Social Media and Direct-to-Consumer Treatments in Pediatric and Young-Adult Patients With Alopecia: Variable Use and Mixed Perceptions.

BACKGROUND: Social media is a common source of health information for children and young adults, yet little is known about how young patients with alopecia engage with hair loss-related content online. Direct-to-consumer (DTC) treatments are also widely marketed for alopecia, but data on their use and perceived effectiveness in pediatric populations remain limited. This study aimed to characterize social media use among patients with alopecia and examine patterns of DTC treatment use. METHODS: We conducted a cross-sectional survey of patients aged ≤ 25 years with physician-diagnosed alopecia at Boston Children's Hospital dermatology clinics between November 2024 and September 2025. Surveys collected demographics, social media engagement, and use and perceived effectiveness of DTC treatments. RESULTS: Of 115 respondents, 65% reported social media use, with higher use reported in older age groups (90% ≥ 18 years, 72% 12-17 years, 34% < 12 years; p < 0.001). Among users, 59% encountered hair loss-related content, most often on TikTok, Instagram, and YouTube. Many reported uncertainty regarding the qualifications of content creators, and nearly one-quarter rarely or never questioned the accuracy of information presented. Among respondents exposed to hair loss-related content, 28% reported trying a treatment seen online. These treatments were associated with low satisfaction, variable costs ($0-$500+), and side effects including dryness, itching, and increased shedding. Across all respondents, 60% reported ever using at least one DTC treatment, though only 30% were current users. Perceived effectiveness was inconsistent. CONCLUSIONS: Social media exposure and marketing of DTC products appear to shape how youth approach alopecia management, although reported experiences were variable and often unsatisfactory. Dermatologists should inquire about online content exposure and DTC product use in clinical care while guiding families toward evidence-based management.