10.5826/dpc.1301a20
Introduction: Dermatological information on social media is dominated by misleading and potentially harmful content from nonexperts. Literature suggests that, to address this issue, dermatologists should develop an online presence. However, successful presence of dermatologists on social media has been criticized for focusing on cosmetic dermatology and not representing the broad spectrum of the specialty.
Objectives: The aim of this study was to systematically analyze which dermatological topics interest the public most, and to find out whether it is feasible for a dermatologist to become influential on social media while presenting all dermatological topics equally.
Methods: The study was performed on an educational dermatology YouTube channel. The 101 videos published in a two-year period were divided into cosmetic (51 videos) and medical dermatology (50 videos). Student’s t-test was conducted to determine whether there were significant differences in views. Medical dermatology videos were then classified into three categories: Acne, facial dermatoses (excluding acne) and other dermatological diseases. A Kruskal-Wallis test was used to compare these three categories and cosmetic dermatology.
Results: When comparing cosmetic and medical dermatology, no significant differences were found. When comparing the four categories, cosmetic dermatology and acne were found to generate significantly more views that other dermatological diseases.
Conclusions: The public seems to be particularly interested in cosmetic dermatology and acne. This might make it challenging to become successful on social media while presenting a balanced portray of dermatology. However, focusing on popular topics can provide a real chance to be influential and protect vulnerable people from misinformation.
text/xml
2160-9381
2425
en
Alba Santamarina-Albertos
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
education
What Do Patients Want To See On Social Media? Evidence From A Two-Year Experiment
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2023-01-31
2022-02-26
2023-01-31
2023-02-27
e2023020
Dermatol Pract Concept
Introduction: Dermatological information on social media is dominated by misleading and potentially harmful content from nonexperts. Literature suggests that, to address this issue, dermatologists should develop an online presence. However, successful presence of dermatologists on social media has been criticized for focusing on cosmetic dermatology and not representing the broad spectrum of the specialty.
Objectives: The aim of this study was to systematically analyze which dermatological topics interest the public most, and to find out whether it is feasible for a dermatologist to become influential on social media while presenting all dermatological topics equally.
Methods: The study was performed on an educational dermatology YouTube channel. The 101 videos published in a two-year period were divided into cosmetic (51 videos) and medical dermatology (50 videos). Student’s t-test was conducted to determine whether there were significant differences in views. Medical dermatology videos were then classified into three categories: Acne, facial dermatoses (excluding acne) and other dermatological diseases. A Kruskal-Wallis test was used to compare these three categories and cosmetic dermatology.
Results: When comparing cosmetic and medical dermatology, no significant differences were found. When comparing the four categories, cosmetic dermatology and acne were found to generate significantly more views that other dermatological diseases.
Conclusions: The public seems to be particularly interested in cosmetic dermatology and acne. This might make it challenging to become successful on social media while presenting a balanced portray of dermatology. However, focusing on popular topics can provide a real chance to be influential and protect vulnerable people from misinformation.
Alba Santamarina-Albertos
2023/01/31
10.5826/dpc.1301a20
e2023020
Dermatology, Medicine and Toxicology Department, University of Valladolid; Dermatology Department, Clinical University Hospital of Valladolid.
2160-9381
education
en
e2023020
Buntinx-Krieg T, Caravaglio J, Domozych R, et al. Dermatology on Reddit: Elucidating trends in dermatologic communications on the world wide web. Dermatol Online J 2017;23:2. 13030/qt9dr1f7x6. Published 2017 Jul 15.
What Do Patients Want To See On Social Media? Evidence From A Two-Year Experiment
https://dpcj.org/index.php/dpc/article/download/2425/1931
      What do Patients Want to See on Social Media?
         Evidence From a Two-Year Experiment
                 Leire Barrutia1,2, Jesús Vega-Gutiérrez1,3, Alba Santamarina-Albertos1,2


1 Dermatology, Medicine and Toxicology Department, University of Valladolid, Valladolid, Spain
2 Dermatology Department, Clinical University Hospital of Valladolid, Valladolid, Spain
3 Dermatology Department, Río Hortega University Hospital, Valladolid, Spain



Key words: social media, internet, acne, health promotion, education
Citation: Barrutia L, Vega-Gutiérrez J, Santamarina-Albertos A. What do patients want to see on social media? Evidence from a two-year
experiment. Dermatol Pract Concept. 2023;13(1):e2023020. DOI: https://doi.org/10.5826/dpc.1301a20
Accepted: April 11, 2022; Published: January 2023
Copyright: ©2023 Barrutia et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Leire Barrutia, MD, Dermatology Department, Clinical University Hospital of Valladolid, Calle Rondilla Sta Teresa
s/n, 47010 Valladolid, Spain. E-mail: leirebarrutia4@gmail.com




  ABSTRACT             Introduction: Dermatological information on social media is dominated by misleading and poten-
                       tially harmful content from nonexperts. Literature suggests that, to address this issue, dermatologists
                       should develop an online presence. However, the successful presence of dermatologists on social media
                       has been criticized for focusing on cosmetic dermatology and not representing the broad spectrum of
                       the specialty.
                       Objectives: The aim of this study was to systematically analyze which dermatological topics interest
                       the public most, and to find out whether it is feasible for a dermatologist to become influential on
                       social media while presenting all dermatological topics equally.
                       Methods: The study was performed on an educational dermatology YouTube channel. The 101 vid-
                       eos published in a two-year period were divided into cosmetic (51 videos) and medical dermatology
                       (50 videos). Student’s t-test was conducted to determine whether there were significant differences in
                       views. Medical dermatology videos were then classified into three categories: Acne, facial dermatoses
                       (excluding acne) and other dermatological diseases. A Kruskal-Wallis test was used to compare these
                       three categories and cosmetic dermatology.
                       Results: When comparing cosmetic and medical dermatology, no significant differences were found.
                       When comparing the four categories, cosmetic dermatology and acne were found to generate signifi-
                       cantly more views that other dermatological diseases.
                       Conclusions: The public seems to be particularly interested in cosmetic dermatology and acne. This
                       might make it challenging to become successful on social media while presenting a balanced portrayal
                       of dermatology. However, focusing on popular topics can provide a real chance to be influential and
                       protect vulnerable people from misinformation.




Original Article | Dermatol Pract Concept. 2023;13(1):e2023020                                                                           1
Introduction                                                      exploring how the public reacts to the presentation of var-
                                                                  ious dermatological topics by dermatologists. Accordingly,
Dermatological information on social media is dominated by        the aim of this research is to determine from the inside which
misleading and potentially harmful content from nonexperts        dermatological topics social media users find most interest-
[1,2]. An analysis of Instagram hashtags [3] found that most      ing. This analysis will allow us to deduce whether it is feasi-
top dermatology-related posts are made by individuals with-       ble for a dermatologist to become influential on social media
out formal dermatology training. A study [4] on the quality       while presenting all dermatological topics with equal promi-
of YouTube videos about psoriasis classified 63% of videos        nence, as suggested from a conceptual perspective [1,12,14].
as misleading or dangerous. Many other studies [5-8] have
noted a vast amount of inaccurate or low-quality dermato-
                                                                  Methods
logical information on different social media platforms.
    This problem primarily affects vulnerable people, such as     Study Design
adolescents and young adults, who are the most active users       Most previous contributions on dermatology in social media
of these platforms [2,9,10]. It has been suggested that in or-    have relied on conceptual developments and secondary sources.
der to address this issue, dermatologists should develop an       This is distinct from the tradition of dermatologic research,
online presence [5,11-13]. However, dermatologists’ partici-      which has mostly relied on primary sources (i.e., everyday prac-
pation in social media is a new phenomenon, and the extant        tice). The present study is based on the direct experience of a
literature offers little insight into how dermatologists can      dermatologist on social media over a two-year period.
develop a successful social media presence. One exception is          In October 2019, one of the authors launched an edu-
a study by Sierro et al. [11], which identified the top 10 der-   cational dermatology YouTube channel. The channel was
matology influencers on social media and found that 83% of        designed to avoid the risks and ethical challenges that social
the content they produced focused on cosmetic dermatology.        media involves for dermatologists [15]. The channel did not
According to Sun et al. [12], this finding might lead to the      include sponsored or personal content, and videos followed
public perception that dermatologists spend the majority of       the DISCERN quality criteria [9]. References to relevant sci-
their time treating conditions with modest morbidity, which       entific literature were provided, individual consultations were
is inconsistent with reality. They highlighted the need to dis-   not answered, and viewers were encouraged to consult a der-
pel this misconception and create content on a wide variety       matologist. While commercial products were shown because
of dermatological diseases from both clinical and histologi-      of strong demand from subscribers, product assessments
cal perspectives [12]. Guzman and Barbieri [1] shared this        relied on effectiveness. No commercial agreements were es-
concern and noted that the presence of dermatologists on so-      tablished. A new video was launched weekly, and following
cial media is limited in comparison with non-dermatologist        a two-year period, the channel had over 134,000 subscribers
sources, which are prone to bias and misinformation. Sim-         and 5.5 ­million views. In total, 101 videos were posted about a
ilarly, Green and Britten [14] argued that dermatologists         wide variety of dermatological topics including acne and acne
should create content showcasing, in a balanced manner, the       scars, rosacea, melasma, hidradenitis suppurativa, psoriasis,
broad spectrum of dermatology by presenting interesting           vitiligo, hair loss, atopic dermatitis, seborrheic dermatitis, nevi,
medical cases, dermoscopic and histologic images, or com-         sun protection, melanoma, basal cell carcinoma, squamous
mentaries on medical literature.                                  cell carcinoma, polymorphous light eruption, hyperhidrosis,
    Therefore, the successful presence of dermatologists on       folliculitis, laser hair removal, keratosis pilaris, post-inflam-
social media remains limited and has been criticized for fo-      matory hyperpigmentation, dermatological treatments such as
cusing on cosmetic dermatology as opposed to accurately           benzoyl peroxide and isotretinoin, skin type, medical peelings,
representing the role of dermatologists [1,12,13]. In this con-   botulinum toxin, and active ingredients in cosmetics.
text, this study examined a research question that has not            All videos were presented by the same dermatologist in
been systematically addressed in the literature: Is it feasible   the same setting and followed a similar approach. They were
for a dermatologist to develop a relevant presence on social      also similar in terms of duration and aesthetic design. We can
media while equally representing all dermatological topics?       assume, therefore, that the differences in the average daily
                                                                  video views were mostly due to varying public interest in the
Objectives                                                        topics covered.

The emergence and prevalence of social media is a relatively      Data Collection and Overview
new and unknown phenomenon. Probably the best way to              of Channel Analytics
understand new phenomena is to explore them as an in-             Data were collected from YouTube Studio, a platform pro-
sider [14]. Consequently, there is a need for insider research    vided by YouTube to help content creators manage their



2                                                                      Original Article | Dermatol Pract Concept. 2023;13(1):e2023020
channels. YouTube Studio provides key channel analytics to          (255.49) and other facial dermatoses (160.18). Videos on
better understand video and channel performance. This re-           other dermatological diseases had the lowest average daily
search focuses on a specific metric: average daily views (i.e.,     views (91.61).
views/days since upload). Other metrics provided by You-               Student’s t-test determined that there were no signifi-
Tube Studio include subscribers, watch time (hours), likes,         cant differences between views of cosmetic dermatology and
dislikes, and shares. All videos posted from 25 October 2019        medical dermatology videos, even though the cosmetic vid-
to 25 October 2021 were included in the study.                      eos had more views on average (p = .1511).
                                                                       The Kruskal-Wallis rank test, which compared the
Statistical Analysis                                                three medical categories and cosmetic videos, showed that
Statistical analysis was performed using Stata 16 (StataCorp        videos on acne and cosmetic dermatology received signifi-
LLC). We categorized the videos according to the topic cov-         cantly more views than those on other dermatological dis-
ered and analyzed whether there were significant differences        eases (p = .0028 and p = .0005, respectively). There was
in average daily views depending on the video category.             a marginally significant difference (p = .0533) between
    To categorize the videos under study, we followed a             views of videos on other facial dermatoses and those on
two-step approach. In the first step, we grouped the videos into    other dermatological diseases. No significant differences
two broad categories: cosmetic dermatology (51 videos) and          were found between cosmetic dermatology and acne
medical dermatology (50 videos). We conducted a Student’s           (p = .2392), cosmetic dermatology and other facial der-
t-test to determine whether there were significant differences      matoses (p = .5493), and acne and other facial dermatoses
between the views counted for both types of videos. Despite the     (p = .1266) (see Table 1).
absence of normality in our data, the relatively large number of       While this research focused on comparing average daily
observations in both categories (n = 50 and n = 51, respectively)   video views, other engagement analytics may add informa-
led us to use the parametric Student’s t-test [16].                 tion about the qualitative perceptions of the public on a You-
    In the second step, we created several subgroups among          Tube channel conducted by a dermatologist. The two-year
the medical videos. Subcategorization was performed be-             period under study led to 221,993 likes, 47,162 shares, and
cause it was apparent that there was great variance in the          17,815 comments (see Table 2).
views within this category. Specifically, we divided the med-          To evaluate the degree of goodness of these channel an-
ical videos into three subgroups: acne; facial dermatoses,          alytics, we used a study on 104,899 YouTube accounts and
excluding acne; and other dermatological diseases. This ar-         classified them as poor, average, or good [21]. Metrics scor-
rangement was based on our empirical observations. Over-            ing at the 60th percentile or higher were considered good.
all, we observed that acne and, to a lesser extent, other facial    Specifically, the study considered the following engagement
dermatoses, such as rosacea and melasma, generated more             analytics:
views than other dermatological diseases. This may be be-
cause self-care is erroneously considered feasible for these        1. Like-to-dislike rate (i.e., percentage of number of likes
conditions. Additionally, facial dermatoses are highly visible,        over the sum of likes and dislikes);
with substantial social repercussions [17-19]. We established       2. Views-to-subscriber ratio (i.e., number of views over
an individual category for acne because of its particularly            number of subscribers);
high prevalence and because it markedly affects adoles-             3. Comments-to-views rate (i.e., percentage of users who
cents and young adults, who comprise YouTube’s largest                 have watched the video and commented on it); and
user base [2,9,10]. We then performed a non-parametric              4. Likes-to-view rate (i.e., percentage of users who have
Kruskal-Wallis rank test to compare the three medical cat-             watched the video and explicitly stated that they liked it).
egories and cosmetic videos. This non-parametric test was
chosen due to the absence of normality in our data and the             When these metrics were applied to the channel, we
relatively scarce number of videos in some categories [16].         observed that in all cases, the channel was above the
    The videos had been published on different dates, which         threshold level required to be considered good. First, the
implies that they had had different opportunities to be             like-to-dislike rate was 98.6% (> 97.4%). Second, the
viewed. Therefore, the videos were not compared in terms of         views-to-subscriber ratio was 41.01 (> 33.1). Third,
total views but in terms of average daily views [20].               the comments-to-views rate was .32% (> .04%). Lastly,
                                                                    the like-to-view rate was 4.03 (> 3.72). Most comments
Results                                                             were highly positive. Many users recognized the value of
                                                                    the knowledge conveyed through the channel and were
Videos on acne had the highest average daily views                  highly appreciative that a dermatologist had offered evi-
(268.66), followed by those on cosmetic dermatology                 dence-based knowledge on social media.



Original Article | Dermatol Pract Concept. 2023;13(1):e2023020                                                                   3
                            Table 1. Types of videos: Testing for significant differences.
                                                                           Views per video since           Average daily views per
                                                     Videos (101)               uploaded                    video since uploaded
 Type of video                                                               Mean               SD              Mean             SD
 Cosmetic dermatology                                     51               61,639.94         71,612.31          255.49          32.54
 Medical dermatology                                      50               46,627.06         44,008.43          181.06         173.69
 Acne                                                     21               70,828.95         50,304.45          268.66         201.94
 Other facial dermatoses (excluding acne)                 11               49,641.82         30,999.87          160.18         115.60
 Other dermatological diseases                            18               16,549.17         18,779.03          91.61          113.51
 Testing for significant differences
 t-test                                                                                           t              d.f.          p-value
 Cosmetic dermatology vs. Medical dermatology                                                 -1.4467           77.355          .1511
 Kruskal-Wallis rank test                                                                     chi-sq.            d.f.          p-value
 Four groups (cosmetic dermatology, acne, other facial dermatoses excluding                   13.884              3           .0031**
 acne, other dermatological diseases)
 Cosmetic vs. Acne                                                                             1.385              1             .2392
 Cosmetic vs. Other facial dermatoses                                                           .359              1             .5493
 Cosmetic vs. Other dermatological diseases                                                    8.956              1           .0028**
 Acne vs. Other facial dermatoses                                                              2.333              1             .1266
 Acne vs. Other dermatological diseases                                                       12.007              1           .0005**
 Other facial dermatoses vs. Other dermatological diseases                                    37.375              1             .0533

Notes: Period: 25 October 2019–25 October 202. SD: Standard deviation; t-test: Two-sample t-test with unequal variances; d.f.: degrees of
freedom.


                                         Table 2. Overview of channel analytics.
               Variable                      Total              Mean                   SD                Min.               Max.
 Views                                    5,504,165            54,207.82          59,750.06              939               399,436
 Subscribers                               134,208             1167.54              1800.94                4                13,111
 Watch time (hours)                        463,840             4,573.17            5,539.08               56                34,079
 Likes                                     221,993             2,182.53            2,126.77               50                12,439
 Dislikes                                    3,043              29.93                40.50                 0                 324
 Shares                                     47,162              465.30              521.58                 6                 3182
 Comments                                   17,815               175                141.47                 3                 771

Notes: Observations (videos) = 101. Period: 25 October 2019–25 October 2021. SD: Standard deviation. Min: Minimum. Max: Maximum.



Discussion and Conclusions                                             [22-24]. Therefore, it is essential that dermatologists share
                                                                       evidence-based information on appropriate sun safety atti-
Our findings show that public concerns focus on acne and               tudes to educate the population and fight misinformation
cosmetic dermatology and that viewers are not equally in-              [25-27]. Several studies [26,28,29] have shown that social
terested in all dermatological topics. Therefore, it might be          media can be a cost-effective way to disseminate awareness
difficult to become successful on social media and ensure              on this topic, and dermatological associations, such as the
visibility while presenting a balanced portrayal of our spe-           National Academy of Sciences’ Interdisciplinary Perspectives
cialty. This represents an important challenge for dermatol-           on Skin Cancer, have concluded that there is a need to pro-
ogists because some topics, despite being less popular, need           mote sun protection in children and young adults on these
to be addressed due to their importance, such as skin cancer           platforms [30].
and its prevention. The literature shows that most videos                  Other examples of non-popular dermatological diseases
about tanning on YouTube portray it positively, and that               that could be addressed on social media include chronic in-
there are more advertisements for tanning salons than the              flammatory skin conditions, such as psoriasis or hidradeni-
total number of videos portraying the dangers of tanning               tis suppurativa. Several studies [24,31,32] have shown that



4                                                                           Original Article | Dermatol Pract Concept. 2023;13(1):e2023020
patient education through social media improves the quality       would otherwise, thereby increasing the likelihood that the
of life of patients with these diseases. Consequently, derma-     YouTube algorithm will promote them to other users. Conse-
tologists face the difficult challenge of finding a balance be-   quently, focusing on popular topics can, in the end, facilitate
tween prioritizing popular topics and not disregarding others     the dissemination of accurate knowledge about the broad
that may have an important impact on people’s well-being.         spectrum of dermatology.
    While keeping this balance in mind, we believe that pri-         Our results show an overall preference for topics related
oritizing the topics that people want to see (i.e., acne and      to facial dermatological issues. The commonality among
cosmetic dermatology) can have the next three benefits for        acne, cosmetic dermatology, and other facial dermatoses is
dermatologists and society as a whole: (1) ensuring visibility,   that they affect the face. Views on videos about these topics
(2) having a positive, evidence-based influence on dermato-       are significantly higher than those on videos about dermato-
logical culture and health-related decisions, and (3) having a    logical diseases that do not normally affect this body area,
real option to convey a complete portrayal of dermatological      such as psoriasis, hyperhidrosis, or hidradenitis suppura-
topics (albeit with unequal prominence).                          tiva. Because the face is the most visible body part, previous
    First, to ensure visibility, YouTube videos must be pro-      studies have found that skin diseases in this area can have a
moted by the YouTube algorithm. While the operation of the        remarkable effect on patients’ self-esteem and a profoundly
algorithm is a black box, it seems to favor content that is       negative impact on quality of life [17-19]. As a consequence,
viewed more frequently by users (i.e., what users, through        it seems logical that users search for these topics more than
their behavior, have revealed they want to see) [21]. This        for less noticeable dermatological diseases.
mechanism makes it extremely difficult to garner public in-          Previous research suggests that social media allows
fluence while presenting topics that the public does not usu-     dermatologists to do social work of great significance,
ally search for on YouTube.                                       disseminating an evidence-based dermatological culture
    Second, focusing on what people want to see provides          and influencing the habits of the most vulnerable people
dermatologists with a real opportunity to have a positive,        [10,25,26,29,33,36,37]. For this reason, many authors have
evidence-based influence on people’s culture and behavior.        encouraged dermatologists into more active participation on
Comments on videos about popular topics illustrate that           these platforms [5,11-13]. Previous literature on the topics
they can help foster important dermatological culture that        that dermatologists should present on social media is very
extends beyond the focal topic: “Since watching your videos,      scarce, but it has been suggested in the context of other as-
I use sunscreen regularly.” In particular, focusing on acne can   pects of social media content that dermatologists should
lead to increased visibility among adolescents [9,10]. This       adapt their content to the population. For instance, Güder
can facilitate the dissemination of important dermatological      and Güder [5] focused on the language used and highlighted
habits, such as sun protection, from a young age, aiding in       that in order to increase visibility, dermatologists should use
skin cancer prevention [26,29,33,34]. Therefore, focusing on      words that are familiar to patients instead of technical terms.
popular topics can be a way to convey important messages          We consider that focusing on popular topics can be a suc-
about other important dermatological issues. Schneider-           cessful strategy that follows a similar approach.
banger et al. [35] presented an interesting example of how           While dermatologists must share information on import-
dermatologists’ concerns about a disease (skin cancer) can        ant topics, such as skin cancer, even at the expense of losing
be associated with the main interests of young females (skin      visibility, our findings indicate that prioritizing the goal of a
aging). Since the prevention of skin aging seems to be an         balanced portrayal of dermatology is difficult to achieve in
important concern among young females, a dermatologist            the real context of social media. This is so because meeting
could broadcast a video emphasizing the association between       this goal implies trying to lead social media users to focus
tanning and premature skin aging, thus helping discourage         their attention on topics in which they have no or little in-
this behavior and, therefore, contributing to reducing the        terest. Disregarding this balance in favor of popular content,
prevalence of skin cancer [35]. Consequently, dermatologists      without completely neglecting other relevant dermatological
can create content about topics that concern users and use it     topics, might be worthy for dermatologists in terms of ac-
to convey additional skin health advice in a compelling way.      complishing a very relevant social mission.
    Third, focusing on people’s interests serves to gain
subscribers and build loyalty [2]. Loyal subscribers tend
to watch more channel videos, including those on less fre-        References
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