From "slugging" to snail mucin

By Emily Margosian, Assistant Editor, October 1, 2023

Social media and the skin have a long history together. For over 15 years, social media has been an ever-growing presence in nearly all facets of life: politics, commerce — and health. Particularly among millennials and Gen Z, social media is often the first and preferred source of cosmetic and medical advice. “I think younger generations appreciate immediate feedback, which leaves the public seeking health care advice online where they can get quick information,” said Sara Moghaddam, MD, FAAD (@drsaramd), a social media correspondent for the AAD’s Your Dermatologist Knows consumer positioning strategy. “We all know that our patients have been ‘Googling’ answers to health care questions for years, and this new phase of social media is just the next wave of where people seek answers to their skin questions.”

Aside from easy access to information, patients may increasingly look to social media for unconventional skin care advice, spurred by pandemic-era demand for at-home beauty and an increasing emphasis on how we appear on-screen. “Patients are doing more trial-and-error type experiments at home and are potentially encountering a lot of misinformation that makes them doubt some of our core advice,” said New York dermatologist Angelo Landriscina, MD, FAAD (@dermangelo).

While not all trending skin care practices are harmful, dermatologists may find it helpful to have a grasp of what patients are encountering online to answer questions about safety, according to Your Dermatologist Knows social media correspondent Oyetewa Oyerinde, MD, FAAD (@oyetewa). “I’d recommend to my colleagues to at least be familiar with practices that are commonly being promoted on social media. Regardless of whether you recommend them or not, that way you have some understanding of what they are when patients come in and ask questions about them.”

Skin care on social media: What’s trending?

According to Lindsey Zubritsky, MD, FAAD, AAD social media ambassador (@dermguru), nearly every day on TikTok yields a new skin care trend. Dr. Zubritsky, who has been active on the platform since 2018 with 1 million current followers, often has first eyes on emerging viral trends. “Some of the bigger ones that I’ve seen in 2023 include nasal tanning spray, petroleum jelly to ‘slug’ the skin, an obsession with K-beauty (Korean beauty), snail mucin, at-home dermaplaning and at-home microneedling, facial tape to reduce wrinkles instead of neuromodulators, and using food such as banana peels to rejuvenate skin or raw potatoes for acne spots.”

Among one of the fastest-growing social media platforms, TikTok not only promotes new skin care trends, but also periodically recycles not-so-golden oldies, according to Dr. Landriscina, who has been active on the platform since 2020 with 415,000 followers. “Funnily enough, a lot of TikTok trends harken back to bygone eras. One I’ve seen lately that concerns me is people concocting skin care remedies at home using beef tallow as a base. Another is using 3% hydrogen peroxide on the face as part of their daily skin care. There has been an emergence of creators with large followings who create general ‘health’ content demonizing everything from seed oils to sunscreen. However, not all the trends are bad. In the last year or so I’ve seen a lot of content from beauty and skin care creators focused on simplifying skin care routines and moving away from extravagant regimens for something more manageable.”

Good or bad, among the many skin trends swirling on social media, a few have risen to the top. These include:

Brow lamination

Popularized over the last several years, brow lamination involves chemically perming the eyebrows upwards. “Brow lamination is a process of reshaping brow hairs via a perm or relaxer treatment. It can be done professionally or at home and is often combined with brow ‘tinting’ which is essentially dyeing,” explained Dr. Landriscina. “Over the last year, there has also been a trend of bleaching eyebrows. These practices can carry all the same risks of similar processes on the scalp, just on the more sensitive eye area. Think irritant or allergic contact dermatitis, or hair breakage.”

DIY procedures

Social media-savvy dermatologists agree: one of the most worrisome recent skin care trends is a rise in office-based procedures attempted at home by patients. “This is something I find really concerning,” said Dr. Moghaddam. “For example, at-home microneedling, or ‘dermarolling,’ is dangerous due to risk of infections and improper techniques. As dermatologists, we all know there are many complications that occur with lack of sterilization or granulomatous reactions that can occur when inappropriate topicals are microneedled into the skin.”

According to Dr. Zubritsky, the use of DIY filler devices has also been popularized on social media. “We’re seeing people use hyaluron pens to self-inject areas on the body, like the lips,” she said.

“Patients will see people who document their entire journey on TikTok or on Instagram using some of these methods, but they often do not show their complications.”

“Definitely at-home devices are one of the biggest things that people ask me about all the time,” affirmed Dr. Oyerinde. “For example, can they do laser hair removal at home? Intense pulsed light (IPL) therapy? At-home filler? I always caution against it. There are just so many complications and reasons why it’s ideal for things like that to be done in-office with a dermatologist. Patients will see people who document their entire journey on TikTok or on Instagram using some of these methods, but they often do not show their complications. I tell patients, even if their immediate effect looks good to you — and they may be using filters and other things to make it look good — you have no idea if they ended up in the emergency room afterward because of a bad reaction.”

Kitchen cabinet beauty

Social media has also inspired patients to look to their own kitchen for skin care solutions — often with mixed results. “I frequently see people trying to use common substances found around the home to treat skin ailments, such as toothpaste, tea tree oil, or apple cider vinegar,” said Dr. Moghaddam. “I have had several patients come into my office with allergic or irritant contact skin reactions to household products, because when left directly on the skin, they can be extremely irritating, cause rashes, or even flare the particular rash they were trying to treat.”

According to Dr. Oyerinde, hot peppers have also made the rounds on social media as a pantry-ready way to achieve a fuller lip look. “I’ve seen people use peppers like Scotch bonnet or habañero, to get their lips to look bigger temporarily. That is potentially very dangerous, because it can cause allergic contact dermatitis, or other rashes that can leave dark spots around the mouth or on the lips that are hard to get rid of,” she said.

Nasal tanning spray

Among the more bizarre (and riskier) skin care trends to get major airtime on social media is the use of a nasally inhaled spray to induce tanner skin. “Nasal spray has been promoted as an alternative to regular tanning and contains either afamelanotide or bremelanotide (melanotan I or II),” explained Dr. Zubritsky. However, the use of melanotan isn’t approved or regulated by the FDA and isn’t available for legal purchase in a number of countries, including the United States.

“It’s not regulated, so you cannot guarantee the product being used is pure or that there is no contamination. Another major risk is that it may cause several nevi to change color or darken and may have a possible association with melanoma or eruptive nevi,” said Dr. Zubritsky.

“Slugging”

Despite its somewhat unappealing moniker, ‘slugging’ has emerged as one of the most popular — and perhaps least harmful — skin care trends to take hold on social media. “Slugging is a trend that’s been around since 2020. It is the practice of ending one’s nighttime skin care routine by applying a thin layer of petroleum-based ointment over the skin to prevent water loss and ‘seal in’ hydration,” explained Dr. Landriscina.

“Slugging has become an extremely popular trend on social media,” added Dr. Zubritsky. “Even if you’ve never heard of the term before, it’s a practice we dermatologists recommend every single day.”

While slugging is typically associated with petroleum jelly applied to the face, the practice can also include application to the feet, hands, lips, and nails. “Interestingly enough, many creators will now refer to any application of petroleum jelly as ‘slugging.’ For example, ‘lip slugging,’ or ‘nail slugging,’ explained Dr. Landriscina. “While this practice seems to be an overall positive, it may not be right for every patient, so be on the lookout.”

“Slugging is one trend I actually approve of,” added Dr. Moghaddam. “We all know that using this type of rich moisturizer can be very helpful for barrier protection. However, it may not be right for everyone and can cause worsening of skin problems for some.”

Snail mucin

Not to be confused with slugging, snail mucin has recently skyrocketed in popularity on social media as a moisturizing agent. Literally derived from snail secretion (formally labeled as “snail secretion filtrate,” or SSF, on product labels), snail mucin has been a longtime mainstay in Korean skin care products prior to its recent debut in the United States.

“Snail mucin is being promoted on social media as an exceptional moisturizing agent — which is its main benefit — but it has also been touted as helping with skin healing and collagen production,” said Dr. Zubritsky.

While there is some evidence as to the efficacy of snail mucin as an anti-aging ingredient (J Drugs Dermatol. 2013;12(4): 453-457), overall, its use is likely not harmful, according to Dr. Oyerinde. “A lot of people are chasing the so-called ‘glazed donut look.’ Basically, how to get the most hydrated skin,” she explained. “One way they’re doing that is through the slugging and snail mucin trends. I don’t see too much harm in that, because being well-moisturized is generally a good thing in my opinion.”

Supplements

While supplements are popular solutions for skin and hair ailments, evidence to support their effectiveness often remains inconsistent. “The practice of taking supplements for anything and everything is another trend that I think may be doing more harm than good,” said Dr. Landriscina. “Definitely ask your patients about this, because many are taking them on a whim after seeing social media content and start and stop taking them at will without consulting a physician.”

“When it comes to things that are not procedurally based, a lot of them are scams. Many products claim to do things that they cannot do,” added Dr. Oyerinde. “For example, products like topical or oral collagen. We just don’t have any great evidence for those things in terms of long-lasting benefits.”

For more discussion of common skin-related supplements — biotin, collagen supplements, and probiotics — that many of your patients may be using, with or without your knowledge, re-visit DermWorld’s recent feature, “Supplements and the skin."

Unsafe sun exposure

Despite ample evidence of its safety and efficacy, sunscreen use remains a hot topic in public health — and a sometimes controversial one on social media. “I’ve seen a huge rise in anti-sunscreen sentiment on social media, which is quite concerning,” said Dr. Zubritsky. “A significant number of users are posting about the detrimental effects of sunscreen and claiming that most sunscreens lead to cancer or contain cancer-causing ingredients. As a result, people are electing to make their own ‘natural’ sunscreen at home.”

“The number one thing that I am concerned about is the trend of avoiding sunscreen and people intentionally exposing themselves to the sun for purported health benefits that have no basis in science,” agreed Dr. Landriscina. “Many times, content relating to these trends is targeted toward men with claims that this will increase their virility or strength. Some take this to the extreme — there have been a few peaks in a trend toward ‘perineum sunning’ where people expose their perineal area to direct sunlight on a daily basis.”

Talking to patients about social media and the skin

Many patients — particularly those who are millennials or Gen Z — are likely getting some degree of skin advice from social media. To adequately address potential areas of concern, dermatologists should be familiar with what information their patients may be receiving online, recommended Dr. Zubritsky. “Whether or not you agree with what people are doing to their skin, it’s imperative that we know what is trending on social media, especially for our younger patients,” she said. “While some of these trends are harmless, others can have serious and detrimental consequences. Every single day, I will see younger patients who come in who are already educated on skin care and already have an extensive regimen. It’s best to be prepared for their questions.”

Dermatologists should also be prepared to help patients set realistic expectations regarding what they see online, and explain why a result may be unrealistic, unsafe, or edited, according to Dr. Oyerinde. “The big thing I tell patients to keep in mind is: just because something’s working for someone else, doesn’t mean it’s going to work for you. For example, 13-step Korean skin care routines. While I don’t think they’re dangerous, it’s probably a waste of a patient’s money and time. Sometimes I’ll have patients come in with bad acne. They’ve seen someone on TikTok with beautiful skin who is using a 13-step routine, and think, ‘If I do this, I’ll have beautiful skin like this person.’ I often tell patients, people who already naturally have great skin tend to be the ones who show off using these products online. It’s really just marketing. No one needs that many steps in their routine; you really only need a gentle wash for the skin, a moisturizer, and sunscreen.”

Also important is to emphasize to patients how to vet potential advice they may receive about their skin online. “I encourage patients to be cautious when obtaining information on social media and encourage them to seek out credentials such as ‘board-certified dermatologist,’ or ‘FAAD,’ which signifies one is a fellow of the American Academy of Dermatology. We as dermatologists should all make our credentials obvious on our profiles and work together to position ourselves as the experts in skin, hair, and nails,” said Dr. Moghaddam.

“As a trusted dermatologist, you can make a real difference in dispelling these myths for your patients...The burden of misinformation around skin health is huge.”

Your Dermatologist Knows, the AAD’s new consumer positioning strategy, aims to help tackle this issue. “Through the AAD’s Your Dermatologist Knows campaign, I focus on making social media content to help educate the public on different types of skin diseases. My fellow social media correspondents and I make videos to help the public have a better understanding of what’s a myth and what’s a fact when it comes to skin care, and which types of things should be seen by a board-certified dermatologist instead of treated at home,” said Dr. Oyerinde.

Participation on social media also offers dermatologists the unique opportunity to combat misinformation in real-time. “The most efficient and effective way to do that is by dispelling myths online,” said Dr. Zubritsky. “Instagram and TikTok both have features where you can directly respond to a video via duet, stitch, or remix, and add your commentary to a video. This is a crucial way to address misinformation directly from the source. It’s also a good way to educate! If there are good trends, people want to know and see that it’s verified by a board-certified dermatologist.”

“As a trusted dermatologist, you can make a real difference in dispelling these myths for your patients,” agreed Dr. Landriscina. “The burden of misinformation around skin health is huge. I always say, the more dermatologists there are creating sound information online, the better. I’ve found that my patients are a lot savvier than they used to be. This means that many of them have heard about the most recent trends. Being active on social media means that I’m able to engage with them more easily on these topics. Even if my fellow dermatologists don’t want to create content, I think it’s helpful to dip one’s toe into these platforms every now and again to see what their patients are seeing.”

Additional DermWorld Resources