Bitch Time 2: Dr. Skinfluencer, MD
On Influencer Derms, Your Face’s First Aid Kit, and Trusting Yourself
Happy New Year! Let’s question authority, talk irritated skin, and do something good for ourselves!
The Rant
It’s no secret that not everyone has easy access to basic medical care. Large populations of people in the US and elsewhere don’t have consistent or equitable access to primary care providers, let alone to specialists like dermatologists. So it’s unsurprising that influencer MDs have become a thing.
There’s a whole ecosystem of licensed, practicing physicians moonlighting as social media stars. If you’ve been in the skincare community for a minute, you’ve probably come across at least a few. The “Dr” or “MD” in their screen names confers a sense of authority online in much the same way a white lab coat distinguishes doctors from other medical staff in their physical offices.
The doctors at the top of the social media heap leverage their titles and expertise to amass hundreds of thousands or even millions of followers. They provide expert quotes to major publications. They launch their own brands. They enjoy a level of celebrity presumably dreamed of by the legions of med students setting up their own social media accounts.
As someone who grew up in a fairly conventional East Asian family, I was taught to view the MD as the highest and most prestigious title ever of all time. So I think the concept of the influencer derm is awesome. Doctors in any specialty spend years and years acquiring an incredible depth of knowledge. They have a lot they can teach us.
However.
(The loudness of my HOWEVER is proportional to the length of my intro.)
HOWEVER. Doctors are human too. No human knows everything about anything. No human is right all the time. And in skincare, where Your Mileage May Vary (YMMV) applies to just about everything and there are almost no absolute, universal rules, a figure of authority speaking in authoritative-sounding absolutes can spread confusion and misinformation faster than a highly skilled nurse can give a shot to a squirmy child.
Just off the top of my head, I can think of a few patently ridiculous things that licensed dermatologists with large social media followings have said.
One very famous one with a highly regarded skincare line proclaimed that moisturizer is bad for skin because it will make skin lazy and…less motivated to produce its own moisture, apparently. (Presumably, this doesn’t include the moisturizers in this MD’s skincare line.)
Another, from a different country, declared that moisturizer is bad for skin because it glues down dead skin cells and prevents them from shedding healthily. (Again, I assume this doesn’t include the moisturizers sold by this doctor’s brand.)
One very popular one has encouraged legions of subscribers to fear skin damage from the blue light emanated by their electronics screens, a fear that appears to be vastly overblown, if it holds any practical validity at all.
And some dermatologists perpetuate long-debunked skincare myths, like that mineral sunscreens reflect UV while organic (“chemical”) ones absorb and convert it to heat.
Doctors are fallible humans just like the rest of us. They have biases. They have their own personal struggles and insecurities and neuroses. And, just like us, they may at times unconsciously let their personal biases, struggles, insecurities, and neuroses skew the advice they give. But unlike the rest of us, doctors speak from a platform of assumed objectivity and authority. That can influence their audiences’ willingness to take what they say seriously, even if it’s something patently ridiculous or only very weakly supported.
Going beyond the possible unconscious biases, there’s another, more difficult-to-swallow pill: no human’s objectivity or integrity are above question. That includes doctors.
If your own social media activity is strictly personal and/or strictly for fun, it can be easy to project that onto others as well, even professional influencers. That’s the underlying assumption that leads to parasocial relationships, in which one person invests a disproportionate level of emotional energy and develops a personal attachment to a public figure whom they’ve come to view as a friend.
The most charismatic and skillful influencers can make their channels look like friendly, just-for-fun places to visit. But for people whose social media presence is tied to their work, social media serves as a marketing platform.
This doesn’t mean that they don’t genuinely enjoy creating their content or interacting with their followers (I sure do!) and it doesn’t mean they aren’t sincere in what they say (I am!). But it does mean that the rest of us should approach what they say with the same critical eye that we would apply to anyone else.
I think it’s harder to remember to do so when you’re looking at content from a doctor than it would be if you were looking at content from a layperson like me or many of my fellow creators.
When I review skincare products or give tips that I think might be helpful, I try to make it clear that I’m telling you about my experience with a product and my observations about my skin in general (and others’ skin if additional anecdotes seem like they’d be useful or amusing). I’m sure I slip up in my language sometimes, but overall, I really hope to communicate that I’m not saying that the things I observe are universal to everyone.
There’s a difference between “this is how this works for me” and “this is what you should do.” Pretty much all of the non-MD creators that I respect use this approach. We know, and we hope you know, that everyone’s skin is different and that we should neither predict nor attempt to prescribe for others’ skin. Since the vast majority of my audience are adults, I do also assume that you guys are aware of this.
On the other hand, I’ve seen many influencer derms dress their advice, their observations, and sometimes their product promotions in authoritative absolutes, as if they’re putting their own white lab coats onto their posts. Maybe unsurprisingly, these authoritative absolutes often present things that only doctors can do as the only things that really “work.”
I’ve seen influencer derms condemn all cosmetic (as in, nonprescription and available for purchase outside of dermatologists’ offices and medspas) skincare as a scam while pushing lasers and/or injectables as the answer to everything. Coincidentally, these derms’ offices tend to offer a variety of laser treatments and injectables. You could argue that they offer these services because those are the ones the derms truly believe in, but even so, believing in the superior effectiveness of these treatments doesn’t necessitate a blanket eyeroll at all nonprescription topical products.
(This is just anecdote, but in my experience and the experience of the countless number of you guys who’ve found your skincare HGs, yes, nonprescription topical products can achieve incredible improvements! The important thing is finding what’s best for you. For that, I think it’s helpful to follow a variety of skincare creators, from dermatologists and licensed aestheticians to actual chemists and industry experts—which is where I’m going to plug my friends Michelle Wong @labmuffinbeautyscience and Stephen Ko @kindofstephen—to laypeople like me).
It’s also important to note that although dermatologists genuinely are skin experts, that doesn’t mean they’re universal skin experts who know every single thing about every possible facet of skincare. Dermatologists are doctors. With the exception of cosmetic dermatologists, most dermatologists are primarily focused on actual diseases and disorders of the skin rather than on optimizing the appearance of generally healthy skin. In fact, it’s my understanding that dermatologists actually get very little training in topical, cosmetic skincare products and uses. They’re more (and rightfully so) focused on pathology.
That also means that the majority of their patients are coming in with an existing problem. Sometimes these problems might be caused or worsened by some product or products that the patient is using. This can cause dermatologists to develop biases against cosmetic skincare products in general because they’re used to seeing them as the source of a problem. People aren’t going to the dermatologist when they’re happy with their skin and the cosmetic products they use. It’s likely that there are many more people who use cosmetic skincare products successfully than otherwise, but derms aren’t seeing those people in their offices.
Cosmetic skincare formulation and innovation also move much faster than the rigorous scientific research that ends up published in medical journals. There are a few “gold standard” actives that both dermatologists and not-dermatologist skincare enthusiasts can agree on: things like vitamin C, retinoids, and sunscreen.
But then there’s an entire universe of far less extensively researched ingredients used in cosmetic skincare. Maybe they’re not studied enough to get a doctor’s seal of approval, but that doesn’t mean they’re actively useless, as I’ve seen some insist. It just means they’re…not as well studied, because we don’t live in a world where it’s possible to get the funding and resources to commit to well designed clinical trials of every single exciting cosmetic ingredient ever. Every single well studied ingredient and medication in use today was at one point unstudied or minimally studied, because that’s kind of how things work.
I’m not trying to tell you not to follow or listen to any influencer dermatologists at all. That would be stupid. I follow several myself and I value the insights they can provide. (My favorite, Dr. Erin Tababa-Santos of @thenerdyderma, approaches cosmetic skincare with an open mind and curiosity, and supports its use alongside prescription actives and other treatments, which is the attitude I think makes the most sense.)
I'm also not saying that I or any other non-MD content creator give better skincare advice than doctors. What I am saying is that not all doctors give better skincare advice than content creators.
Maintain your critical thinking when it comes to influencers in white coats. Yes, they bring valuable perspective and insight into the skin as a living organ, prone to disease and disorder. But they’re also human. Their knowledge is ultimately limited, their judgment isn’t infallible, and their word isn’t absolute truth. No one’s is.
(Just) the Tip
All this talk about dermatologists makes me think of those dermatologist skincare brands we all know from the skincare aisles at the drugstore and supermarket.
I’m not talking about the skincare brands actually marketed under some celebrity dermatologist’s name. Those are usually very expensive. I’m talking about the “recommended by dermatologists” brands like Cetaphil, Cerave, and Eucerin.
If you guys are like me, then skincare is more than just a daily hygiene chore to you. You enjoy using more than just basic products on it. You probably also enjoy trying out new things. Which is great. The drawback to skincare as an adventure, though, is that even if you have skin like steel, at some point something you experiment with may anger your skin. When that happens, generally the best thing to do is to cut out everything but your most tried-and-true basics until your skin calms down and heals up.
For this reason, keep a backup of at least a cleanser and a moisturizer that you have used extensively and know for a fact your skin doesn’t find objectionable. They don’t have to be Cetaphil face wash and Cerave in the tub, but they do have to be the blandest and most inoffensive products in your arsenal. That way, if you move on to other, more interesting products and run into a problem, you won’t have to suffer a minute longer than necessary or run out and get more of your basics. Think of this as your skin’s first aid kit.
(And if you haven’t yet found the products that are inoffensive for your skin, take some time out of your product testing schedule to grab a few basics from those dermatologist-recommended basic brands and try them out. As with all other skincare, YMMV means no one can guarantee that your skin in particular won’t react to them, but products from those brands tend to be very blandly but solidly formulated and less likely to cause reactions than, say, ginseng cream with the extracts of 5 obscure mushrooms in the INCI.)
A Challenge for You
Spend any amount of time in the skincare community, and you’ll hear something that triggers a reaction of self-doubt. Some fellow skincare enthusiast or influencer or influencer derm will authoritatively declare that something you swear by is actually super wrong and damaging. Or they’ll authoritatively declare that something you assiduously avoid is actually super beneficial and people who avoid that thing will be sorry. And then you’ll start to question your own decisions.
It’s good to stay open-minded. It’s good to be receptive to new information and to adjust your own routine and habits as you learn new things.
However.
It’s also good to remember that your skin is your skin. If you’ve been paying attention to what works for it and what doesn’t, then you do often know better about your own skin than any stranger on the Internet, no matter how many followers they have or how many titles they append to their name.
I’m a very vocal proponent of the low pH cleanser life. Switching to low pH cleansers has done amazing things for my skin. Attempting to reintroduce any high pH cleanser to my routine always results in regret.
Many others have had similar experiences, but not everyone. I have one friend specifically who swears by high pH cleansers and feels her skin does better with those than with gentle, low pH ones. Her skin is lovely and she’s happy with it, so guess what? My general guideline is not her rule. Because YMMV.
There are things that are true for a lot of people, and those things become “common knowledge,” but for every single “rule” you can think of, there will be exceptions and outliers. If you’re confident that what you’ve been using or doing is working well for you, then don’t let any Dr. Superskin, MD convince you you’re doing it wrong.
My challenge to you for this issue is simply to practice a balance between open-mindedness and trust in your knowledge of your own skin. The next time someone you consider credible gives a piece of advice that goes against something you believe works best for your skin, take their argument in without instantly rejecting it or instantly believing it. Spend some time considering whether what you’re doing is truly working out for your skin. If it is, believe in yourself and keep doing it! Only change what you’re doing if you come to the conclusion that this new piece of information may genuinely be true for you.
Thank you guys for reading this extra long issue! Feel free to comment or share if you want, and I hope you’ll be back for the next Bitch Time!
There are MD influencers claiming moisturizer is bad?? 😂 This is the problem with the skincare industry as a whole. Every product is amazing or terrible depending on who you’re listening to. When, YMMV the answer every time.