To the Editor:
Atopic dermatitis (eczema) affects approximately 20% of children worldwide.1 In atopic dermatitis management, patient education is crucial for optimal outcomes.2 The COVID-19 pandemic has impacted patient-physician interactions. To ensure safety of patients and physicians, visits may have been canceled, postponed, or conducted virtually, leaving less time for discussion and questions.3 As a consequence, patients may seek information about atopic dermatitis from alternative sources, including YouTube videos. We performed a cross-sectional study to analyze YouTube videos about topical treatments for atopic dermatitis.
During the week of July 16, 2020, we performed 4 private browser YouTube searches with default filters using the following terms: eczema topicals, eczema topical treatments, atopic dermatitis topicals, and atopic dermatitis topical treatments. For video selection, we defined topical treatments as topical corticosteroids, topical calcineurin inhibitors, crisaborole, emollients, wet wraps, and any prospective treatment topically administered. For each of the 4 searches, 2 researchers (A.M. and A.T.) independently examined the top 75 videos, yielding a total of 300 videos. Of them, 98 videos were duplicates, 19 videos were not about atopic dermatitis, and 91 videos were not about topical treatments, leaving a total of 92 videos for analysis (Figure 1).
Figure 1. Visual representation of the YouTube video selection process.
For the 92 included videos, the length; upload year; number of views, likes, dislikes, and comments; interaction ratio (IR)(the sum of likes, dislikes, and comments divided by the number of views); and video content were determined. The videos were placed into mutually exclusive categories as follows: (1) patient experience, defined as a video about patient perspective; (2) professional source, defined as a video featuring a physician, physician extender, pharmacist, or scientist, or produced by a formal organization; or (3) other. The DISCERN Instrument was used for grading the reliability and quality of the 92 included videos. This instrument consists of 16 questions with the responses rated on a scale of 1 to 5.4 For analysis of DISCERN scores, patient experience and other videos were grouped together as nonprofessional source videos. A 2-sample t-test was used to compare DISCERN scores between professional source and nonprofessional source videos.
Most videos were uploaded in 2017 (n=19), 2018 (n=23), and 2019 (n=25), but 20 were uploaded in 2012-2016 and 5 were uploaded in 2020. The 92 videos had a mean length of 8 minutes and 35 seconds (range, 30 seconds to 62 minutes and 23 seconds).
Patient experience videos accounted for 23.9% (n=22) of videos. These videos discussed topical steroid withdrawal (TSW)(n=16), instructions for making emollients (n=2), and treatment successes (n=4). Professional source videos represented 67.4% (n=62) of videos. Of them, 40.3% (n=25) were physician oriented, defined as having extensive medical terminology or qualifying for continuing medical education credit. Three (4.8%) of the professional source videos were sponsored by a drug company. Other constituted the remaining 8.7% (n=8) of videos. Patient experience videos had more views (median views [interquartile range], 6865 [10,307]) and higher engagement (median IR [interquartile range], 0.038 [0.022]) than professional source videos (views: median views [interquartile range], 1052.5 [10,610.5]; engagement: median IR [interquartile range], 0.006 [0.008]).
Although less popular, professional source videos had a significantly higher DISCERN overall quality rating score (question 16) compared to those categorized as nonprofessional source (3.92 vs 1.53; P<.001). In contrast, nonprofessional source videos scored significantly higher on the quality-of-life question (question 13) compared to professional source videos (3.90 vs 2.56; P<.001)(eTable). (Three professional source videos were removed from YouTube before DISCERN scores could be assigned.)
Notably, 20.7% (n=19) of the 92 videos discussed TSW, and most of them were patient experiences (n=16). Other categories included topical steroids excluding TSW (n=11), steroid phobia (n=2), topical calcineurin inhibitors (n=2), crisaborole (n=6), news broadcast (n=7), wet wraps (n=5), product advertisement (n=7), and research (n=11)(Figure 2). Interestingly, there were no videos focusing on the calcineurin inhibitor black box warning.
Figure 2. Video categories for atopic dermatitis topical treatments. Featured categories are not mutually exclusive or comprehensivee. TSW indicates topical steroid withdrawal.
Similar to prior studies, our results indicate preference for patient-generated videos over videos produced by or including a professional source.5 Additionally, only 3 of 19 videos about TSW were from a professional source, increasing the potential for patient misconceptions about topical corticosteroids. Future studies should examine the educational impact of patient-generated videos as well as features that make the patient experience videos more desirable for viewing.