Thread by @HarkerDavid

I've been having trouble getting my residency research project published. Since I don't feel like arguing with reviewer #2 anymore, I figured I'd just tweet it! More people will probably see my work this way anyway ...

#dermtwitter #dermatology

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1st, thanks to @HeidiJacobe for all of her help with this project.

And for an abstract in twitter form:

tl;dr ➡️ there's a lot of bogus derm content on twitter, but the most popular misinformation often isn't addressed by the @AADskin's tweets or online patient info articles.

When I first got into #medtwitter as an MS4, there weren't a lot of derms on here (which has thankfully changed!)

I did, however, notice a lot of tweets like this one:

Which got me wondering, what kind of dermatologic misinformation is popular on twitter, and are public education efforts by official derm orgs addressing this popular spurious content?

Turns out there had already been some research looking into this question. One particular study in @JAMADerm about twitter and acne caught my attention with this line:

jamanetwork.com/journals/jamad…

I wanted to expand on the above study's work by identifying popular twitter dermatology themes about a few skin diseases, uncover which accounts were producing this content, and compare the content with what the @AADskin tweets and publishes online for the lay public.

Using @discovertext, for the first week of each month in 2017 I gathered all the tweets about acne, eczema, psoriasis, vitiligo, and skin cancer that contained both the disease name and the words 'cure' or 'treat'

I then sorted the tweets in each disease category by retweet count as a surrogate measure for tweet popularity, and skimmed off the top ten most popular tweets about each disease for my final analysis.

My total data set had about 19k tweets with the following breakdown:

Even with this 30,000 foot view of my data, it was already apparent that there was discordance between what the public tweeted about, and what the AAD tweeted about. Below is a breakdown of AAD tweets over 2017:

Things got really interesting when I looked at what these popular tweets were about, and who was tweeting them.

This was the most popular tweet in my entire data set, clocking in at over 35k retweets, which is more retweets than the @AADskin has followers!

The plant shown above is aloe vera, and I couldn't find any AAD tweets or online patient education resources addressing this apparently rather popular concept of aloe vera as a treatment for acne, among other things.

The other aim of my study was to figure out who was producing popular derm misinformation, particularly the accounts with no medical credentials which I termed "non-expert." The big hitter in the acne tweet set was @AcneSkinSite, an account with almost 900k followers.

The website says this person is a "professional makeup artist and skincare guru" who also runs a website selling essential oils. Here's a ridiculous figure comparing the follower count of a "skincare guru" with no medical credentials with the @AADskin account:

And on and it it went, with tweets like these dominating the acne category:

In fact, not a single one of the top ten most retweeted acne tweets were by a physician or official derm organization.

It was, however, interesting to observe that the influence of non-expert accounts varied by the disease in question.

Misinformation from popular sources promoting unfounded treatments which were minimally if at all addressed by AAD content was rampant for acne and eczema, but much less so for psoriasis and skin cancer.

Skin cancer was the complete opposite of acne. None of the top ten most retweeted skin cancer tweets had any misinformation, and most were made by medical accounts, like the one below:

But none of the skin cancer tweets were nearly as popular as the acne tweets. The highest retweet number any skin cancer tweet achieved was only 35 - one one-thousandth that of the most popular acne tweet.

Overall, my data suggested an opportunity for orgs like the @AADskin. Use tools like @discovertext to "biopsy" the derm twittersphere, figure out what content is getting high traffic, and pivot tweets and online education materials to address popular misinformation.

I also think it's crucial for dermatologists to be active on this platform to help in these efforts. Fortunately, #dermtwitter has grown rapidly over the past year or so!

Thanks for reading along. This was a lot more fun than sending back a 4th or 5th paper revision. Long live #dermtwitter!