Researchers find misinformation about acne drug in popular TikTok videos

Researchers from George Washington University (GW), US, have found TikTok videos about the hormonal acne drug spironolactone could be a useful tool for information but can also spread misinformation about side effects.

Published in the Journal of Drugs and Dermatology, the researchers assessed the quality and reliability of the drug information among the top 50 TikTok videos under the hashtag #spironolactone. The results indicate that these top videos disseminate misinformation about side effects and leave out key information that could impact patient decisions about the drug before consulting with their dermatologist. 

The study authors assume this could be a sacrifice made in exchange for viral content.

Spironolactone was developed as a treatment for blood pressure as it blocks the hormone aldosterone which controls the balance of water and salts in the body. This hormone-blocking action also helps block androgens and testosterone, which are causes of acne vulgaris. 

As a result, dermatologists have found spironolactone to be highly effective in helping women control hormonal acne and have been prescribing it for this purpose for approximately 30 years. The rate of prescriptions has increased recently, with a three-to-four-fold increase in spironolactone prescriptions from dermatologists between 2017 to 2020, according to a different study published in JAMA Dermatology. 

In early 2024, the American Academy of Dermatology released updated guidelines for managing acne vulgaris, which included spironolactone for managing hormonal causes.

Given the increase in spironolactone use, plus the wide viewership of content about the drug on social media, the GW researchers sought to assess TikTok content as a communication tool.

Misinformation and virality

The study measured the overall reliability and quality of the health information in the videos and found that TikTok videos about spironolactone scored low for both. 

This means the videos, particularly patient testimonials, were at risk of spreading misinformation about the treatment, say the researchers.

“For example, one video claimed spearmint tea is equally as effective as spironolactone in the treatment of acne,” say the study authors. “Others discussed their self-discontinuation and re-initiation of spironolactone without consulting their dermatologists.”

Some patient testimonials may be outsizing the side effects of the drug, such as attributing feelings of depression and anxiety to the drug treatment. These are not recorded effects of spironolactone, says the study. 

Spironolactone can cause side effects but it tends to be mild and not everyone experiences them, according to the UK National Health Service. Common side effects of the drug include dizziness, headaches and breast tenderness.

Educational videos from dermatologists, which scored higher for quality and reliability, had the highest number of views among the top videos. While this means viewers are seeking out experts on the TikTok platform, the study’s researchers still found the short-form format of these educational videos lacked key information that would be useful for spironolactone users. 

“The nature of short-form TikTok videos made with the intention of virality may not allow discussions of doubt and further reading materials,” they say. “The majority of videos did not mention areas of uncertainty and did not cite additional sources of information for patient reference.”

Instead, the researchers recommend adding references through captions or overlay text.

“For dermatologists creating social media videos, it would be beneficial to include additional materials for viewers to reference when able. For example, references can be added to caption links, or studies can be mentioned in on-screen text bubbles.”

Social media filling a gap

The study results of this assessment highlight communication opportunities and also risks. The number of videos by spironolactone patients indicates that they are seeking to fill a communication gap about the drug, a space that can be filled by expert sources, say the authors.

“Given the high percentage of patient-made videos, our findings point to a critical need for comprehensive counseling by health care providers about spironolactone.”

If dermatologists aren’t able to close this gap, patients seeking additional information online may make uninformed health decisions that have harmful impacts, they add.

“If patients watch poor quality or unreliable videos after their medical visit, they may decide not to start spironolactone, possibly leading to further dyspigmentation and scarring from acne. Providing clear, evidence-based information during consultations can empower patients to navigate social media content more critically and make informed decisions about their treatment.”