Keratosis pilaris on TikTok: A cross-sectional analysis of trending content.

To the Editor: In 2020, TikTok became the most downloaded app globally, reaching over one billion users. While the credibility of educational content on TikTok may vary among videos, they can contain valuable information about common dermatologic conditions, including keratosis pilaris (KP), an underrecognized condition usually appearing in childhood and progressing into adolescence. Our purpose was to examine the quality of popular KP content on TikTok and identify areas for improving the delivery of medical information on the app.

On December 28, 2021, TikTok was searched for videos containing #keratosispilaris. After screening 132 videos, the top 100 videos generated based on viewership were included in this study, excluding non-English and repetitive videos. The content was assessed by 2 independent reviewers using the DISCERN 16-item questionnaire, previously validated to determine the quality of written health information regarding treatment options. Reviewers evaluate the reliability of published content using a scale of 1 (poor) to 5 (excellent).

Content creators consisted of physicians (32%), nonphysicians (52%), and private companies (16%); the majority of physician creators were dermatologists (84%). Overall, the videos had a mean DISCERN score of 1.59, with high interrater reliability (Cohen’s Kappa > 0.75). Physician creators’ videos received the highest DISCERN scores, averaging 1.87; and when stratified by specialty, dermatologists received the highest scores, averaging 1.90. However, internists received the most likes and comments, 260,000 and 2455, respectively. Some creators referred to KP in colloquial terms, including “strawberry” or “chicken” skin (36%), and/or used hashtags containing variations of these phrases (28%) in their videos, although the majority did not (Table I).

Table I

Keratosis pilaris content on TikTok overview

	Number of videos (n = 100) (%)	Mean number of likes (K)	Mean number of comments	DISCERN SCORE
Content creator
Physician	32 (32)	163	1694	1.87
Nonphysician	52 (52)	90	629	1.47
Private company	16 (16)	66	465	1.35
Gender
Male	24 (24)	2016	1996	1.80
Female	59 (59)	90	944	1.55
N/A∗	17 (17)	516	455	1.34
Physician specialty
Dermatology	27 (84)	154	1629	1.90
Internal medicine	4 (13)	260	2455	1.88
Family medicine	1 (3)	26	402	1.85
Video type
Personal experience	9 (9)	88	794	1.15
Educational content	34 (34)	144	1543	1.86
Home remedies	28 (28)	117	715	1.51
Treatment advertisement	23 (23)	74	553	1.43
Other	6 (6)	49	336	1.34
#chickenskin #strawberryskin #strawberrylegs #strawberryarms #strawberrybumps
Hashtag used	28 (28)	84	779	1.59
No hashtag used	72 (72)	120	84	1.57
Verbal or written reference to chicken or strawberry skin in video
Reference used	36 (36)	113	1026	1.63
No Reference used	64 (64)	1026	897	1.55

If the creator was a private company, gender may not be available.

The elevated DISCERN score of physician creators highlights the importance of physician-created educational content to reduce the spread of misinformation on TikTok. To reach a wider audience, popular creators referenced the terms “strawberry” or “chicken” skin in their videos and included hashtags with these colloquial terms. According to the literature, patient education materials are less effective when patients lack adequate health literacy. Videos including colloquial hashtags had approximately 9.3 times more comments than videos without them, suggesting that content with these hashtags may appear more approachable and encourage interaction from users. Although videos that did not include these hashtags had a 1.4 times higher average number of likes, this difference was marginal when compared with the difference in the number of comments. Increased engagement indicates that simplified terminology may be used as a tool by physicians to reach a broad audience by improving comprehension.

Study limitations include the lack of reproducibility because of its cross-sectional nature, the generalizability of TikTok users to the general population, and the inability to fully encompass self-identified gender expression in a categorical manner. Additionally, the DISCERN score was conceived to assess the quality of writing, not video or educational content. Our data demonstrated elevated engagement with videos including colloquial terms. Hence, we advocate the use of simplified language when promoting educational content on apps such as TikTok. With patient education materials expanding to easily accessible apps, it is important to increase physician awareness of what users are learning and methods to increase the visibility of reliable health videos.

Conflicts of interest

None disclosed.