According to insights from participating dermatologists, approximately 60%-85% of dermatology patients were women aged 25-44 years with advanced digital skills who lived in megacities and used social media to obtain information on dermatological issues and choose a physician. Younger patients were more interested in cosmetic dermatology topics, whereas middle-aged patients often inquired about medical dermatology topics. In line with the digital data of 2023, the experts declared that they received nearly 90% of dermatology-related queries from Instagram [21].

In the present era, media and omnichannel communication have reshaped societal perceptions and self-perceptions of beauty standards [22,23]. As a result, young women consider self-image to be at the forefront of social acceptance. Under the pressing desire “to be within the societal beauty standards,” young adults are open to various cosmetic procedures and collect information mainly through digital platforms. Therefore, medical interactions on social media are slightly inclined toward cosmetic dermatology.

The leading causes of social media use among Turkish patients include seeking a diagnosis and learning about treatment options or procedures. Generally, a Google search is the first step in seeking dermatological information on the internet. However, most social media users are unfamiliar with the personalization algorithms of these platforms, which operate backstage to select and bring forth specific content according to previous search activities, labeling it as “recommended” or “suggested.” Moreover, depending on the topic, social media users often encounter massive amounts of information and have trouble determining whether the information is evidence based and relevant to their skin problems. With limited medical literacy in dermatology and digital competence, patients often perceive content shared on social media accounts with a “high number of followers” as “reliable.” However, most patients seeking information on the internet do not confirm whether the information is supported by scholarly sources or endorsed by dermatologists. Furthermore, it should be emphasized that individuals without professional training in dermatology cannot correctly categorize, evaluate, and discern accurate information by surfing websites, watching videos, and reading posts.

In cosmetic issues, especially, the procedure outcomes are presented with “before” and “after” photos, the majority of which are digitally edited. The medical content is prepared in a promising and appealing tone to draw the attention of nonmedical audiences. Therefore, dermatology patients should be vigilant and skeptical about medical content on social media lacking citations and making exaggerated promises about health outcomes. Inevitably, the absence of quality control and low levels of skepticism among social media users may lead them to websites broadcasting nonfactual information; this could delay access to effective treatment or result in patients experiencing complicated outcomes. Unlike in real life, patients have easy access to many websites via the internet, receive many recommendations, and use various skin products without consulting a dermatologist. Patients usually consult a dermatologist only when skin problems are not resolved with suggestions found on social media. Experts underlined the challenge of managing complex skin problems in daily clinical practice. Relying on overly promising posts and receiving dermatological treatment at later stages of the disease, patients have difficulty complying with more extended and comprehensive treatment plans. Additionally, it has been observed that the effectiveness of therapy is decreased in some cases due to delayed intervention.

According to recent national data, Turkey has a relatively young (median age 31.6 years), highly urbanized (77.2%) population, with equal gender distribution (women comprise 49.9% of the population) and an overall adult (age >15 years) literacy rate of 96.7% [21].

Some essential digital headlines of the Turkish population are as follows [21]:

Since dermatology patients on social media are a subset of internet users in Turkey, it is imperative to delineate the essential patient characteristics. Instagram, WhatsApp, Twitter, TikTok, and Facebook are the most frequently used platforms, and with 90.6% of users, Instagram is the most popular social network in Turkey (Figure 1) [21].

The average time spent on Instagram per capita in Turkey was 20.2 hours per month in 2022, but it increased to 21 hours and 24 minutes in 2023 (Figure 2) [21].

Of the population aged 16-64 years, 39.5% use the internet for “researching health issues and healthcare products” as one of the main reasons, and 17.7% follow beauty experts [21]. Figure 3 illustrates the reasons for internet use among the population aged 16-64 years in Turkey.

In a recent survey study on patients with seborrheic dermatitis, 81% of patients declared that they trusted the dermatologist’s decision on the treatment. However, 78.8% (104/132) also consulted social media for additional remedies for their diseases [26]. Among those who consulted social media, 54.8% started to use over-the-counter products, 35.6% implemented diet and lifestyle changes, and 7.7% started supplement use recommended on social media. The rest of the cohort (1.9%) started to use self-made products. Similar to our findings, 85.6% of those who consulted social media were female patients, and 78.8% were between the ages of 18 and 30 years. Instagram (63.6%) and YouTube (53%) were the most commonly used digital platforms for seeking health information [26].

Dermatological diseases are common, immediately noticeable, and generally nonfatal, yet they have similar symptoms. Although the skin is the largest organ in the human body, public awareness about skin health has increased only recently. It is a typical underestimation that most skin problems can be overcome without consulting a physician. Therefore, patients consult a dermatologist after unsuccessful self-treatment attempts, when the symptoms get worse and more problematic. Increasing patients’ health literacy is the cornerstone to improving patient understanding of cutaneous problems. In this respect, social media presents an excellent opportunity to disseminate scientific facts, as it readily engages large audiences without restrictions related to time and location.

Many studies have revealed that most individually prepared medical content is not based on scientific evidence or is occasionally entirely false [9,27]. For example, a recent cross-sectional analysis of a trendy topic, keratosis pilaris, on TikTok revealed that 52% of the content creators are nonphysicians, 16% are private companies, and 32% are physicians [28]. Interestingly, 16% of content-creating physicians were in medical branches other than dermatology (84% were dermatologists). In addition, a study characterizing the credentials of dermatology influencers on Instagram reported that board-certified dermatologists constitute only 4% of the Instagram accounts with popular dermatology content [29]. Furthermore, 71% of all influencers and 27% of health care influencers did not mention credentials on their accounts [29]. Finally, recent studies about effective communication on social media underlined that patients preferred dermatological content created by certified dermatologists and wished such content was more broadly available [7,9,19].

Dermatologists who want to participate in social media platforms should realize that in addition to patient education and heightened awareness, social media enables them to provide services they cannot offer in overcrowded outpatient settings. For example, sharing evidence-based information about routine skincare or aging will help patients on the internet differentiate scientific quality from temptation-provoking rhetoric in the content source. Furthermore, physicians can perform patient follow-ups more effectively, that is, they can communicate medication side effects and remind patients of medication use instructions. These efforts will soon lead to more medically literate patients in both the digital and real worlds.

Content creation, user engagement, and maintenance of digital patient communication require a time commitment, a budget to allocate a professional team, and follow-up on current advancements. Combating misleading dermatological information on social media is not a mission that the participation of a few dedicated dermatologists can accomplish. Instead, it demands the involvement of specialty associations, academic institutions, and reputable scientific journals to act in unison for the common objective. High-impact journals and leading institutions in dermatology have recently recognized the power of social networking worldwide, and therefore, activated social media accounts on different platforms [5,9,15,18,30,31]. There is an emerging need for Turkish patients to access verified information presented in lay summaries from scholarly sources. However, unfortunately, the social media presence of relevant institutions is far behind what is desired in Turkey.

The level of social media presence varies mainly according to age and the perception of dermatologists toward social media. Being exceptionally acquainted with digitalization early in life, younger dermatologists are more competent with the algorithms of digital platforms and eager to build a successful career, including maintaining a strong social media presence. On the other hand, being active on social networks may be controversial for more experienced dermatologists and academicians. There may be various underlying reasons, such as timidity in communication in the digital world, incompetence with digitalization, and discomfort with or prejudice against social networks due to everyday use. Furthermore, the social media presence of dermatologists may depend on the institution in which they work. In Turkey, private hospitals use social media extensively to broadcast information about diseases, procedures performed, and technical expertise.

Dermatologists have a leading role in high-quality health information available on the internet. It should be remembered that whether in the digital or real world, a physician is a respected, trusted source of medical information for patients and a role model for the next generation of physicians as well as colleagues. Considering social platforms as meeting points for academia and the general population, dermatologists need to fulfill their scientific roles in disseminating reliable information. In contrast to this, most social media account owners who have a substantial impact on patients are not health care professionals. Some patients have noted that they follow popular profiles for “fun” but do not rely on them to solve critical health issues. Moreover, a survey about patients’ self-reported trust in physicians based on their behaviors on digital platforms has shown that social media users prefer professionalism in essential matters such as health [32]. Therefore, it should be noted that it is difficult to earn trust and to reestablish it when it is lost. A physician-patient relationship built on medical facts will result in guidance and permanent engagement with most patients and health information seekers on social networks, eventually counteracting misleading content by disseminating accurate information. Therefore, dermatologists should preserve their professional stances on social media despite the complexities of digital platforms.

Since dermatology is one of the hot topics on social networks, most content creators in this field need help in their leadership role in the cosmetics market, which can readily promote unrealistic promises and propagate harmful trends. As a result, globally and locally, academic institutions, medical associations, and legal authorities have recently passed professionalism policies to regulate digital medical communication and preserve patient privacy and confidentiality (Textbox 1) [33-36]. It should be noted that policies and codes of ethics for social media use should be applied to every account owner who broadcasts health-related content.

The underlying essential elements of effective communication on social media include a well-structured strategy, content creation, and engagement metrics. When creating content, the device(s) on which the content will be shared should also be considered; for instance, if most website traffic comes from smartphones, posts should be mobile-friendly.

Searching for accurate information is the primary driver of social media use for most dermatology patients. Therefore, broadcasting on social media is crucial to increasing factual dermatological knowledge on digital networks [37,38]. The panelists believe that dermatologists with predefined strategies before broadcasting on social media will have successful engagement rates. The strategy should be individualized for the target population with the help of search engine optimization workups. Some steps, outlined in the following sections, should be carefully defined before posting content on digital platforms, including the platform selection, format, and multimedia tools to use. The panelists believe that the most straightforward, yet practical steps of content creation and sharing are summarized in Figure 4 [37].

Broadcasting informative content involves the selection of the social media platform and content topics as well as the frequency of broadcasting. For a dermatologist, content creation is a time-consuming process, as it requires literature review, rewriting for the target audience, preparation of visuals, and editing according to the format of the digital platform.

Most new social media account owners prefer to stay socially active by copying content they like from other accounts. However, such an approach can facilitate the dissemination of misinformation from the original site, causing the account holder to lose patients’ trust and increasing the cited site’s rankings by transmitting linked tools. In fact, patients understand and prefer authentically created content in lay language. With transparency, professionalism, and clear boundaries, dermatologists should refrain from overpromising results to attract attention; instead, they should be open to receiving negative reviews and accept them as part of digital communication.

Not all followers who use social media are patients or advice seekers. One out of 10 followers is reported to write intentionally provocative and offensive messages on social media and is labeled as a troll [39]. Keeping up with the rules of physician-patient communication upheld in face-to-face settings on digital platforms may be a practical way to sustain professionalism on these platforms [39].

The experiences of Turkish dermatologists with a strong social media presence and inquiries from patients on informative digital channels indicate that medical advice-seeking individuals need help accessing scientific information. Therefore, dermatologists who master this field should become critical players in the dissemination of accurate knowledge and in raising public awareness in digital settings. Recently accumulated local data on the impact of social media on dermatology-related professions have pointed out that patients or health information seekers are misguided by unconfirmed and unmonitored digital content. Given that the digital world will soon be much more indispensable in dermatology and patient-physician relationships, combating misleading information created by nonqualified account owners should be a shared responsibility of dermatologists, academic institutions, and board associations. The authors of this paper state that increasing the digital operational competence of dermatologists, while complying with the ethical rules of the medical profession, is the cornerstone for disseminating evidence-based information and patient awareness in the field of dermatology on digital platforms. For the highest benefits of health information seekers, social media presence rates of institutions and dermatologists should be increased collaboratively.

Some key recommendations drawn from this study are as follows: