By Laura Freeman

When too many voices are speaking at the same time, it’s hard to make sense of what is being said. It’s even more difficult to know who to listen to when those voices are online and you don’t know who is speaking from actual expertise, and who is simply repeating something they heard somewhere else.

This cacophony of advice from social media influencers, podcasts, and marketing videos has led to an influx of dermatology cases demonstrating what can go wrong when too many sources of advice get applied to unsuspecting skin.

“A couple of conditions we see more frequently are allergy contact dermatitis from products that have allergic potential in some patients and irritant contact dermatitis from layering too many active ingredients, “Stephanie Ives, MD of Total Dermatology said. “For example, people who want to look younger may see one influencer recommending a product with salicylic acid. They see a podcaster talking about alpha hydroxy or beta hydroxy acid. Then they see another video showing before and after results from retinol. If they try them all, it can be too much.”

Another issue is advice that may work fine for one skin type, while being wrong for another. People with dry skin may not tolerate a strong astringent, and those with oily skin may develop problems from heavy moisturizers or anything that blocks pores.

“We’re seeing perioral dermatitis which can occur due to a variety of mechanisms, including overly occlusive products and topical steroids,” Ives said.

In recent years, a problem with potentially serious effects results from the online war about what sunscreen ingredients are safe. Some ingredients used in U.S. products are not allowed in Europe and some Asian countries. While increasing vitamin D is a growing trend, frustration in trying to find safe sun protection leaves some people avoiding sunscreens altogether and increasing their risk of skin cancer and sun damage.

“Hats, lightweight coverups and timing of sun exposure can make a difference, and dermatologists can recommend sun-blocks and sunscreens with simple ingredients that work,” Ives said. “For anyone who is out in the sun, doing nothing is not an option.

“ And social media talk about ingredients can be misleading. Natural is a term that is over-used and doesn’t necessarily mean safe.”

Some ingredients that might be safe to eat or drink can be sensitizing on the skin. For example, products using citrus oils for fragrance may cause a rash or a rapid sunburn. Peppermint can be a delightful smell, but if the concentration is too strong or if it gets into the eyes, it can burn.

There are even medications that can change the interaction between the skin and its environment. What may have been fine last week may cause problems today for someone who has just started a course of antibiotics, NSAID or several other medications.

When skin care products or online advice are suspected as contributing to skin problems, what can a doctor do?

“Asking patients to bring in all the products they are using can be helpful, as well as asking them for a timeline of when products were initiated with relation to a rash or other symptom” Ives said. “It’s important to discontinue agents thought to have caused the rash along with those that could prevent or slow healing.

“My general recommendation is for patients to pare down their skin care regimen as much as possible until resolution. A gentle cleanser, moisturizer and sunscreen are typically sufficient. A combination of anti-inflammatory agents and/or oral antibiotics can then be tailored to the specific rash or problem at hand. Once the issue is resolved, patients can work with their provider to tailor a skin care plan specific to their individual needs.”

How can physicians help patients avoid the problems that can come from relying too much on social media for skin care advice?

“It’s difficult to know who to trust on social media,” Ives said. “It helps to look for credentials, which you can verify through organizations like the American Academy of Dermatology or medical boards. It’s also important to know if these individuals have conflicts of interest for the products and services they are endorsing.

“The American Academy of Dermatology Association has a website with great resources for patients. You can find information on an array of skin diseases there, as well as helpful tips on skin care basics, sun protection and other topics. It’s http://aad.org/public.”