TikTok as a tool to engage with public health and promote dermatologic expertise
By Emily Margosian, Assistant Editor, May 1, 2022
For a fleeting moment, there were few questions more pressing than, “Is it a Bones Day?”
Last fall, Noodle, a 13-year-old pug, shot to stardom on one of the world’s fastest-growing social media platforms. Whether or not the elderly pug decided to stand (a “Bones Day”) or plop back down when set on his feet (a “No Bones Day”), captured the attention of TikTok’s over 1 billion active users, who used the sleepy pug as a daily horoscope of sorts. However, in true testament to an app that prioritizes content lasting only 60 seconds or less, only a week after a glowing New York Times profile, Noodle was declared “officially canceled” by Rolling Stone.
Launched in 2016, TikTok rapidly climbed in popularity during the start of the pandemic while many Americans found themselves abruptly stuck at home, netting 2 billion total downloads worldwide as of 2021 (https://doi.org/10.1016/j.jaad.2021.02.050). Often affiliated with Gen Z and powerful viral trends (occasionally with real-world consequences), TikTok has nevertheless accumulated a user base spanning multiple generations and areas of interest. With so many eyeballs at its command, it is not surprising that dermatology has also found its way onto the app.
However, with any social media platform, misinformation can abound. TikTok has been both praised and criticized for its ability to spread information to an enormous audience at lightning speed by both experts and imposters alike. This month, DermWorld speaks with social media experts and dermatologist power users about TikTok’s potential as a tool for public health engagement and education, as well as tips for physicians on how to successfully and safely navigate the platform.
What is Tiktok?
“TikTok defines itself as the leading destination for short-form mobile video with a mission to inspire creativity and bring joy,” explained Lauren Gebhardt, AAD senior public social media specialist. “It relies on short-form, trend-based video content, which differs from other video-focused social media platforms, such as YouTube, that offer extended length and longevity.”
TikTok video uploads are capped at three minutes in length (with the maximum duration only available to certain users), and most range from 15-60 seconds. What makes TikTok unique from other platforms is its use of a complex algorithm to provide a never-ending stream of curated video content for its users via its ‘For You Page.’ This differs from other social media sites where users are typically presented content in chronological order, and only from accounts they follow. For You Page content is typically selected by TikTok’s algorithm depending on the content a user liked, interacted with, or searched. “This algorithm creates a positive feedback loop in which popular content creators or viral trends are prioritized on the users’ homepages, in turn providing the creators of these videos with an even larger audience,” explained a 2021 JAAD article.
In addition to the For You Page, TikTok also offers its users two other primary landing pages within the app: the ‘Following’ page and the ‘Discover’ feed. “Each of these areas offer different features and benefits. The Following page curates content just from the users one follows, giving the user some level of control over this page. The Discover feed curates videos from trending hashtags and sounds, giving the user insight into what is popular. This feed is one place to find upcoming trends to capitalize on,” explained Gebhardt.
“Nowadays nobody really goes to a website to find information. They either Google or follow sources on social media. I found a lot of the content I was making on TikTok started to gain traction, and I never looked back.”
While TikTok offers a variety of in-app editing features, including filters, animated texts, and transitions, content that goes highly viral typically features the use of two unique features of the platform: the duet function and use of the “sound” functionality.
For Twitter users, the duet feature essentially functions as a video equivalent of the ‘quote tweet’ feature utilized by the short-form text-based platform, allowing users to juxtapose their own reactions next to the original piece of content. “The duet function is a unique way to collaborate with other creators. The function allows a user to create a video that plays alongside another video within the app. Other users will then be able to view the videos simultaneously. This is popular for filming reactions and commentary on another user’s content,” explained Gebhardt.
Likewise, the ‘sound’ functionality allows users to use and create soundbites within the platform. ‘Sounds’ range from song clips from TV shows or movies, to recordings from users themselves that can be repurposed to partake in viral trends. “Sound trends move quickly, but are enticing for the algorithm,” noted Gebhardt. Content that typically goes viral on TikTok often features the use of trending hashtags or popular background sounds to reach wider audiences.
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Dermatologists on TikTok (“DermTok”)
Dermatology content has proven to be fairly popular on the platform and has since been dubbed the rise of “DermTok.” Gen Z, the primary user base of TikTok, has a rising interest in skin care, which has led to a growing community of skin health enthusiasts on the app. However, “given the relative scarcity of highly popular board-certified dermatologists on TikTok, inaccurate dermatologic information or nonevidence-based treatments can be disseminated more easily,” caution the authors of a recent JAAD paper.
However, a small but growing cohort of dermatology experts are building a presence on TikTok, using the platform to share digestible information about skin health. Muneeb Shah, DO, dermatology resident at Campbell University in North Carolina (@DermDoctor), has amassed over 13 million followers on the app since downloading it in early 2020. “I initially never thought anyone would watch my videos,” said Dr. Shah. “I was a big TikTok consumer myself. It’s a very addicting platform, and I thought there was this opportunity to make videos that were entertaining and educational. Once it took off, I started to take it much more seriously. I know what I do reflects dermatology as a profession, and I think there’s a certain level of responsibility involved for any dermatologist on social media.”
New York dermatologist Angelo Landriscina, MD, FAAD (@DermAngelo), also started gaining traction on TikTok in early 2020, having currently amassed 313,000 followers on the platform. “I started posting on TikTok in January 2020. Shortly after, a big event happened in the world that made a lot of people a captive audience at home,” he explained. “I had originally been writing a blog, but nowadays nobody really goes to a website to find information. They either Google or follow sources on social media. I found a lot of the content I was making on TikTok started to gain traction, and I never looked back.”
Popular #DermTok content typically includes general skin care advice, product feedback, education about common dermatologic conditions, and correction of misinformation on viral skin care trends and procedures, with the duet function serving as a popular vehicle to do so. According to Dr. Shah, most of his content falls in the latter category. “Because my audience got so large, I essentially come home from clinic and look at all the videos I’ve been tagged in. A lot of my content is responding to other videos.”
“There’s a lot of misinformation, especially related to skin diseases, and there are a lot of people who claim to be experts. What’s beautiful about TikTok is that unlike Instagram, YouTube, or Facebook, the duet feature allows me to respond within 24 hours of someone uploading a video and say, ‘this is not safe,’ or ‘this is not something I recommend.’”
While TikTok’s dependence on viral content makes it easy for misinformation to spread, the structure of the app in turn makes it uniquely suited to counteract it in a way that other platforms do not, said Dr. Shah. “There’s a lot of misinformation, especially related to skin diseases, and there are a lot of people who claim to be experts. What’s beautiful about TikTok is that unlike Instagram, YouTube, or Facebook, the duet feature allows me to respond within 24 hours of someone uploading a video and say, ‘this is not safe,’ or ‘this is not something I recommend.’ There’s an ability to react to misinformation immediately.”
Some dermatologist users say TikTok has also had a positive impact on their practice from a marketing standpoint. “I’ve had a lot of people find me through TikTok, then go to my Instagram, follow me there, and then make appointments,” said Dr. Landriscina. “Vice versa, I’ve had patients who are referred to me and then start following me on social media. Sometimes I think the reason that they decide to come back is because they feel like they got to know me a little better in a way. Personally, TikTok has given me the ability to do something a little bit more creative with my medical background that’s really gratifying at the same time,”
Dr. Shah admits that TikTok is likely not for every dermatologist. “For some people, social media is not going to be worth their time, so you have to identify what your own objective is,” he explained. “Instagram for example, has almost no organic growth, but it may be good for you if you’re trying to grow your presence within a very specific local area. YouTube is more suited for education and is essentially a search engine more than anything else. TikTok is different, because even as an unknown person with no social media following, if you make a video that resonates with a lot of people, you don’t need to have a million followers to get a million views. You can go from relative obscurity to a household name quickly because of the way the algorithm works, whereas on other platforms it’s a much slower growth.”
Potential pitfalls for medical professionals posting on TikTok
As with all social media, TikTok requires careful navigation from physicians to avoid potential pitfalls and maintain ethical conduct online.
“For dermatologists, it is important to establish credibility on the platform. This can be done by including your credentials, including the FAAD designation, on your profile. Remember that patients and potential patients may view the content, so avoid oversharing or posting controversial opinions,” recommended Gebhardt. “Always follow privacy laws and refrain from sharing patient photos or protected health information without explicit, written permission. Don’t forget that anonymity and confidentiality are never guaranteed on the internet, even in a private direct message, so choose interactions carefully.”
Dr. Shah advises careful navigation and potential legal consultation for dermatologists looking to build a presence on TikTok. “What you do online reflects you as a clinician and is a reflection of the profession, so you need to be very careful about what you say and what you do. Obviously, you should not be giving anyone direct medical advice. I get messages and pictures of conditions from people every day, maybe a couple times an hour, and I do not respond to them,” he said.
Dr. Landriscina says he primarily protects himself by staying rooted in data and making it clear to his audience that he is not providing medical advice. “I know that sounds very basic, but if it can be construed as giving individualized advice, avoid it. My followers know ‘If there’s ever a question, go see a physician in person.’”
TikTok user demographics
Best practice recommendations
While there are some universal guidelines for posting on social media, each platform has its own tailored best practices depending on its audience and unique format. Success on another platform may not necessarily translate to success on TikTok.
> How often should I post?
“TikTok is a fast-paced platform, so frequent posting is recommended. For optimal success, users should be posting 1-3 times per day, with some full-time creators posting as much as 10 times per day. However, when getting started, posting 4-5 times per week will help to establish a presence on the app,” recommended Gebhardt.
“Typically, I will upload about once a day. However, if things get really busy in my personal life or at work, I will absolutely skip a day because it’s definitely not my priority,” said Dr. Landriscina. “One of the good things about the platform is you can build up a backlog of videos. Whether I post that day or not, my content is still getting served up to people. They might see a video I posted a year ago, but it’s brand-new to them.”
> How can I harness the algorithm?
“Trends are the driving force behind TikTok’s success, so paying attention to viral sounds and themes will help widen your audience. Hashtags are another way to reach an engaged audience. Including #dermatologist or #dermatology can help set content apart from other skin care influencers. Topical hashtags such as #skincaretips, #acne, or #sunscreen can also help deliver videos to the desired audience,” recommended Gebhardt. “Trending hashtags, which can be found on the Discover feed or by viewing hashtags used by others, can also extend the reach of posts.”
“These algorithms change all the time. I try to jump on trends or viral sounds and apply them to the topics I’m talking about because the algorithm likes videos that have a certain sound attached to them and will serve up your video to people,” recommended Dr. Landriscina. “Another helpful thing is if people watch your video all the way through or more than once, that will give it a push within the algorithm. You want to provide something that’s going to hold people’s attention. One way to do that is by presenting information in a list format. Another is by creating shareable content. Every time someone hits that share button, it’s a huge boost in the algorithm.”
> How long should my videos be?
“TikTok allows for videos up to three minutes, but shorter videos tend to get higher engagement,” said Gebhardt. “Most videos on the platform are less than one minute. No matter the length, it is important that TikTok videos get straight to the point and deliver messages quickly. When discussing a complex topic, consider making multiple videos explaining different components instead of one long video.”
> What are some tips for working within the time limit?
“Due to the nature of TikTok, a lot of the most successful videos are under 15 seconds. There’s not a lot of time to get a point across. I think that lends well to small bite-sized pieces of information, essentially teaching people something new within a minute,” recommended Dr. Landriscina. “That can be very challenging sometimes, and there are certain topics you just can’t get into. For example, you can cover what you should do when you get a pimple in 60 seconds, but not so much the pathogenesis of acne. For the layperson, that’s probably better suited to something long-form like YouTube. I try to keep it fun and bring humor into it, because education on social media is about meeting people where they are.”
> What topics are a natural fit on TikTok?
“I try to address certain niches, like things that people might be afraid to ask their dermatologist in person,” advised Dr. Landriscina. “People are also very interested in what products they should buy, and that’s one of the things they’re turning to social media for. As dermatologists, I don’t think that we’re classically well-versed in exactly what’s out there. I’ve had to build a secondary knowledge base, basically giving information on what people should look for in products, what different ingredients do for the skin, and what the data are behind certain formulations.”
> What topics should I avoid?
“There’s not a lot of opportunity for nuance on TikTok, so I won’t make videos about certain conditions,” said Dr. Shah. “For example, seborrheic keratosis is a benign growth, but they look very scary and can resemble melanoma. I won’t make videos about that, because I feel like it might decrease people’s concerns about abnormal growths and could give a false sense of security. I don’t want to do anything that is going to deter someone from consulting with a dermatologist about an area of concern.”
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