top posts; of these, 27 posters (10%) reported board certification in a medical specialty, of which 23 (9%) were confirmed online. Self-identified dermatologists were responsible for 16% of top posts (40 posts). Only 5% of top posts (14 posts) were made by American Board of Dermatology-certified dermatologists. Of the 7 individuals using the hashtag #boardcertifieddermatologist, 4 were certified by the American Board of Dermatology and 1 was a board-certified dermatologist in Korea.
TABLE 2.
Characteristics of the Individuals Posting Dermatology-Related Content |
Content of Dermatology-Related Posts |
|||
---|---|---|---|---|
n | Medical (n, %) | Procedural (n, %) | ||
Non-health related | 167 | Education | 67 (48%) | 18(15%) |
Health-related | 91 | Product Advertisement | 19(14%) | 7 (6%) |
Self-identified Physicians | 73 | Self-Promotion | 21 (15%) | 69 (58%) |
Physicians practicing internationally | 44 | Patient Posted | 33 (24%) | 24 (20%) |
Physicians practicing in the US | 29 | |||
Dermatologists (practicing in the US and internationally) | 40 | |||
Dermatologists (certified by American Board of Dermatology) | 14 | |||
Nurses / Nurse Practitioners | 9 | |||
Dentists | 4 | |||
Estheticians | 3 | |||
Physician Assistants | 2 |
Of the 40 posts by self-identified dermatologists, 14 posters practice in America and 3 in Canada. Other countries represented included: Brazil (7), Russia (4),Turkey (2), Poland (2), and one post each practicing in the United Kingdom, Philippines, Panama, Lebanon, Korea, Istanbul, Iran, and Indonesia.
Of the posts with medical dermatology hashtags, 13% were advertisements, 16% self-promotional, 23% posted by patients, and 48% educational. For procedural dermatology-related hashtags, 6% were advertisements, 58% self-promotional, 20% posted by patients, and 15% educational (Table 2). Posts made by board-certified dermatologists were educational in content 93% of the time, with only 7% of posts being self-promotional. Non-physician healthcare professionals posted self-promotional content 56% of the time. Non-dermatologist physicians posted self-promotional content 67% of the time.
DISCUSSION
We found that board-certified dermatologists produce a small proportion of the top dermatology-related posts published on Instagram. The vast majority of dermatology-related top posts are made by individuals without formal dermatology training. Furthermore, compared to non-physician healthcare professionals and non-dermatologist physicians, board-certified dermatologists posting on Instagram tend to eschew self-promotion in favor of educational content. As the use of social media for health information grows, our patients stand to benefit from the increased presence of dermatologists on these platforms.
ACKNOWLEDGMENT
We would like to acknowledge Dr. Matthew Park for assistance with study design.
DISCLOSURES
Dr. Park has received consulting fees from Skin Resource.MD. Dr. Christman has no relevant financial interests to report. Dr. Linos is supported by the NIH through the following grants: K76AG054631, R21CA212201, DP20D024079, and the UCSF Helen Diller Impact Grant Award. Dr. Rieder has received consulting fees from Unilever and UCB Pharmaceuticals. Drs. Park, Christman, and Rieder have active social media accounts, including Instagram accounts..
REFERENCES
- 1.Social media “likes” healthcare: From marketing to social business. 2012:40 http://www.pwc.com/us/en/health-industries/health-research-institute/publications/pdf/health-care-social-media-report.pdf. Accessed October 10, 2017.
- 2.Dorfman RG, Vaca EE, Mahmood E, Fine NA, Schierle CF. Plastic Surgery-Related Hashtag Utilization on Instagram: Implications for Education and Marketing. Aesthet Surg J. 2017. [DOI] [PubMed] [Google Scholar]
- 3.Guidry JP, Carlyle K, Messner M, Jin Y. On pins and needles: how vaccines are portrayed on Pinterest. Vaccine. 2015;33(39):5051–5056. [DOI] [PubMed] [Google Scholar]
- 4.Chaffey D Global social media research summary 2017. 2017:2017 https://www.smartinsights.com/social-media-marketing/social-media-strategy/new-global-social-media-research/. Accessed November 5, 2017.
- 5.Wilmer EN, Gustafson CJ, Ahn CS, Davis SA, Feldman SR. Huang WW. Most common dermatologic conditions encountered by dermatologists and nondermatologists. Cutis. 2014;94(6):285–292. [PubMed] [Google Scholar]
- 6.ASDS Survey: Nearly 10.5 Million Treatments Performed in 2016. 2017. https://asds.net/2016-procedures-survey.aspx. Accessed September 20, 2017.