Inaccurate Medical Information Common on TikTok Regarding Brittle Nail Syndrome

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This new data highlights the lack of reliability with regard to medical information disseminated on social media platforms, and the frequency at which such information is observed.

Accurate medical information on conditions such as Brittle Nail Syndrome (BNS) is lacking on the social media platform TikTok, according to recent findings, with less than 10% of creator groups being board-certified dermatologists (BCDs).1

Study Summary

  • The study analyzed the top 125 TikTok videos regarding Brittle Nail Syndrome (BNS), which amassed a total of 28,899,480 views and 1,925,915 likes.
  • The creators of the videos were categorized into groups, with patients (30.4%) and health/wellness "gurus" (16%) being the dominant categories, while board-certified dermatologists (BCDs) accounted for only 8.8%.
  • The most common content category was treatment (49%), and approximately 85% of the videos adhered to BNS treatment guidelines by mentioning relevant recommendations.
  • Despite a lack of strong evidence, 24.6% of the TikTok video content indicated biotin as a treatment option for BNS, even though the FDA had cautioned against its interference with laboratory tests.
  • The research underscored the imperative for increased participation of BCDs on TikTok to counteract misinformation, with only a minority (25.8%) of dermatology-related videos being posted on TikTok by BCDs in a related study.

This new research into influencer-recommendations for dermatologic conditions on TikTok was conducted by investigators, given the immense growth in the number of social media users sharing online health information and given TikTok’s expanding to become the world's fastest growing social media platform.2

This analysis was carried out with the purpose of assessing the use of TikTok by dermatology professionals and patients, with the team using BNS as a narrow focus for examination. It was authored by Shari R. Lipner, from the Weill Cornell Medicine’s Department of Dermatology, in New York, NY.

“Brittle nail syndrome (BNS), defined as nail plate fragility resulting in soft nails that split, flake, or crumble, is a common nail condition affecting up to 20% of the population,” Lipner and colleagues wrote. “In this study, we sought to characterize TikTok video creators and content on BNS.”

Background and Findings

BNS is a prevalent concern known to impact around 20% of the population, and it is notably common among women over 50 years old and particularly with greater prevalence in fingernails as opposed to toenails.3

The study’s investigators note that the condition is characterized by nails that exhibit splitting, softening, flaking, and reduced elasticity, issues which can manifest in onychorrhexis, onychoschizia, superficial keratin granulation, and worn-down nails.

In their new research, the investigators sought to provide an in-depth examination of TikTok content creators in addition to information on their posts linked to BNS. On January 25, 2023, the team executed a search on TikTok to find the top 125 most-viewed videos associated with the "brittle nails" search term.

For the purposes of ensuring consistency, videos which had been made in languages other than English were not considered by the investigators. The team’s research also involved categorizing these types of videos based upon both the video’s creators and the nature of their content.

The investigators categorized the identified videos into distinct categories according to the type of content which they presented. These different categories revolved around treatment-related posts featuring recommendations on specific medications, nail products, supplements, vitamins, treatment regimens, and alternative remedies for BNS.

The research team also included educational videos with content that sought to explain the underlying causes and pathological aspects of BNS, as well as personal posts in which creators had shared their personal experiences and anecdotes on brittle nails.

In order for the team to gauge the accuracy of the treatment-related content on TikTok, they evaluated the videos against the consensus guidelines which had been established in 2020 for optimal management of BNS and set forth by a set of nail experts.

Following the research team’s assessment of the top 125 BNS videos featured on TikTok, they found that these videos collectively had a substantial 28,899,480 views and 1,925,915 likes. The team reported that the content was shown to be diverse, with the highest proportion of creators being in the following 3 categories: health or wellness ‘gurus’ at 16%, patients at 30.4%, and nail artists at 15.2%.

Notably, the investigators found that only 8.8% of videos were found to have been posted by board-certified dermatologists, with most practicing in the US and a single one in the Philippines. Among the included videos, the team noted that the most common topic was shown to be treatment at 49%, with 85% having mentioned at least a single recommendation which was in line with BNS treatment guidelines.

The investigators reported that nail strengtheners, moisturizers, and biotin supplements were shown to be among the treatments covered, though only a single video pointed out the FDA’s warning on biotin’s interference in laboratory tests.

Even though there has been little conclusive evidence identified regarding efficacy of biotin in BNS treatment, the investigators found that a significant number (24.6%) of the identified videos recommended biotin as a potential treatment option.

The research team further stated that TikTok's content remains unregulated and their study consequently underscores the importance of greater vigilance among BCDs to prevent the dissemination of inaccurate and unreliable information related to BNS and its treatments on TikTok.

“TikTok creators have a large impact and influence on their followers,” they wrote. “Therefore, it is imperative that medical information being posted is accurate and evidence based. Encouraging BCDs and other dermatology organizations to increase their presence on social media platforms such as TikTok would likely improve dissemination of reliable medical information to larger audiences.”

References

  1. Conway, J. and Lipner, S.R. (2023), Limited treatment information on brittle nail syndrome on TikTok™ and only a minority of videos are posted by board-certified dermatologists: A cross-sectional study. J Cosmet Dermatol. https://doi.org/10.1111/jocd.15961.
  2. Cooper BR, Concilla A, Albrecht JM, et al. Social media as a medium for dermatologic education. Curr Dermatol Rep. 2022; 11(2): 103-109. doi:10.1007/s13671-022-00359-4.
  3. Chessa MA, Iorizzo M, Richert B, et al. Pathogenesis, Clinical Signs and Treatment Recommendations in Brittle Nails: A Review [published correction appears in Dermatol Ther (Heidelb). 2020 Jan 22;]. Dermatol Ther (Heidelb). 2020; 10(1): 15-27. doi:10.1007/s13555-019-00338-x.
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