Mask-related acne in the COVID-19 pandemic: an analysis of Twitter posts and influencers.

Widespread use of facial masks during the COVID‐19 pandemic has been linked to the development of acne breakouts, frequently referred to as ‘maskne’., Social media platforms, including Twitter, have previously been shown to inform patient perceptions regarding acne. Given the growing influence of social media in providing health information,, we sought to characterize Tweets about mask‐related acne to better recognize the distribution of potential influencers and the role of dermatologists in supplying education and guidance.

We conducted a retrospective analysis of English Tweets regarding mask‐related acne posted in September 2020. This study utilized publicly available online data and did not qualify as human subject research, therefore institutional review board approval was not required at the University of Connecticut Health Center.

Analysed Tweets were ‘high impact’ (had at least one retweet) and novel (not posted more than once by the same author). Retweets were not considered. Author types and demographics were collected using available information on public Twitter profiles. Tweet content was assessed and categorized into several major groups (Table S1).

Most of the 690 Tweets analysed were by patients (68.8% compared with 31.2% from nonpatients). Healthcare providers and organizations (1.7%) and dermatologists (0.1%) accounted for a small portion of Tweets. Other nonpatient authors included beauty bloggers or aestheticians (8.4%), media networks and personnel (7.5%), and businesses selling tangible products (6.5%). Patients most frequently Tweeted complaints of or questions about mask‐related acne (89.1%), whereas the majority of commercial business Tweets promoted brand‐name acne treatments or online shopping links (83.7%) (Fig. 1). Demographic characteristics of the sample of influencers and patients are delineated in Table 1.

Figure 1

Overall volume, topic distribution and content of mask‐related acne Tweets in September 2020, stratified by author type. For each author type, the total number of Tweets is denoted at the top of each bar in the figure. The distribution of Tweets is specifically delineated for each author type. Tweets were classified based on common ideas and themes, which are further described in Table S1.

Table 1

Demographic distribution of patient and nonpatient authors posting Tweets regarding mask‐related acne.

	Patient Tweets, n (%)	Nonpatient Tweets, n (%)
Total Tweets	475 (100.0)	215 (100.0)
Demographic attribute
Gender
Male	56 (11.8)	5 (2.3)
Female	412 (86.7)	69 (32.4)
Genderqueer or nonbinary	2 (0.4)	1 (0.5)
Not availablea	5 (1.1)	1 (0.5)
Not applicableb	0 (0)	139 (64.4)
Race
White/Hispanic	313 (65.9)	30 (13.9)
Person of colour	146 (30.7)	42 (19.9)
Not availablea	16 (3.4)	4 (1.9)
Not applicableb	0 (0)	139 (64.4)

a Those that were difficult to ascertain using publicly available information;

b pertaining to Twitter accounts of groups or organizations.

The findings emphasize a shortage of educational Tweets regarding mask‐related acne, which is important given the frequency with which patients expressed frustration with mask‐related acne and sought management guidance. Although many healthcare professionals and health organizations posted links to educational videos, these individuals were overall under‐represented in the sample of influencers. Beauty bloggers, aestheticians and news networks are likely to play an educational role through their overall Tweet volume and frequent posting of informational materials and links. However, although these resources may be helpful, dermatologists and other healthcare professionals should be better suited to lead this conversation, given their experience and ability to differentiate mask‐related acne from similar‐appearing dermatological conditions.

Effective acne treatments, including retinoids, salicylic acid and benzoyl peroxide were occasionally discussed on Twitter. However, many remedies that do not appear in American Academy of Dermatology recommendations, such as turmeric masks, herpanacine supplements and essential oil concoctions, were also promoted. This may lead to confusion among patients, especially if they are unable to verify these recommendations with those from dermatologists or other healthcare professionals on social media. Additionally, commercial businesses mainly promoted brand‐name acne products, which are probably more costly than unbranded treatments and may not be the optimal treatment choice.

There are several limitations to this study, including the inability to definitively verify some author demographics. Additionally, this cross‐sectional study of one time period may not reflect the distribution of mask‐related Tweets earlier in the COVID‐19 pandemic. As our understanding of mask‐related acne continues to improve, the dermatology community should be encouraged to contribute its knowledge and recommendations regarding evidence‐based practice through social media.

Table S1. Classification guidelines for mask‐related acne Tweet content.

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