Analysis of Dermatology Content by Top Influencers on Twitter and Their Academic Impact: Cross-Sectional Study

Introduction

Social media platforms such as Twitter allow dermatologists to collaborate, share information with the public, expand their practices, and communicate directly with patients [1]. Concerningly, popular dermatology social media content is often generated by prolific content creators known as “influencers,” not board-certified dermatologists or individuals with evidence-based training [2]. We, therefore, conducted an analysis of top dermatology accounts on Twitter, the content posted by these accounts, and their users’ academic productivity and impact.

Methods

The content aggregator Cronycle [3], which has been used in multiple peer-reviewed studies of social media in health care, was used to identify the top 100 Twitter accounts in May 2021 for the topic “dermatology.” Two independent researchers with experience in dermatology and social media extracted the accounts’ self-reported names, credentials, and geographic locations. Content from the 3 most recent Twitter posts for each account was categorized as “educational” if relaying dermatology or health care information, “professional” if associated with promoting conferences or professional events, “advertising” if related to specific products or services, or “personal” for all other posts. A consensus meeting resolved any discrepancies. Foreign language content was translated using Google Translate (Google LLC) if an English translation was not directly available from Twitter. Account users’ names were checked for American Board of Medical Specialties certifications through the Certification Matters search tool [4]. Academic citation metrics as of August 2021 (including the h-index [5] and the number of total publications and citations over an individual’s career) according to the Web of Science and Google Scholar databases were also recorded.

Results

Of the top 100 accounts, 92 appeared to represent individuals and 8 were organizations (Table 1). Most were US board-certified physicians (n=52), and of these, 45 (87%) were dermatologists. However, credential verification was difficult for physicians certified or practicing outside the United States.

Academic citation metrics according to the h-index (mean 14, SD 13; median 12, range 0-71) and total publications (mean 89, SD 148; median 43, range 2-950) were highly variable for 81 individuals with citation profiles. Educational posts were the most common (118/293, 40%), followed by professional content (86/293, 29%), personal posts (53/293, 18%), and lastly, advertising (36/293, 12%). Top quartile accounts by Cronycle rank posted far more educational content (>50%) than other categories of posts (Figure 1), and the educational category occurred most frequently in each quartile. Advertising was the least common content category, in contrast to other platforms such as Instagram, where the most common content was related to advertising [6] and posted predominantly by nondermatologist influencers [7].

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Discussion

We offer a cross-sectional snapshot of associations between content, popularity, and academics, prompting many avenues for further work and repeat assessment. For example, it remains to be seen whether social media branding affects academic influence, or vice versa. Twitter excels at encouraging user interactions through “mentions” and “follows,” with the “hashtag” function allowing easy searching and content propagation. However, without further protections, Twitter could also risk spreading harmful misinformation as an educationally oriented platform. While Twitter verification policies are currently in flux, account registration does not require identity verification, though this could be explored in the future to highlight board-certified physician accounts, especially for international dermatologists where external credential verification resources are limited.