As someone with rosacea, a chronic skin condition that causes redness and irritation, I often read skincare advice online. I enjoy hearing expert perspectives and reading anecdotal advice to get to know what works.
Recently, however, much information shared online is driven by a desire to go viral. Dr. Emma Craythorne, founder of prescription skincare brand Klira, recently spoke of a study about eczema which looked at 50 TikTok influencers talking about the condition and topical steroids.
The study found that there was at least one piece of misinformation in every claim and some even went as far as saying that steroid use was dangerous, which increased mistrust but had no medical basis at all. As a consequence, patients were not using the recommended treatments, and their skin was actually becoming worse.
© Getty ImagesSo, as you can see, fear-mongering content is rife. For people feeling worried about their skin, their social media searches uncover doom and gloom, when they would simply be given a solution if they were speaking to balanced experts.
My skincare journey online
When I was first diagnosed with rosacea eight years ago, I began sharing my own skin journey online. Being a journalist means that I have access to expert dermatologists, and often I share video interviews with them in the hope of democratising prestigious skin advice that many people can't afford.
Just last month, Dr. Haus from Dr. Haus Dermatology shared a lengthy video with my audience about rosacea, costing no one a penny (watch it below). He shared his findings from almost 30 years of treating rosacea, and yet a simple consultation at his clinic starts at £340. This is when social media can be great; when people who couldn't normally access experts, get their wisdom for free.
The waters become murky when unregulated information spreads just as easily, leading to miseducation and often fear. As a content creator, the main thing I notice when inviting questions about rosacea is that people are now terrified of basic ingredients.
The spread of misinformation – and oversimplification
If I share a video doing my makeup, a commenter will inevitably ask, "Why are you using this? It contains an ingredient which is proven to aggravate rosacea". But what they might not realise that in such a small dose, it's highly unlikely to do so. There's no black-and-white formula for what will or won't exacerbate a skin condition, but the internet says otherwise.
Lex Gillies is arguably the leading online voice in the rosacea space, having documented research and conversations with experts for decades now. She actively nurtures a community of people worried about their skin and agrees that patient anxiety is at a high. "It's understandable that people are nervous and that they might want to wrest back some control by feverishly analysing the ingredients of products. I've seen huge lists floating around social media (such as 'ingredients you should never use if you have rosacea') that I believe over-simplify the issue and create more fear."
What bothers me about this is that people with chronic skin conditions simply want answers and solutions. But in an age where a sensationalised video is more likely to go viral, it's not in an author's best interest to make a calm, gentle video explaining what works and why.
Something like "this one ingredient is making your skin break out" is far more likely to generate clicks, and therefore when people look for solutions they're met with terrifying warnings. Nuance is entirely missed, and miscommunication leads to feelings of hopelessness.
The harmful power of TikTok
Scrolling TikTok recently, I've been inundated with videos telling me that I shouldn't be using any skincare containing niacinamide if I have rosacea. Having interviewed so many consultant dermatologists over the years, I've become confused. Not only have they never suggested this to be a common irritant, they all agree that it can, in fact, be helpful.
Irritants are such a personal topic, and I don't wish to diminish any one person's experience. But I think where things get complicated is that you only need one far-reaching, charismatic person to have a bad experience with something, and a blanket rule to avoid it becomes gospel.
"Niacinamide is an excellent choice in rosacea. It is anti-inflammatory, barrier supportive and can help to reduce post-inflammatory pigmentation, very important in skin of colour. As with most products, concentration matters, so maybe start at 2-3% with sensitive, rosacea-prone skin" explains Dr. Justine Hextall, consultant dermatologist at the Tarrant Street Clinic in Arundel.
"Niacinamide is generally a well-tolerated ingredient and I would not usually consider it harmful for people with rosacea," agrees Dr. Derrick Phillips, another consultant dermatologist based in Harley Street.
So why is my TikTok for you page insisting that I shouldn't be touching it with a barge pole? I have a hunch. Because it's in everything. And the more relatable a video is, touching on ingredients that you're already using, then the more likely you are to watch it.
"The more relatable a video is, touching on ingredients that you're already using, then the more likely you are to watch it."
The complications around clean beauty
Context is key when making any kind of skincare decision, and this is where online advice falls short of being able to be accurate. Apps such as the Yuka app are widely used in a bid to differentiate between 'safe' and 'harmful' ingredients, but without a nuanced discussion it simply can't be taken as correct guidance. Skincare expert and Skin Rocks brand founder, Caroline Hirons, agrees.
"I hate the Yuka app. It is nonsense and not based on science. It will flag a product as dangerous or 'toxic' for including a very standard, proven safe ingredient, and cite studies that are outdated or misleading.
"It will class a chemical SPF as 'dangerous', a product that is literally proven to protect you from skin cancer. If you prefer mineral SPFs from a textural standpoint then fine, but claiming that rigorously-tested chemical-based UV filters are dangerous is nonsense. For context, the brand Ultraviolette is classed as 'bad', and Australian SPFs are some of the best and most strictly regulated on the market."
© Alan Chapman/Dave Benett/Getty IYuka has risen in popularity with those trying to adopt more of a 'clean beauty' approach. "Apps such as Yuka can be helpful in encouraging people to think more carefully about the ingredients in their skincare, but they also oversimplify what is a complex and nuanced area," suggests Dr. Derrick.
"Skincare ingredients cannot really be judged in isolation. The overall formulation, the concentration of each ingredient, how the product is used and the individual's skin type all matter.
"There is also a tendency for some apps to view certain ingredients, such as preservatives, quite negatively, while treating 'natural' ingredients more favourably. In reality, natural ingredients can also cause irritation, allergic contact dermatitis or disruption to the skin barrier, particularly in sensitive skin or when used at the wrong concentration.
"I don’t routinely recommend using apps such as Yuka as the main way to choose skincare. I have seen them increase anxiety around ingredients and lead people away from products that may actually be well suited to their skin. Skincare is not just about whether an ingredient is 'good' or 'bad'; it is about whether a product is appropriate for that person's skin."
"Skincare is not just about whether an ingredient is 'good' or 'bad'; it is about whether a product is appropriate for that person's skin."
The impact on those with chronic skin conditions
Of course, for those seeking support with chronic skin conditions like mine, the results can be even more distressing. "I am seeing uncontrolled eczema in those too afraid to use prescription creams and good skin care," Hextall continues. "I am also seeing significant skin reactions to so-called 'natural' products that often contain high concentrations of known allergens such as essential oils.
"I see acne being made worse with occlusive oils and homemade pastes, and significant sunburn in those making SPF at their kitchen table. It doesn't make sense."
Finding the answer
So, what is the solution in an online world full of content designed to catch our attention and hold onto it?
"With so much noise out there, sensible evidence-based advice from accredited professionals is being lost. There needs to be clear guidance and standards, especially when it comes to giving medical advice. At best, it stops the individual getting the help they need. At worst, it may lead to serious, even fatal consequences if the outcome is an increase in the development of skin cancer," worries Hextall.
"We have to learn to trust the cosmetic chemists making our products. People forget that the skincare industry is a highly regulated industry," advises digital content creator James Welsh, who specialises in skincare.
It's important to remember, especially when managing a skin condition, that the online world is built to be consumed. Fear-based advice will never help anyone, the most trusted advice will come from an expert, not from a TikTok video.
As someone who has managed to reduce her own rosacea symptoms from following simple, mostly boring advice, my personal experience has been to simply follow the science.
"Fear-based advice will never help anyone; the most trusted advice will come from an expert, not from a TikTok video"
Speak to a consultant dermatologist if you can. Your GP will refer you if your skin requires medical attention, and you'll be placed on a waiting list. In the meantime, seek out consultant dermatologists online such as Dr. Derrick and Dr. Hextall and listen to their guidance. Lots of creators these days are wearing scrubs, but it doesn't necessarily mean they have years of hands-on experience treating skin. Find someone who specialises in your condition and take heed of their guidance until you can have a one-to-one.
I know a video that says "it will all be ok in the end" is far less clickable, but that's the takeaway that every consultant dermatologist would love for you to know. So please have faith, and don't lose hope; you can reduce your symptoms and feel happier in your skin.
