Analyzing Fitzpatrick skin type distribution of vitiligo on Instagram

What is known about this subject in regard to women and their families? Women and their families face much social stigma due to these autoimmune skin conditions. What is new from this article as messages for women and their families? Women have an increased psychological burden form vitiligo. Those with vitiligo may benefit from social support found on social media. Vitiligo is a chronic autoimmune disease that arises when CD8+ T lymphocytes attack and destroy melanocytes, the pigment-producing cells found in the epidermis. Vitiligo patients have milky white patches of skin and often encounter isolation, stigmatization, and diminished quality of life (QoL).1 Vitiligo has recently gained increased awareness with celebrities like Winnie Harlow discussing the psychosocial effects of her disease publicly and recent food and drug administration approval of the topical medication, ruxolitinib.2 Previous studies exploring vitiligo-related content and trends on platforms such as YouTube and Instagram showed that most content reflects patient experiences.3 Thus, social media platforms represent an accessible educational tool for reaching different patient populations to increase awareness. Understanding gaps in demographic distribution will be important for patient education. In this study, we sought to compare Fitzpatrick skin type (FST) representation on Instagram and actual reported demographic distribution for vitiligo. Public Instagram posts were pulled from @vitiligosociety, @worldvitiligo, and #vitiligo hashtags using the Instaloader Python Module on November 25, 2022. @vitiligosociety, @worldvitiligo, and #vitiligo were chosen based on search popularity. Photos were independently rated on FST by a medical student followed by a board-certified dermatologist to validate results (Supplementary Figure 1, https://links.lww.com/IJWD/A46). Photos were analyzed by year posted, gender, age, and body area photographed. Advertisements, group photos, black-and-white photos, and photos with nonvisible skin were excluded. χ2 test was used to compare each Instagram account to reported prevalence based on self-reporting, which revealed that FST I to III had a higher prevalence of 0.66 relative to types IV to VI at 0.34 in the United States.4 We found that @vitiligosociety, @worldvitiligo, and #vitiligo had a significantly larger prevalence (indicated by darker colors) of FST IV to VI ≥ 0.64 (Table 1) compared to previously reported prevalence. We also compared the age range, gender, and location of vitiligo exposed on the different accounts (Table 2).Table 1: Prevalence of FST I to III compared to FST IV to VI in #vitiligo, @vitiligosociety, and @worldvitiligo Table 2 - Frequency of age range, sex, and location of vitiligo for @vitiligosociety, @worldvitiligo, and #vitiligo posts Group @Vitiligosociety @Worldvitiligo #Vitiligo Age group, y 0–17 (Pediatric) 49 133 63 ≥18 (Adult) 305 1021 574 Sex Male 67 357 158 Female 291 785 489 Location of vitiligo Face 80 204 158 Body 66 312 489 Both face and body 248 851 78 Skin of color (SOC) individuals traditionally have decreased representation in dermatology textbooks and social media.5 Our findings suggest that in vitiligo, there was more representation of darker skin types (FST IV to VI) on Instagram compared to the reported prevalence. This may be attributed to differential impacts on patients with darker skin color (FST IV to VI) as they have reported lower QoL compared to vitiligo patients with FST I to III.1 Women are also overrepresented in our cohort as female vitiligo patients often struggle with social stigmatization and difficulty in finding a partner.2 Vitiligo lesions located on the hands and face have been associated with lower QoL relative to those in nonvisible regions.6 This further highlights the challenges faced by vitiligo patients, including low self-esteem, discrimination, and social difficulties.7 Vitiligo lesions located on the hands and face have been associated with lower QoL relative to those in nonvisible regions.6 This further highlights the challenges faced by vitiligo patients, including low self-esteem, discrimination, and social difficulties.7 These results within Instagram may reflect the increased social support SOC individuals receive on social media. Our study's limitations include restriction to public posts as private posts were inaccessible due to Instagram's privacy policy, lack of other social media platforms and focus on one inflammatory skin condition where pigmentation is particularly affected. Additionally, the reported incidence was based on a survey-based study, which has the potential for selection bias. Nevertheless, our study highlights that SOC representation on Instagram varies and represents an underutilized avenue that dermatologists should be aware of. Equitable delivery of vitiligo care is essential for addressing the psychosocial challenges faced by female and darker-skinned populations Future efforts to increase social awareness of dermatological conditions should take advantage of social media demographic representation to engage different communities. Conflicts of interest None. Funding Supported by the Skin of Color Society Career Development Award to J.S. Study approval N/A Author contributions JS: Participated in research design. BTN and JS: Participated in writing of the paper and performance of research, and data analysis. Supplementary data Supplementary material associated with this article can be found at https://links.lww.com/IJWD/A46.