Patterns of Promotional Content by Dermatology Influencers on TikTok

Research Letter

TikTok, a social media platform for sharing short videos, has become a source of dermatologic information for the general public [1,2]. Compared to other platforms, TikTok has high engagement rates (ratio of likes and comments to followers)—approximately 5 times those of Instagram [1]. The platform is rife with promotional content [1,2], potentially influencing public behavior and consumption, such as boosting CeraVe’s sales in early 2021 [3]. Here, we sought to characterize promotional content among accounts with the most popular dermatology-related TikTok videos.

We analyzed 14 hashtags to identify the top dermatology TikTok videos for analysis of promotional content. Our hashtags were based on precedent social media studies and included the top 5 dermatology-related diagnoses and the top 5 dermatology procedures [4]. We also added 4 hashtags anecdotally found to be popular on TikTok (Table 1). The top 100 posts for each hashtag were queried on February 26, 2021, totaling 1400 posts. Based on the precedent for identifying Instagram influencers, we employed two criteria to define influencer status [4]. The first criteria required accounts to have ≥500,000 followers; the second required being featured in the top 100 posts across all hashtags ≥3 times. Promotional content was defined per the Federal Trade Commission: any disclosures (hashtags, text, or video content indicating advertisement, ambassadors, discounts, or tags) in the influencers’ 9 most recent posts or biography [5]. Similarly, personal promotion was defined as disclosures promoting the influencers’ own products or services.

From February 14 to May 14, 2021, TikTok videos with hashtags of interest accumulated 17.6 billion views (Table 1). Of the 1400 posts recorded, there were 1337 unique posts from 738 unique accounts. After excluding non-English–language posts and accounts with posts unrelated to dermatology, 112 accounts remained with ≥500,000 followers and 77 accounts featured ≥3 times in the top 100, totaling 162 accounts meeting one or both influencer criteria (Table 2). Of this total, 14 (8.6%) were dermatologists, with 8 out of 14 being board-certified. Over one-third (57/162, 35.2%) of these influencers had promotional content on their account, and 32.1% (52/162) had personal promotional content. Promotional status was undetermined in 15.4% (25/162) of accounts (non-English).

About 35% of dermatology influencers featured promotional content on TikTok, which raises concerns about conflicts of interest. Although dermatologists represent a fraction of influencers, a majority (8/14, 57.1%) featured promotional content. Noncredentialled, dermatology-related accounts had the highest rate of promotional content (22/28, 78.6%), which included skincare brand partnerships, product links, and personalized discount codes. Disclosures, which can be indicated using #ad in the video descriptions or explicitly mentioning conflicts in the videos, should be stated in user biographies, especially when providing product links with affiliate marketing incentives. Additionally, clearly stating a lack of conflict when recommending or reviewing products could reduce perceptions of conflict.

Given the prevalence of nondermatology and nonmedical influencers creating dermatology content, leveraging TikTok to counter misinformation may be essential to ensure patients and health consumers are provided accurate information. While new avenues to share educational content are important, the negative influence of promotional content remains a concern.