Welcome to the Don't Be Rash Pediatric Dermatology
Podcast, the owner's manual for your kid's skin.
I'm your host, Dr. K, board -certified pediatric
dermatologist and father of two boys. I'm here
to chat with you to promote dermatological education
and improve skin health in our children everywhere.
Let's get started. Welcome to Don't Be Rash,
the pediatric dermatology show, coming to you
from historic Bethlehem, Pennsylvania. I'm your
host and board -certified pediatric dermatologist,
Dr. Andrew Krakowski. On today's show, we'll
discuss kids and social media skin trends. As
a father of two young boys myself, this topic
is near and dear to my own heart. Like it or
not, social media has pervaded most of our lives.
Platforms like TikTok and Instagram have given
birth to skincare obsessions among kids such
that we have nine-year-olds using anti-aging
serums and wrinkle prevention products. And if
you think your kids are immune to these trends,
well, then you never heard of "slugging" or the
"glass skin challenge" or the extremely dangerous
"fire challenge." But don't worry. Today's show
will help make you better aware of these trends
and hopefully give you some tools for how to
deal with them. Joining us today as our guest
co-host is renowned pediatric dermatologist,
Dr. Sheilagh Maguiness. Dr. Maguiness is double board
certified in dermatology and pediatric dermatology.
In addition to having a thriving practice in
Minneapolis, Minnesota, Dr. Maguiness currently
serves as the Immediate Past President of the
Society for Pediatric Dermatology. Like me, she's
a parent to two tween boys and she's a recognized
expert on, among other things, the topic of kids
and social media skin trends. Welcome, Dr. Maguiness.
Thanks for joining me today. Thanks for having
me. So what do you say to the parent who believes
that their children are not being influenced
by social media platforms like TikTok and Instagram?
Oh, goodness. I would say I wish that were true.
But unfortunately, we have strong data to the
opposite of that. You know, over the last, I
would say, two to three years, we've really seen
a complete rise in interest, consumer interest,
sales, et cetera, of teens and tweens getting
extremely into skincare and often to their detriment.
What's driving the interest? Well, I think it's
the proliferation of social media, you know,
with TikTok and Instagram and all of the users.
You know, we have Gen Alpha, which is 2 billion
people. It's actually the largest generation
now. So Gen Alpha, anyone born, you know, after
2010, these are the kiddos that are digitally
fluent, Andrew. I mean, these kids are spending,
we know, based on research studies. three or
over three hours a day online. And much of that
is on social media platforms. So, you know, as
parents, we may not want to believe that our
kids are taking part in this, but they absolutely
are. So one of the benefits of doing a podcast
like this is to raise awareness so that parents
and their tweens and teens can really have a
good discussion about the good, the bad, and
the ugly about social media. And in this case,
how it relates to how kids are approaching skincare.
What age group are we talking about mostly you
seeing this affecting? I think tweens and teens
for sure. And we know that based on survey data,
different studies that have come out, but also
market data. For example, Andrew, did you know
that households with teens or tweens are outspending
other households that don't have tweens or teens
by two to one, specifically on skincare? So the
rise in sales at popular beauty outlets is in
part largely being derived from sales that are
from tweens and teens who are really into this.
And you just have to go on social media before
you'll be served many different videos with very
young so-called "skinfluencers" as young as eight
years old showing. "Get Ready With Me" videos,
complex, really multi -step, inappropriate skincare
being used by this population driven by this
phenomenon. And is there a gender breakdown?
Is it heavier weighted to females versus males?
Or I mean, what are you seeing? So in my practice,
and maybe you'll feel the same, and I do think
this is largely female driven, especially when
I myself have been kind of like a little spy
on social media, going into those get ready with
me videos. It is mostly tween and teen girls
that I think are driving this market. And that's
a really interesting point, because on the one
hand, we have this dichotomy where the tween
girls are kind of over consuming. And we can
talk about this a little later, being targeted
directly by the marketing tactics of these companies.
And then we have tween boys like you and I, we
both are parents to tween boys who have largely
been left out of this conversation. So it really
is a strong dichotomy. And yes, I would say that
from my experience in clinic with my tween and
teen girls coming in for various skincare complaints,
a lot of them are carrying a huge bag of different
products that they're using, sometimes all together
at the same time, which is obviously not how
products are intended to be used or tested for.
Of course. So for the person, the uninitiated
out there, walk us through what does a "Get Ready
with Me" video look like? I mean, what would you
see if you were a mom or dad logging on and watching
the same thing that your son or daughter presumably
would be watching? Well, I have seen "Get Ready
With Me" videos all the way from six-year-old
girls to, you know, 18. And there are very popular
beauty influencers online who have millions of
followers whose videos got tens of millions of
views. And a "Get Ready With Me" video is simply
this influencer, whether it's a tween teen or
other, showing you their skincare regimen. And
that might be, you know, washing their face,
putting on a variety of toners and serums and
moisturizers. et cetera, and then doing their
makeup, et cetera, commenting on products. But
there is a really hidden kind of rule for these
"Get Ready with Me" videos. And that is that a
lot of times these influencers are being paid
by companies to show the products. They have
been gifted the products by companies. You know,
there's definitely influencers as young as six
who are being given product by companies to show
in videos. And of course, if you're a six- to
eight-year-old on a medium like TikTok or Instagram,
of course, the parents are actively involved
in doing that and kind of involved in this influencing
journey that their child is on and helping edit
the videos, participating. the video so there's
lots of layers to this and they're all not necessarily
good. I think you hit on the "layers" right There
literally and figuratively are layers involved
in this uh 20 30 products being used at one time
we in your experience when you've seen these
videos do most or any or all of them seem to
have some level of thought behind the order of
use and what each product is supposed to be doing
is being applied in some logical fashion or are
the people who are using these products literally
just putting it on their skin without really
understanding what they're doing I think it depends
on the age and the credentials. Of course, we
have some healthcare professionals that do "Get
Ready With Me" videos, and I think there's a lot
more thought behind and evidence-based thinking
behind what they're doing. But, you know, for
example, one of the big trends right now is called
a "skincare smoothie." And if you've never heard
of that, it just means that you actually squeeze
out a little bit of all the products, put them
in your hand or on the top of the container,
and then spread them all over. your face in a
way in which they weren't designed or formulated
to be applied to the skin. And this is really
popular and trending right now, this "smoothie."
So I would say that from the tween and teen standpoint,
I don't believe there is a lot of understanding
about some of the active ingredients that can
be extremely harsh and inappropriate for young
skin. And also, you know, about the order of
application. And then I don't know, Andrew, if
you heard about the recent really interesting
study that was published, in June, in Pediatrics,
like a very reputable journal. They looked at
TikTok skincare regimens that had over a million
views put out by tweens and teens. And the amount
of products, the expense of the products, and
the repeated exposure to potential irritants
and allergens just shows you that, you know,
we're really doing more harm than good by applying
all of these things and causing irritation and
even long, lifelong contact allergies. I mean,
we know just in the world of acne itself. that
they're not meant to be put on together. They
can inactivate one another or they can exacerbate
or amplify the side effects of one another when
used in sort of a concurrent fashion. And here
you're just describing lumping a bunch of stuff
together and rubbing it on your face. That's
not going to be necessarily a good thing. No,
it's going to lead to a lot of irritation and
rashes. You know, the active ingredients that
are available over the counter are no joke. You
can buy a 10% salicylic acid serum. You can
buy a 10% glycolic acid serums. All of the AHAs,
the BHAs that you're putting on that literally
are kind of like almost prescription strength
exfoliants. And if you leave that on, you will
cause an irritant or almost like a chemical burn
for parents listening. So we really have to be
careful and pay attention to the ingredients.
Because although the bottle may be pink and...
pretty and very fruity scented. And of course,
that just is a nod to the aggressive and maybe
predatory marketing that's going on with respect
to our young people. But it's important to pay
attention to what the ingredients are because
some of the actives can really do a lot of harm
to a teen's developing skin barrier. So what
do you think the draw is? If you're a tween and
you're coming home from school, long day, you're
sitting at home and you have a couple minutes
to yourself. What's the draw to even watch something
like this? I mean, is it peer pressure? Are your
friends doing it or are they trying to glean
information, education? What do you think the
draw is to do this in the first place? Oh, gosh,
Andrew, I think there are many reasons. So first
of all, this is the "selfie" generation, right?
We are looking at ourselves on social media.
We are posting selfies. There's a lot of influencing
culture that really. basically emphasizes and
prioritizes appearance and beauty think of the
filters a lot of these young people are seeing
themselves and others curated very carefully
by a filter and so what they actually look like
is really not what's being showed on the screen
and i think that is fueling also this interest
in beauty and maintaining a youthful appearance
etc and i think it's really becoming you know,
at the point of an epidemic proportion here.
And obviously, we know that that can impact not
only skin health, but mental health for our young
tweens and teens. Do the parents know what's
going on? For the most part, do we have any statistics
one way or the other that parents are aware that
this is what their children are (A) watching and
(B) doing? Or is it, hey, whatever happens behind
closed doors is what's happening? I don't know.
Well, I think if your tweener teen asks you for
a gift card to a popular beauty outlet and you
go with them and you see what's on the shelf,
you probably have a good idea. So I would say
moms of tween and teen girls probably do have
a good idea. This is what people are gifting
each other for birthday present at parties. I
mean, there's a whole culture of sleepover parties
that are skincare or self-care related where
kids are putting on these, you know, irritating
masks that smell like watermelon and getting
a rash afterwards. I mean, it's a whole movement.
So I think that some parents are aware, but they
might not realize what they need to say no to
and what they can enthusiastically say "yes" to.
You know, in the study that I mentioned that
was published by Northwestern, they looked at
all of these skincare regimens and, you know,
only a quarter. included a sunscreen, which you
and I both know is arguably the most important
step when you're this young. Obviously, when
you're 12 to 14 or younger, you have the most
collagen you are ever going to have. So protecting
that by using a broad spectrum SPF every day
is, you know, the most important part of any
tween and teen skincare, yet it's often not even
discussed. I love kind of where we're going with
this. For the person out there who's not aware
of what some of these kids are talking about,
can you walk us through some of the specific
media trends and "challenges" that you're seeing?
Sure. Well, let's take it with the sun care,
basically. You know, just last year, there was
a social media trend going on about how to contour
your face and look very bronzed in certain areas
while not in others by only selectively applying
sunscreen to certain parts of your face and then
tanning the rest. Obviously, a tan means that
your skin has been damaged. It's not good at
any age, especially not when you're young. Most
significant sun exposure when you're young is
what is directly caused. related to risk for
skin cancer over time, let alone photo-aging
and looking visibly damaged from the sun. So
we certainly don't want to be selectively applying
sunscreen. You and I both know there was like
a "sunburn challenge" or writing your name with
sunscreen to like make various, you know, designs
on someone's back with selective application
of sunscreen. But all of those things are really
dangerous. You know, they're trending. They go.
viral. Kids look at it, they think, oh, that's
cool. And of course, risk-taking behaviors is
really rampant at this age group. So it's one
of those things where as, you know, as parents,
we can kind of be aware of it and be educating
kids about how to apply the sunscreen appropriately,
how, you know, high the SPF should be, educating
about the UV index and what exposure is the most
risky, and then of course reapplying. So all
of those things are great to talk about. with
your teen about and open a healthy conversation
by maybe talking about this trend. Your teen,
you might catch your teen by surprise. They might
be excited to chat with you about it. What is
this "glass skin challenge" I've heard about? So
glass skin is, you know, I think there's a filter
for this too, where you can look extremely dewy,
like your skin is shining and glowing, like you're
looking in a mirror or glass. And there are various
serums and actives that people tout as being
able to give you this glass skin look. And, you
know, again, the focus on beauty and appearance
here, I think, is negative. But the ingredients
for this trend are probably less harmful than
others. we might talk about because I think people
are using things like snail mucin or hyaluronic
acid. Those are things that are humectants that
plump the skin that I don't think are necessarily
bad for tween skin, but certainly not necessary.
We did actually publish an article a couple months
ago on a girl that came in and she was having
an allergic reaction around her lips. Apparently,
I mean, we'd have...we had heard of snail mucin,
but had not really read up on it. And one of,
apparently one of the specific things you're
not supposed to do is put it on mucosal surfaces.
And she had been using it on her lips and she
wound up getting. basically had an allergic contact
dermatitis looking rash around her face in that
area. And we did attribute it eventually to the
snail mucin. She stopped using it and it went
away and got better. So in that sense, I guess
it wasn't totally benign, but it sounds grosser
than it really is. So this is one I've not seen
or heard of myself yet in my kids' social network.
And I guess I'm oblivious when I'm walking through
the aisle at Target. I'm not seeing "charcoal"
out on the aisles. So I've missed this one. There's
some popular brands that contain charcoal-containing
cleansers, etc. And making all kinds of claims,
that's another whole topic we could have today,
Andrew, that you and I both know that the health,
wellness, and beauty industry is not regulated
by the FDA to the same scrutiny that the pharmaceutical
industry is. So a lot of times when parents are
trying to find guidance by looking at a bottle
and seeing all these great claims that are printed
right on the label, they have to know that there's
really a... A strong lack of regulation here
and companies really don't have to answer to
anyone. They can put anything on the label. So
you really do have to be very careful when you're
selecting products for, you know, children. And
that's true for baby care all the way up to tweens
and teens. The one I get really sort of nervous
about are the retinols. Can you talk a little
bit about that? What's your experience seeing
people use those? Oh, I mean, that's part of
this whole so-called "Sephora kids" trend is that
young kids are using retinol products at a very
young age and doing so with the idea of maintaining
a youthful appearance, you know, obviously at...
ages 6 to 12, that's completely unnecessary.
And of course, retinol, even over-the-counter
retinols or prescription strength like we use
for acne or other indications, they are very
strong exfoliants and they can cause a lot of
skin barrier breakdown and damage. And also,
you know, that leads to an impaired skin barrier
that can then be more primed when you apply other
things on the skin to then develop more irritation,
allergy. or even sometimes skin infections. And
I have seen that in children who are using harsh
exfoliating acids or retinols, yes. And then
they've participated in dermablading. Do you
know what this trend is? I have, but please share
it with the audience just so everybody's on the
same page. Yeah, so dermablading is the act of
kind of removing the small vellus hairs on the
face. And you can blow this, you know, kind of
chalky substance onto the face and see all the
tiny hairs. And then with a very sharp razor,
just... like you would shave with, you actually
shave the face. And people do feel like that
allows them to achieve what you just talked about,
this glass skin dewy finish. But at the same
time, with a straight razor, you're irritating
the hair follicles. You're making some small
micro tears or abrasions in the skin. Of course,
you can cut yourself too. And then boom, you've
got an irritated face with little portals of
entry for bacteria. And you can then develop
impetigo. Yeah, I've definitely taken care of
a couple of kids who have burned themselves with
over-the-counter strength retinols, not even
the prescription strength retin-A type medicines
that we're talking about for acne. And when they
ask about dermablading, I say it's like using
a cheese grater on your face. You just can't
see the damage that you're doing and try to get
them to avoid doing it. But it sounds like
all bets are off when you're on social media
and talking about it behind a microphone or a
camera. Oh, yeah. And they show themselves doing
it. And with magnification, it's really interesting,
but also very damaging. What do you see as the
role of the pediatric dermatologist in all of
this? Other than the direct - obviously - "we're
there to answer your questions when you see us."
But have you taken more of an advocacy position
here at all? Or do you see us maybe doing that?
So I think there are two ways to do this, one
of which is what's happening right now with us
discussing this and giving parents, you know,
a real good education from two, you know, board
certified experts who see it all the time. So
this is a great way to help educate. You can
do it on an individual basis in clinic. As I
mentioned, I have these young girls come in with
all of these products. And guess what we're doing?
Every single time we are paring it down. And
so telling parents what they can say yes to.
So you can say yes to a gentle cleanser. You
can say yes to a moisturizer. And you definitely
want to enthusiastically say yes to sunscreen,
SPF. So those are the real backbones of any skincare
regimen for myself, for you, and for our tweens
and teens. But guess what the surveys tell us
that they're actually buying in all of these
beauty outlets? It's actually treatment and toners.
That's the highest number of products. Yes, sunscreen
doesn't even make the list, Andrew. So this is
our opportunity. I knew sunscreen wasn't on there.
I mean, you know, that's probably not surprising.
But toners and a nine-year-old, geez, like,
wow, okay. Toners, yes. Exactly. Toners and treatments
and serums. Those are the top categories for
retail sales over the counter. And it's driving
billions of dollars of growth in the industry.
And guess who's taking notice of it? The brands,
right? So then all of a sudden, these techniques
of aggressive and I would even venture to say
predatory marketing to tweens and teens where
they know they can get you. And part of that
is blurring the line between education. and marketing
or entertainment and marketing. But that's really
getting very fuzzy out there. And our tweens
and teens don't know how to spot the difference,
right? So that's where we need to have a great
conversation about them. And as parents, you
could ask them, hey, what are you seeing? Have
you seen a "Get Ready With Me" video? Let's critically
appraise this video together. Why do you think
she's using all of these pink, fruity-scented
products that cost $120? Where do you think she
got them from? Teach them to look down at the
video and see if it's an ad or a paid partnership
or if they're tagging the companies in their
videos. And use it as an opportunity to tell
the kiddos, hey, just have a degree, an index
of suspicion when you're watching these. Are
they actually trying to tell you something that's
good for you? Or are they being paid to show
you this content? Most of the conversations,
if not all, that I've had around this topic in
the clinic usually were prompted by dads asking
me, does my daughter really need to use all this
stuff? I haven't really noticed moms asking me
that, maybe because they've already weeded out
what they feel is good or useful and aren't bothering
me with the questions. But dads will do it. I've
found them to be very receptive for the scaling
down for one good reason. It's going to save
them about 200 bucks a month, right? They are
very happy to hear that they don't need their
daughters using 100 products...that maybe two or
three would suffice. And ultimately, I think
I've had some of the kids kind of smile and say,
"Oh, that's good to know as well. I can use my
money better elsewhere!" How do you bring up the
topic of enrolling the parents in this process
of getting them educated about this and maybe
peeling back a little bit? Well, I think it's
a really nice opportunity to talk about what
is healthy hygiene habits. And isn't it great
that your child is interested and wants to start
early, right? And we know that the girls are
looking to mom because mom is modeling this for
them. Mom is using her cleanser, her moisturizer,
her whatever serum. So the little girls are getting
that modeled for them by mom and often will even
borrow from mom to use their products or, you
know, kind of use that as a jumping off point.
But then, you know, in clinic or, you know, with
educating moms to say, you know what, your skin
doesn't need this yet. Here's what we can do.
We can go together and you can actively participate.
Participate with me and we will pick out a good,
safe, and really appropriate, age-appropriate
skincare regimen together. That's kind of a nice
bonding experience for them to do. And then for
the dads, you're right. Of course, they don't
want, you know, to be spending all this money
having their kids use all these expensive products
when they're literally making problems for their
skin and not helping at all. In fact, it is detrimental.
And that's what the big study in pediatrics showed
us. But this is a nice time to say, hey, you
know, get the dads involved and say, hey, you
know, what do you think a healthy hygiene habit?
starts with and getting those boys to start washing
their face or taking more showers or just taking
more of an interest because it is really important
to start good hygiene practices early. And self
-care is a really important thing for both young
boys and girls. So we need to make sure that
we're getting it across in both avenues. How
do you broach the topic to the patient, the tween,
without pushing? too much so that you're starting
to get them to worry about their own self -esteem
or, you know, there's that balance, right? So
how do you involve them more directly in the
process of understanding what's important and
what's not and kind of getting them to understand
that there is a fine line maybe between going
overboard and now you've kind of gotten yourself
into some trouble psychologically. Yeah, I think
when that population shows up with a big bag
of products and you have that opportunity to
pare down and to educate and to show them that
and teach them that repeatedly exposing your
skin to these potential irritants and allergens
over and over again is going to make you potentially
allergic to some of these ingredients for the
rest of your life. That's a really important
thing to hone in on because a lot of the products
have. fragrance, essential oils, harsh botanical
ingredients. And so telling the kids and they
will know, Andrew, they know the ingredients.
So you can name it by name and it will give you
amazing street cred with your tween and teen
patients. If you can say, you know, here's what
you need and here's what's safe for you. You
know, it's okay to use a glycerin. It's okay
to use like a petrolatum for slugging. It's okay
to use, you know, certain ingredients, but it's
not okay to use harsh exfoliating acids or retinols
right now. Maybe save if you want to splurge
on something really fancy that you've seen. Maybe
that's the time to splurge on sunscreen. And
that's what parents can say yes to. Yeah, I totally
agree. Since you brought it up, do you want to
explain what "slugging" is? Of course. Actually,
in dermatology, we've got to say that we are
big fans of slugging. So slugging is the act
of putting like a thick, thick occlusive moisturizer
on your skin, most commonly a petrolatum -based,
so plain Vaseline or Aquaphor, et cetera, to
try to trap water in and, again, achieve what
people would call that glass skin type of appearance.
And it can be very, very nice to help restore
the skin barrier. We use this technique actually
a lot in our kids with eczema and dry skin. sensitive
skin. We usually call it the "soak and smear" technique,
but slugging is certainly what's trending online.
Yeah. Now, speaking of trending online, there's
a little bit of a darker side to this. And it
wasn't just a recent phenomenon. This is something
that we've heard over the last 10, 15 years.
Things have, quote unquote, gone viral. And there
are these challenges that I'm talking about.
Are you familiar with what I'm referring to?
Yes, absolutely. Risk-taking behavior and challenges
have definitely percolated and gained momentum
on social media for sure. And always seems like
there's a new one. I mean, that's the bummer.
Someone can come up with something crazier or
more dangerous to do. But the ones that I wanted
to share with the audience and make sure that
people are aware that they're out there were
ones that I've actually seen myself. So are you
familiar with the "Salt Ice Challenge?" I sure
am. Yep. Okay. Can you explain what that is?
Oh, goodness. So this is where teens will...
You might not be able to explain it because it
makes zero sense to do it. I know. Well, I think
that the challenge of pain and how long you can
tolerate something is sort of a common theme
to several of these. And there are some similarities.
So the salt ice challenge is when the kids will
put salt on the skin. And having salt on the
skin lowers the freezing point of water. And
if you put an ice cube on, you will rapidly
achieve lower temperatures than you would with
just a regular ice cube. And of course, that
results in a frostbite kind of burn injury to
the skin. We've all been in - many pediatric dermatologists
have been in - the emergency room asked to look
at these very geographic type burns with blistering.
And then if you, you know, probe a little further,
you might find that this is an "external job" from
our salt ice challenge. And it's similar to the
"deodorant challenge," if parents don't know about
that one. But that's when you hold an aerosolized
deodorant, which does have accelerators and different
chemicals that are quite cold, very, very close
to the skin. And again, you're basically inducing
a thermal injury that way. Those ones look circular
because, of course, the diameter of the spray.
But that's another one that's out there, too.
And those two are quite similar. Another painful
one that gives you a hint because it's a geometric
pattern you often are looking at sort of in a
rectangle is the "eraser challenge" where, as
I understand it - and we wrote this up a couple
of years ago, it was back in San Diego. There
were, pardon the pun, a rash of kids who were
taking. school erasers and just grinding it into
their skin until they basically peeled off the
top layer of the epidermis, maybe even down into
the dermis a little bit. They definitely could
get scarring. That was one of the big risks.
You won the challenge by going. longer and deeper
and harder than the guy or gal you were competing
against. So I remember we ended the article by
saying there were no winners in the eraser challenge.
There aren't. And I think our tweens and teens
don't realize that what they're doing can cause,
you know, a really deep abrasion, erosion. Even
if they get into the dermis, they can have a
scar. And that, of course, the post-inflammatory
changes to the skin, whether it's hypo- or hyper-pigmentation,
can last for years. they may carry around these
wounds with them for a very, very long time.
Yeah, this is a definite example of a couple
of split seconds of bad decision you might be
having to carry around for a lifetime. Have you
heard of the "tooth filing" challenge? The tooth
filing one is really upsetting because, of course,
if you file down a permanent tooth, that... that's
for life that's permanent unless you get a cap
on and so yes some kind of like desire to make
the teeth more pointy using a very coarse nail
file and filing the teeth into a point is definitely
something that has been on tiktok and going around
and obviously This is one of the more detrimental
challenges out there because it's so long term.
And also when you file the enamel off the teeth,
you can have a whole host of dental problems
down the road. So this is something that is really
not a good thing to do. And we would hope that
it doesn't gain any more momentum than it already
has. Yeah, that one's crazy. I mean, you would
think as a parent that you would be able to spot
that. But the problem is by the time you see
it, the damage has been done. You can't reverse
that. So...totally nuts! How about the "fire challenge?"
Have you heard of that one? I haven't seen it,
but I guess setting fire to flammable liquids
on the skin. I mean, that's, again, like a recipe
for a complete disaster. Yeah, I've seen videos
of this on YouTube where kids do this. They'll
put something on. Actually, the one that I did,
do remember seeing was DEET, the insect repellent
that we do, or at least I do recommend. Was it
an alcohol base maybe? Yeah, it's, it is flammable.
And there were, and there were a couple challenges
around, you know, being near a campfire with
your DEET on and what you could do with it. So
that's nuts. Oh my goodness. Right. The good
news is conversations like this, not all social
media is bad. I mean, we can actually use this
as a as a foothold for educating our patients,
educating our families. Right. You know, is there
any sort of regulations that you would like to
see put in place as an advocate? Or what can
we do at a higher level to prevent kind of this
some of these crazy things? Well, we did talk
about. the general lack of regulation in health,
wellness, and beauty. And luckily, people are
starting to take notice and want to do better.
For example, I think just a few months ago in
California, there was a bill that was proposed
that would actually ban the sales of these kind
of anti-aging ingredients to teens and tweens
or anyone under 18. Now, I'm not sure if that
will pass or how practical it would be to obtain
ID at any of these retailers, but at least we
have... some health policymakers taking notice.
And one of the biggest advancements we had, actually,
Andrea, was the development of MOCRA. Are you
familiar with that? It's called the Modernization
of Cosmetics Regulation Act, and it was signed
into law by the Biden administration in 2023.
And that was really a first step at getting more
regulatory authority into the hands of the FDA.
Because before that, before MOCRA was signed
into law, you know, Companies were not mandated
to remove products from the shelf, even if they
were dangerous or had, you know, multiple adverse
events, you know, with them. And the FDA did
not have legal jurisdiction to make companies
have recalls of products that were unsafe. Now
that's changed. They do. But there's still so
much of what I like to call the Wild West out
there in the beauty industry where, you know,
we have unregulated claim making, unethical.
marketing practices. We have, you know, facilities
and manufacturers who may not even be registered
with the FDA. So there's a lot of cleaning up
that we need to do. And so drawing attention
to it and raising awareness is really important
so that if people feel so, you know, politically
inclined, they might be, you know, able to bring
this up with one of their representatives. So
that's definitely one way to approach, you know,
the lack of regulation. Another is education.
So you and I both know that pediatric dermatology
is a very tiny subspecialty of medicine, right?
So there's only 400 of us board-certified pediatric
dermatologists in the whole country practicing.
And we can do a lot of good in clinic, but we
also need to kind of battle misinformation and
provide educational assets to patients and families
in a variety of settings. And that's one of the
reasons why I myself actually started a social
media presence. So I am on TikTok. I am on Instagram.
But in my work with the Society for Pediatric
Dermatology, we've created a wonderful page filled
with helpful resources for patients, families,
and even primary care providers who may not have
as much experience. So giving that education,
getting it out there, making it free and accessible
and easy to digest, that's a really important
way that we can start. to make a difference.
I totally agree. And it's not just having the
resources to educate, it's having the time. And
I mean, let's be honest, you have to have the
conversation 20, 30 times before you can get
it into a... a package that's just efficient
enough to reach either the patient or the parent
of that patient in the 10 or 15 minutes that
we get for a skin visit, let alone the pediatrician
who's trying to do, you know, head to toe care
on a kid - vaccines, development, etc.. They don't have
the time for that. So I love it that the patient
handouts and all the resources that the Society
for Pediatric Dermatology has out there are invaluable,
I think, for. that mission um you'd like to think
or at least i would like to think that geez the
answer here is just educating the kids but i
i mean just thinking of my own boys right I get
them alone and I can see that there's a message
that's received, right? But then they get in
with their three or four other friends and it's
like all of the social mores and norms that we've
tried to impress on them can go right out the
window pretty quickly in the group. So I don't
- I hear that. You get what I'm saying? So I'm
not sure if it's gonna come down to just, is
it simple as teaching confidence and self -perception?
Yes, I'm sure that's part of it. But for me,
the real answer is, and you've sort of alluded
to it, is trying to become. partners with maybe
the platforms that are kind of the most guilty,
Facebook, Instagram, TikTok. To me, that's where
we're going to have to have some discussion,
some partnership. And I'm using that word very
specifically because there'll be a quid pro quo
there. But there has to be some level of trying
to do better for these kids in terms of what
messages they get. I'm involved in a project
slightly related to this. It's regarding... Minors,
so under the age of 18 years of age for the most
part, who are seeking elective cosmetic procedures.
And there's some guidelines that we're putting
together. Murad Alam and Kristen Kelly were working
on this. Yeah, it's an important project. I'm
aware of it. Thank you for the work you're doing.
Society for Peds Derm has supported it. And I
was surprised. This was not something I knew
going into the project, but someone did a...
research literally like i guess a little secret
investigative they went undercover as an underage
under 18 years of age woman on Facebook open
an account put a few blogs in about how she, as
the undercover agent, was concerned about how
her nose looked and i think - i want to quote this -
in, in less than four hours she had an ad come
to her from a plastic surgeon willing to do the
nose surgery...the nose job... the rhinoplasty
Wow. You know, that's scary. That's pretty scary.
And geez, could we do better than that? Right.
I mean, that seems to me such an easy technological
fix. You can't get these ads if you're under
this age. And it's just not happening because
I think you hit the nail on the head. There's
too much money involved in it. There's huge money
involved. Yeah. And the techniques are very,
very sophisticated for how they know who the
person is, the content that that user is creating,
and then have the exact ads targeted to that
exact population. So they know that the yield
is going to be really high for the next click
or the next purchase. Yeah, and it's a constantly
moving target. I mean, as these platforms change,
we went from Facebook to Instagram to TikTok
as sort of being the source of information that
the population we're talking about, at least,
is getting their messaging from. That's going
to change, right? Who knows what it's going to
be next? What role does artificial intelligence
play? I mean, right now, I don't know if you
use AI at all in your life, but I still am kind
of in the realm of where I'll use it more as
a more evolved Google search, right? If I want
to dive deep into a topic I'll use, I could see
that being very helpful in certain ways, right?
Where you could maybe load your proposed regimen
into an artificial intelligence platform and
have it spit back out, hey, you shouldn't use
product C and D together because it could cause
a very well-known problem. Or what you're missing
from your regimen is, in fact, a sunscreen. Wouldn't
that be kind of cool, right? That'd be great,
right? But I don't know. Have you seen anything
like that? Or do you have any hope? Not yet,
because I think consensus is really hard to get
online. I mean, there's just a lot of different...
I would say stakeholders, right? Because we have
the doctors and the dermatologists, the pediatricians
who would give a certain set of recommendations.
And then we have a whole host of other people
who are recommending something completely different.
So because there are so many different stakeholders,
what AI might generate may or may not be science
or evidence -based. So it's really, I think we're
still in the infancy of all of this and it is
really tricky. And unfortunately, I do think
that more regulation is going to be at least
part of the answer. How can we limit targeted
ads to kids under 18 or at least under 12? You
know, I mean, we have to draw the line somewhere.
12 years of age is kind of also on the parents,
I feel, right? So where's the money coming from?
You gotta have a discussion with your kids. Like,
I'm giving you $50 a month, where's it going?
Well, if you're purchasing online, it shouldn't
be that hard to find that, right? And then it's,
well, what's in this bundle that you brought
home? Oh my goodness, I don't even understand
what half of these things are. Great, bring them
into the dermatologist or your pediatric dermatologist
if you're lucky enough to have one. And then,
but maybe you as a parent could. Put some of
these things into a search engine and find out
what they're being used for and what the dangers
around them are. Right. I mean, that to me seems.
Yeah, I love that. I mean, using this as an opportunity
to connect with, educate and, you know, grow
with with your child, because I think it's really
important. You want to know what they're doing,
what they're applying, what they're spending
their money on and use it as a chance to. I don't
know, advocate, but also have fun with it, right?
Because at the end of the day, that's what skincare
should be. It should be easy, accessible, age
-appropriate, safe, and fun. I love it. Yeah,
that really is the trick. And I think we're going
in the right direction here. I mean, the fact
that you're an expert in this topic and are drawing
so much attention around it, the idea that there
was this wonderful... an important article to
come out in what I think many people would consider
at least one of the top two pediatrics journals,
if not the top one in the country. Great. the
American Academy of Pediatrics hopefully will
be spotlighting this issue more and more as we
go along. So I think this is just the start of
it. I think we're right at the point where we
can get involved as much or as little as we want
around this topic and make some big strides in
the right direction. Me too. So thank you so
much for highlighting this topic. It's one that
is both, you know, a little bit fun and a little
bit scary to talk about with families. Well,
with that, I'd like to thank Dr. Sheilagh Maguiness
for joining me today. She's coming from Minneapolis,
Minnesota, where she is a practicing pediatric
dermatologist. So you can try to book an appointment
with her to discuss your very complex skin regimen
for you or your tween. And I also want to thank
her both in her role as a colleague of mine,
but also as the Immediate Past President of the
Society for Pediatric Dermatology for bringing
this issue to light. Have a wonderful day. Thanks
for joining us. Thanks for tuning in to this
episode of the Don't Be Rash Pediatric Dermatology
Podcast. I'm your host, Dr. Andrew Krakowski.
Don't forget to subscribe to our show on your
favorite podcast platform and check out dontberash
.org for more information. A special thank you
to our nonprofit sponsor, the St. Luke's University
Health Network, for making this episode possible.
Until next time, remember, keep calm and don't
be rash.