INTRODUCTION
Hair loss, caused by multi-faceted conditions such as alopecia areata (AA) and pattern hair loss (PHL, or androgenetic alopecia), has an estimated global prevalence of up to 2% for AA and up to 80% in men and 42% in women for PHL. These conditions often cause significant emotional distress and psychological burden to patients, leading to increased demand for effective treatments. This has created a multibillion-dollar industry with over 2.2 million hair restoration procedures performed worldwide in 2019 according to the International Society of Hair Restoration Surgery.
The ever-increasing presence of social media in healthcare has not only improved patients' understanding of their conditions, but also shifted the traditional patient-doctor relationship towards more patient autonomy; patients with better access to pertinent medical information may be more encouraged to adapt the practice of shared decision-making with their physicians, leading to lesser decisional regret.
The advent of popular applications (‘apps’) on these platforms, such as TikTok and YouTube, has opened the door to rapid and unregulated dissemination of medical information with potential implications such as marketing of unproven treatments without proper disclosures or discussion of risks. With billions of active users worldwide, these platforms preferentially attract individuals under the age of 35 years, leading to an average American adolescent spending 3 h per day on TikTok and YouTube combined.
Visual presentation is an important aspect in dermatology as cutaneous conditions affecting physical appearances can adversely affect patients' quality of life (QoL); some patients may prefer to seek online information prior to their scheduled consultation, and a recent study identified a correlation between higher patient-rated dermatologists and an active social media profile.
Due to differences in engagement, quality, and accuracy of information presented by laypersons compared to medical professionals on social media, dermatologists treating hair loss have the potential to improve their communications with patients by knowing their sources of information. The study aims to gauge current public interest trends on hair loss caused by AA and PHL, as well as to characterize and evaluate the top or most-viewed videos relating to AA and PHL on TikTok and YouTube.
METHODS
To examine fluctuations of public interest trends on AA and PHL, we used Google Trends () and obtained weekly relative search volumes (RSV) over a period of 5 years from September 2017 to September 2022. RSV fluctuations pertaining to the topic ‘alopecia areata’ and ‘pattern hair loss’ were identified and correlated with health-related news over matching time periods (see detailed search strategy in Supplement Appendix A (Appendix )).
We also characterized and assessed the top or most-viewed 80 videos posted on two social media platforms, TikTok and YouTube, for viewer engagement, quality, and accuracy (Figure ) (see Supplement Appendix B and C (Appendix )). Videos were categorized based on content type and content producer and independently assessed by two authors (TW, SPR); discrepancies were discussed and resolved with a third author (AKG).
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Viewer engagement, quality, and accuracy were quantified using the engagement ratio, the DISCERN instrument, and the Dy et al. Accuracy Scale (DAS) as previously described. Interrater reliability and statistical significance were calculated using the Cohen's kappa coefficient, and two-tailed t tests with a significance level of p < 0.05, respectively.
RESULTS
Fluctuations in health-related web searches on Google
AA generated consistently higher RSV values compared to PHL across all time periods over the past 5 years (Figure ). Prior to 2022, RSV trends for health-related AA and PHL web searches exhibited cyclical fluctuations without significant changes overall. Periodic increases in RSV likely reflect seasonal changes associated with disease worsening in AA, with one study reporting increased incidences of disease flares in October, November, and January. Fluctuations in PHL-related searches are likely caused by shortened daytime durations in North America during the autumn and winter seasons, leading to reduced outdoor activities and renewed interest in hair restoration procedures. External events reported in previous studies, such as the COVID-19 pandemic, do not appear to exhibit effects on RSV trends for either AA or PHL.
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During 2022, two notable peaks in RSV for AA searches were observed to date, with RSV values of 100 and 19 during the week of March 27–April 2 and June 12–18, respectively. The first peak reflects the highest volume of web searches from the past 5 years, with matching RSV trends to the search term ‘will smith’ (relating to the event at the Oscars in March 2022). The second peak reflects an 81-point RSV reduction relative to the first peak and matches with the search term ‘olumiant’, a new US FDA (Food and Drug Administration) approved treatment for AA. Both peaks also partially matched with the search term ‘does alopecia go away’.
Characteristics of
A total of 80 top or most viewed English videos were extracted from TikTok and YouTube (Supplement Table 1 (Appendix )). A comparison of the characteristics of AA and PHL videos in terms of content category, male versus female presenters, and content presenters has been summarized (Figure ).
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On TikTok, 65% (13/20) of AA-related contents were focused on personal experiences, followed by 25% (5/20) on medical education; the majority of contents were presented by females (70% [14/20]) and created by patients (75% [15/20]). PHL-related content was predominately categorized as medical education (70% [14/20]), with 60% (12/20) created by healthcare providers including board-certified dermatologists.
On YouTube, a majority of content were medical education videos with 85% (17/20) on AA and 50% (10/20) on PHL. Content presenters were predominantly female (55% [11/20]) and patients (30% [6/20]) for AA, compared to male (60% [16/20]) and healthcare providers (35% [7/20]) for PHL.
Videos on surgical hair restoration procedures were notably absent across both platforms, with the exception for PHL-related contents on YouTube (10% [2/20]) (Figure , Appendix ).
Of all the videos, 34%(27/80) were deemed as promoting medical or nutraceutical products (Table ); which featured recommended and approved treatments such as topical minoxidil for AA and PHL, oral finasteride for PHL, and baricitinib for AA, in addition to investigational agents (oral minoxidil, dupilumab, microneedling) and nutraceuticals (ayurvedic or homeopathic treatments). Across both platforms, none of the aforementioned videos included sponsorship statements, albeit with up to 50% of videos having disclaimers on YouTube (Table ).
TABLE 1 Overview of product promotional videos for alopecia areata (AA) or pattern hair loss (PHL).
| Parameters | TikTok | YouTube | ||
| AA (n = 2) | PHL (n = 7) | AA (n = 8) | PHL (n = 10) | |
| Content category % (n) | ||||
| Medical product promotion | 50 (1/2) | 71 (5/7) | 25 (2/8) | 40 (4/10) |
| Nutraceuticals product promotion | 50 (1/2) | 29 (2/7) | 88 (7/8) | 70 (7/10) |
| Disclaimer % (n) | 0 | 14 (1/7) | 25 (2/8) | 50 (5/10) |
| Sponsorship statement % (n) | 0 | 0 | 0 | 0 |
| Medical products | Baricitinib |
Minoxidil (topical) Minoxidil (oral) Finasteride (oral) Microneedling device |
Minoxidil (topical) Dupilumab |
Minoxidil (topical) Minoxidil (oral) Microneedling device |
Engagement
Four videos were excluded from analysis due to disabled comments section (n = 1), website embedment without feedback features (n = 1), and irrelevant subjects (n = 2), which includes 1 TikTok video on AA and 3 TikTok videos on PHL.
Results showed that AA-related content on TikTok, predominantly created by patients (Figure ), generated significantly higher engagement ratios compared to PHL-related content (0.079 ± 0.047 vs. 0.036 ± 0.0007. p = 0.00089), and across platforms compared to both AA- (0.017 ± 0.0099, p = 0.0000095) and PHL-related content (0.024 ± 0.017, p = 0.000052) on YouTube (Figure ).
Quality and accuracy
Substantial (ĸ = 0.74) and near-perfect (ĸ = 0.93) agreements were found between the two independent raters (TW and SPR) who conducted DISCERN and DAS assessments, respectively, for videos pertaining to medical education, product promotion, and surgical hair restoration. A total of 57 videos were included for analysis, with the exclusion of 2 PHL-related videos on TikTok due to irrelevant subjects.
Overall, healthcare providers on both platforms produced contents with an average DISCERN score of 2.15 ± 0.78 (range; 1.13–3.70) and an average DAS score of 3.10 ± 1.10 (range; 1–4), while non-healthcare provider sources had an average DISCERN score of 1.47 ± 0.43 (range; 1.0–2.66) and an average DAS score of 1.94 ± 1.05 (range; 1–4).
Significant improvement in quality was observed in videos created by healthcare providers on YouTube (DISCERN 2.80 ± 0.75 vs. 1.50 ± 0.44 p = 0.00000059) and across platforms compared to healthcare providers (DISCERN 2.80 ± 0.75 vs. 1.68 ± 0.37 p = 0.000077) and other sources (DISCERN 2.80 ± 0.75 vs. 1.40 ± 0.40 p = 0.000062) on TikTok (Figure ). Information presented by healthcare providers on YouTube also had higher accuracy compared to other presenter groups (DAS 3.40 ± 0.97 vs. 1.76 ± 1.04 p = 0.00019), but not significantly different compared to healthcare providers on TikTok (DAS 3.40 ± 0.97 vs. 2.89 ± 1.18 p = 0.28) (Figure ). In contrast, no significant improvement in quality or accuracy was observed in videos created by healthcare providers on TikTok.
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DISCUSSION
To our knowledge, this study is the first to examine health-related online interest trends on AA and PHL and provide cross-sectional analysis of AA- and PHL-related videos on social media. Our results indicate that news in popular culture exerted disproportionately higher impact on public interests of AA. Assessments of videos posted on popular platforms showed higher proportions of female patients sharing their personal experiences of AA, which generated significantly higher engagement on TikTok, in contrast to PHL contents where the majority of presenters were male and healthcare providers. Videos produced by healthcare providers on YouTube were of significantly higher quality and accuracy; however, no difference was observed on TikTok.
Online interest trends are often dynamic and appear to be influenced by health and non-health related events to different extents; recognizing these periodic changes may assist physicians in preparing for increased patient flows or demands for certain treatments. Previous studies assessing changes in web searches conducted on Google have correlated fluctuations with clinically significant impacts such as higher number of patients receiving surgical hair restoration procedures.
Findings of this study are consistent with previous reports indicating YouTube as a platform for medical education by healthcare providers including dermatologists; however, high-quality content does not guarantee increased engagement. The significant improvement in quality and accuracy can be explained by differences in video lengths where detailed discussions could take place on YouTube compared to TikTok. Contrary to a study by Nguyen and colleagues, videos created by healthcare providers on TikTok included in this study were not significantly different in quality or accuracy compared to other sources; with videos varying from 10 to 40 s in duration, TikTok may have reduced utility for informing patients.
In addition, our results indicate potential areas of improvement for healthcare providers on social media such as citing their sources of information, discussing benefits and risks of treatments, and encouraging shared decision-making.
Lack of sponsorship disclosures was observed consistently across both platforms for all product promotional videos included in this study; with videos featuring nutraceutical products described as ‘amazing hair savior’, to videos featuring the trade name and packaging of an investigational agent for AA described as ‘potentially a miracle drug’. Exposure of potentially biased information on management could predispose patients to treatments without scientific evidence and adversely influence future patient-doctor communications and shared decision-making.
While surgical hair restoration procedures were covered to a lesser degree both on YouTube and TikTok, the relative lack of coverage of this treatment in male and female PHL patients suggests improved patient-doctor communications on surgical options are warranted.
Some limitations of our findings include web searches restricted to the Google platform, which may be under-utilized in non-native English speakers, leading to the exclusion of important health-related trends outside of North America. Unforeseen changes in the search algorithms of video-sharing platforms, as well as short turnover time of popular videos, may also limit reproducibility.
Popular social media platforms that disproportionately retain young consumers, with built-in advertisement features, make it ideal for companies marketing therapeutic products for early onset diseases; this is evident in AA patients with the highest rate of incidence occurring in the 20–24 years and 30–34 years age groups globally for both sexes, while the initial onset of PHL may occur between the age of 20–25 years or post-pubertal age groups for males and females, respectively. Furthermore, the effects of AA- and PHL-related medical content on social media could be enhanced due to the inverse association between QoL and age of onset; this was shown in patients whose age of onset is in the 30s or ≤20s, who are more likely to have reduced QoL caused by AA and PHL respectively.
Therefore, physicians who adopt share decision-making with patients could benefit from keeping up-to-date with the current social media landscape, especially for young patients as they become increasingly reliant on social media for medical information. Being aware of the type of treatments discussed online may not only improve patient-doctor communications but also encourage physicians to increase their online presence to provide higher quality and accurate information to the public discourse; this would help in starting nuanced discussions about the risks and benefits of different treatment options, while supporting a patient's autonomy and improving the likelihood of having a satisfactory outcome.
ACKNOWLEDGEMENT
None.
FUNDING INFORMATION
None.
CONFLICT OF INTEREST
Aditya K. Gupta, Shruthi Polla Ravi and Tong Wang report no competing interests to declare.
DATA AVAILABILITY STATEMENT
Supporting data are available from the corresponding author upon reasonable request.
ETHICAL APPROVAL
The authors declare that human ethics approval was not required for this article.
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Abstract
Background
With an ever‐growing influence of social media in healthcare, concurrent with increased emphasis on patient autonomy and shared decision‐making, dermatologists treating hair loss need to be cognizant of online interest trends and the types of information disseminated across popular platforms.
Objectives
To evaluate recent health‐related interest trends and assess engagement, quality, and accuracy of alopecia areata (AA) and pattern hair loss (PHL, androgenetic alopecia) contents on social media.
Methods
Relative search volumes (RSVs) were extracted from Google Trends using the search category ‘alopecia areata’ and ‘pattern hair loss’. Eighty matching videos on TikTok and YouTube were also extracted and characterized. Viewer engagement was estimated using the engagement ratio, and quality and accuracy were assessed using DISCERN and Dy et al. Accuracy Scale (DAS).
Conclusions
AA‐related contents on TikTok discussing personal experiences of female subjects were significantly more engaging. DISCERN and DAS scoring showed significantly higher quality and accuracy in videos created by healthcare providers on YouTube, but not TikTok, which could in part be related to YouTube videos being longer. RSV fluctuations corresponding to news in popular culture had high impact. Sponsorship disclosures were generally not reported in product promotional videos.
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Details
; Polla Ravi, Shruthi 1
; Wang, Tong 1
1 Mediprobe Research Inc, London, Ontario, Canada