Skin, hair, and nail supplements advertised on Instagram

Abstract

Teens and young adults increasingly utilize social media for health information. Dermatologic supplements, advertised on social media, may be pharmacologically active and risk adverse effects. Instagram was searched, and 100 posts from March 2021 were evaluated for ingredients, health claims, account verification status, and endorsements. Only 4% of posts were made by verified accounts, and 1% of posts contained a visible Supplement Facts label. The Food and Drug Administration does not regulate dietary supplements. Ingredients such as vitamin A found in posts can pose teratogenic risk. Other potentially dangerous ingredients included saw palmetto and biotin. To accurately counsel patients who may retrieve health information from Instagram, it is important for practitioners to be familiar with social media claims.

To better advise patients, healthcare professionals must understand the promotion of health and dermatologic products on social media. American consumers,¹ especially teens and young adults,² often turn to the internet for health information. Further, international research suggests that social media is becoming increasingly relevant as a source for health-related information for young people.^3,4 One topic of increasing interest to consumers is that of skin, hair, and nail supplements, which are often advertised on social media and endorsed by celebrities. Research indicates that dietary supplements are commonly used specifically for dermatological purposes. A recent study of the National Health and Nutrition Examination Survey illustrated that nearly 88% of respondents using dietary supplements reported taking them for healthy skin, hair, and nails.⁵ Although they can be pharmacologically active, these products are not regulated as drugs by the Food and Drug Administration (FDA) in the United States.⁶ Reports have also linked these products to adverse effects, such as birth defects, toxicity, allergies, and drug interactions.^7,8 The objective of this study was to investigate Instagram posts related to skin, hair, and nail supplements with regards to ingredients mentioned, endorsements, and health claims.

METHODS

Instagram was searched between April and May 2021 for photos and videos with the hashtags “skin supplement,” “skin supplements,” “nail supplement,” “nail supplements,” “hair supplement,” and “hair supplements.” Posts from March 2021 were evaluated using inclusion criteria until 100 posts were collected. Posts in a language other than English and posts from the same account posted on the same day were excluded. Post media (photos and/or videos), descriptions, hashtags, and comments were evaluated for the following: ingredients; health and other claims; celebrity, influencer, or healthcare professional endorsements; and account verification status (an account is verified if there is a blue checkmark next to the name).

RESULTS

Most supplements were oral. While 96% of the posts had a picture of the product or the product box in the post, only one post had a visible image of the Supplement Facts label. Only 4% of posts were made by verified accounts.

The total number of ingredients mentioned ranged from 0 to 10, with a median of 2 ingredients. Table 1 lists the number of posts containing various ingredients. Proprietary blends were mentioned in 15% of posts. No mention of ingredients or what may be contained in the supplement was made in 19% of posts.

Table 1.

Ingredients mentioned in posts

Ingredient	Posts
Collagen	27
Biotin	23
Glutathione	10
Probiotics	7
Evening primrose oil	5
Prebiotics	4
Vitamin A	4
Coenzyme Q10	4
Keratin	1
Saw palmetto	1
Hormone (dihydrotestosterone inhibitor)	1

Vitamins were mentioned in the post, image, or hashtags without specifying which vitamins were included in 31% of posts. The total number of vitamins on each post ranged from 0 to 6, with a median of 0. Among the four posts mentioning vitamin A, only one visibly displayed the vitamin A dose (133 mcg RE). The percentage daily value was not clearly visible.

Minerals were mentioned in the post, image, or hashtags without specifying which minerals were included in the product in 28% of posts. The total number of minerals on each post ranged from 0 to 2, with a median of 0.

The most common conditions mentioned in posts were hair loss/growth (31%), acne (20%), aging (14%), hyperpigmentation (13%), and wrinkles/fine lines (7%). Common health claims included making skin glow (23%), being an antioxidant (22%), boosting immunity (14%), hydrating (11%), improving skin tone (11%), lightening/whitening skin (11%), boosting energy (10%), clearing skin (10%), helping with skin inflammation (8%), and improving gut health (8%).

Posts containing videos or images of influencers promoting the product comprised 22% of the sample. One post was made by a healthcare professional (board-certified dermatologist) and featured a celebrity.

DISCUSSION

In this survey of dermatology supplements promoted via Instagram posts, it was found that such products contained a wide variety of active ingredients. Of concern, these products made wide-ranging health claims. In addition, risks of ingredients were not described.

In the United States, the FDA does not evaluate the safety or effectiveness of dietary supplements, nor does it approve them. The FDA can only remove a dietary supplement from the market if the product presents false or misleading claims or is shown to be unsafe.⁹ There are multiple kinds of supplements: dietary supplements, which are intended to supplement the diet; nutraceuticals, which are a drug-food hybrid intended to treat health conditions; and cosmeceuticals, which are often marketed as a drug and cosmetic mixture.¹⁰

We found a wide variety of health claims in these posts. Claims ranged from the most common one of “making skin glow,” to one product claiming to “assist with heart damage repair.” Posts commonly purported benefits of supplements for acne, hyperpigmentation, and aging. Many health claims were included in the supplement posts in the form of hashtags and were often unrelated to skin, hair, and nails, such as “slimming.” In fact, one supplement post featured 21 health benefits, claiming to address diabetes and cardiovascular, brain, and musculoskeletal health in addition to preventing conditions such as glaucoma and Alzheimer’s disease. However, the FDA does not confirm the validity of such claims.⁹

Adverse effects of dermatology supplements are a significant concern. Consumers may purchase products they see on social media without reviewing the ingredients or dosages. Dosage is an important consideration, as studies of dermatology supplement labels in 2020 and 2021 have noted numerous ingredient doses exceeding the recommended daily value.^8,11

Vitamin A deserves special mention. Vitamin A, found in 4% of posts, has been linked to birth defects in doses exceeding 10,000 IU.¹² A 2021 study of dermatology supplements sold online and containing vitamin A noted that three of these supplements were likely teratogenic due to exceedingly high doses.⁸ As such, women of reproductive potential could easily purchase supplements advertised on Instagram without evaluating teratogenic potential, which posed an ethical concern.¹³

Other concerning ingredients include biotin and saw palmetto. Biotin ingestion has been linked to false laboratory test results, including inaccurate nonhormone and hormone assays.¹⁴ Due to this risk, the FDA issued a warning in 2019: specifically, biotin has been reported to result in falsely low levels for troponin, an important marker for heart attack diagnosis.¹⁵ One supplement post included saw palmetto, an ingredient linked to birth defects and increased bleeding risk in patients taking warfarin.⁷

Another major area of concern is that nearly one-fifth of posts (19%) had no information on what ingredients were contained in the supplement at all. Almost a third of posts (31%) and over a quarter (28%) mentioned vitamins and minerals, respectively, without specifying which vitamins or minerals were included in the product. This is extremely concerning, due to the multiple adverse events linked to supplement ingredients and high doses of certain vitamins and minerals.^7,16–20

With regards to health information, the dilemma of social media is that, while its accessible user-based nature is a benefit, questions regarding the information’s quality and authority may limit its utility. One tactic commonly used by products such as supplements are the use of influencers. Influencers, or users with many followers, can orient users as they navigate online content.^4,21

In this survey, many of the posts were not made directly by the brand, but rather by a micro-influencer, celebrity, or in some cases, a physician. Other studies in 2020 and 2022 found that board-certified dermatologists represented only 4% of popular dermatology-related Instagram accounts, and that dermatologists created <4% of top acne Instagram posts.^22,23 As such, the literature suggests that social media is an underutilized patient education tool for dermatologists and could be used more widely to broadcast accurate medical information.^21,22,24

Study limitations include its cross-sectional design limitations, as posts evaluated in the study may be removed or edited in the future. Additionally, this study was limited to 100 posts made during a 1-month period. Finally, this study did not evaluate social media platforms other than Instagram.

In conclusion, this study reveals the frequently advertised ingredients and health claims made by skin, hair, and nail supplements on Instagram. An important finding is that only 1% of posts were made by a board-certified dermatologist. Many products lacked information regarding which vitamins and minerals were contained in the supplements, and some lacked any information on ingredients, although certain ingredients can pose health risks, especially orally and in large doses. Risks include falsely low troponin in laboratory results, teratogenicity, and increased bleeding. These results reflect the increasing need for the medical community to engage with social media and offer accurate information for patients.^21,22,24