J Clin Aesthet Dermatol. 2024;17(5):40–42
by Kelly McCoy, MD; Madelyn M. Class, BS; Victoria Ricles, BS; Gabriela Wagoner, BS; Devon Cross, MD; Aspen Trautz, MD; and Andrew C. Krakowski, MD
Drs. McCoy, Cross, Trautz, and Krakowski are with St. Luke’s Department of Dermatology at St. Luke’s University Health Network in Easton, Pennsylvania. Ms. Class and Ms. Wagoner are with the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania. Ms. Ricles is with the Drexel University College of Medicine in Philadelphia, Pennsylvania.
FUNDING: No funding was provided for this article.
DISCLOSURES: The authors have no conflicts of interest relevant to the contents of this article.
ABSTRACT: We live in an electronic world with near-ubiquitous access to smartphones and social media. One consequence of this new reality is that children and teenagers may be unduly swayed by social media influencers who promote skincare products and practices, colloquially referred to as “skinfluencers,” and enjoy unfettered access to emerging trends–not all of which lead to positive results. Herein, we describe two cases of adolescents presenting to a pediatric dermatology department after trying different beauty trends endorsed by social media influencers. The first patient developed allergic contact dermatitis to “snail slime” (96% Snail Secretion Filtrate; COSRX), a popular over-the-counter skincare product that has received notable attention on social media platforms due to its purported skin hydrating effects. The second patient presented urgently due to her mother’s concerns of “overnight moles,” which, in fact, the patient had acquired after applying makeup using a social media-endorsed “freckle stamp.” Clinicians should be aware of these emerging trends to properly educate, manage, and treat patients susceptible to their influence–especially within the particularly impressionable teenage population.
Keywords: Social media, TikTok, makeup, snail mucin, contact dermatitis, freckles, freckle stamp, Henna, eruptive moles, influencers
Introduction
Social media, like it or not, now constitutes a more regular portion of teenagers’ lives than ever. In a 2022 survey of teenagers, ages 13 to 17 years, 97 percent of those surveyed reported using the Internet every day, and two-thirds reported using the TikTok social media application “frequently.”1 The majority of social media users report encountering “influencers” while online and report that influencers within the beauty sector (i.e., “skinfluencers”) have the most power over their purchases.2 Social media platforms provide these influencers, most of whom have no formal training in dermatology, with an immediate and elevated platform from which they may introduce impressionable viewers to appearance-altering fads, with unchecked regard to safety and efficacy and with near-total lack of consequence when something goes wrong. Herein, we discuss two cases of adolescents presenting to a pediatric dermatology department with skin conditions secondary to exposure to emerging social media fads.
Case Reports
Case 1. A 14-year-old female patient presented with a complaint of two months of lip pain, swelling, crusting, and oozing. She had been applying “snail slime” (96% Snail Secretion Filtrate; COSRX, Seoul, South Korea) to her mucosal lips multiple times a day to improve skin hydration, a trend which she first heard about on social media. Notably, the product manufacturer specifically instructs users to apply the filtrate to facial skin only and to avoid mucosal surfaces. This patient had developed a reaction a few weeks after starting her “snail slime” regimen, which she documented in a series of at-home “selfie” photographs (Figure 1).
She was now attempting to treat the irritation with a homemade concoction: a balm of coconut oil and organic beeswax; however, that only seemed to make things worse. Dermatological examination revealed erythematous and scaly lesions on the patient’s lips (Figure 2).
The patient was advised to stop application of any “snail slime” and all topical products other than those recommended by her pediatric dermatology team. She was prescribed hydrocortisone 2.5% ointment twice daily for 10 days to calm the inflammation and was counseled to frequently use white petroleum jelly to act as a skin barrier. Blood work was ordered to evaluate for alternative causes of lip swelling, such as angioedema or inflammatory bowel disease. Patch testing was performed to evaluate for other etiologies for her contact dermatitis. All testing was subsequently negative. The patient reported that her symptoms resolved within two days of “snail slime” cessation and initiation of topical steroids. She has promised to try to avoid TikTok for future skincare instructions.
Snail mucin, derived from the slime of snails, has emerged on social media as a substance with several purported medical and cosmetic applications. Proponents of snail mucin have suggested it may have antioxidant and antimicrobial properties, may increase production of the extracellular matrix proteins collagen and fibronectin, could enhance wound healing, and might reduce cutaneous signs of photoaging.3 These asserted dermatological benefits have led to snail mucin’s rapid growth in popularity as an ingredient in skincare products. Its use is especially prevalent among young adults and adolescents, largely due to social media’s influence, with the tag “#snailslimeskincare” having been viewed over 4.5 million times on TikTok at the time of this submission.
While skincare innovations are exciting, it is important to remember that products made from natural sources can still contain potential allergic contacts and irritants. Poison ivy, after all, is just as “organic” as snail mucin, and its ability to elicit adverse skin reactions is infamous.
Snail mucin is not currently included in the American Contact Dermatitis Society Core Allergen Series; consequently, if true allergy is suspected, then a “use” patch test on a small area of skin should be considered. Additionally, care must be taken to follow manufacturer instructions on acceptable usage, and evidence-based recommendations should be the overall goal. Given the popularity of this product, more rigorously controlled prospective studies should also be considered.
Case 2. A 16-year-old female patient was seen urgently at her mother’s insistence over concerns of “overnight moles” on her daughter’s cheeks. The mother believed that some of the lesions had been present since at least three years of age; however, the number had seemingly “more than doubled” overnight. The patient herself denied any change in size, color, or quantity of lesions. Originally, the patient denied using any new lotions, creams, or medication on the affected areas. On exam, scattered, discrete, 1mm to 4mm round, ovoid, homogenously light and dark brown macules were noted on the anterior neck and bilateral cheeks (Figure 3).
The patient was questioned privately (i.e., without her mother in the exam room) and admitted to applying the lesions with “a new makeup tool I heard about on TikTok” (Figure 4). She did not offer any further explanation for why she had not simply explained that fact to her mother, who was less than enthused with her daughter’s foray into the world of special effects makeup artistry. The patient was counseled on the possible adverse reactions that could occur when using new makeup products and on the importance of using sun protection to prevent photoaging and skin cancer. The mother apologized for “taking an appointment away from someone who probably really needed it.
Freckle paint, an emerging social media beauty “hack,” is a cosmetic product used to create the appearance of moles or freckles on the skin. It comes in various forms, including stamps, brushes, and makeup kits, and it has seen increasing frequency of use among adolescents and young adults. Like snail mucin, freckle paint may contain potential allergens or irritants. Our patient’s freckle paint was a type of henna tattoo paint. Paraphenylenediamine (PPD), found in some henna tattoo formulations, is a well-known and potent sensitizer.4 Additionally, the sudden emergence of artificial freckles or moles on the skin may lead to false alarms of new, changing, or evolving skin lesions and subsequent unnecessary utilization of in-demand clinical resources.
Conclusion
Both patients in this case series were directly influenced by social media. In a 2021 survey by the American Society for Dermatological Surgery, social media was ranked as the second most important factor in consumers’ skincare purchases, only slightly behind recommendations from dermatologists.5 Like other appearance-altering procedures, such as tattooing and cosmetic procedures, social media-derived practices and behaviors can have short- and long-term detrimental effects. Dermatologists must be aware of these trends and fads and their potential side effects to help prevent patients, especially impressionable teenagers, from suffering harmful consequences of unregulated or misguided product choices and skincare practices.
References
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- Brieva A, Philips N, Tejedor R, et al. Molecular basis for the regenerative properties of a secretion of the mollusk Cryptomphalus aspersa. Skin Pharmacol Physiol. 2008;21(1):15-22.
- Bolognia JL, Schaffer JV, Cerroni L. Dermatoses Due to Plants. In: Dermatology. 4th ed. China: Elsevier; 2018:286–303.
- American Society for Dermatological Surgery. American Society for Dermatologic Surgery (ASDS) 2021 Consumer Survey on Cosmetic Dermatologic Procedures [Internet]. c2023 [cited 11 Nov 2023]. Available from: https://www.asds.net/portals/0/PDF/consumer-survey-2021-infographic.pdf.