Analysis of Reddit Reveals Clascoterone Questions Among People with Acne

J Clin Aesthet Dermatol. 2025;18(11):37–40.

by Jennifer Wang, MD; Paras Patel, MD; Jessica Mineroff, MD; and Jared Jagdeo, MD, MS

Dr. Wang, Dr. Mineroff, and Dr. Jagdeo are with the Department of Dermatology at State University of New York, Downstate Health Sciences University in Brooklyn, New York and the Dermatology Service at the Veterans Affairs New York Harbor Healthcare System – Brooklyn Campus in Brooklyn, New York. Dr. Patel is with the Rowan University School of Osteopathic Medicine in Stratford, New Jersey and the Dermatology Service at the Veterans Affairs New York Harbor Healthcare System – Brooklyn Campus in Brooklyn, New York.

FUNDING: No funding was provided for this article.

DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article.

Abstract: Objective. Patients with acne are increasingly using social media platforms such as Reddit to seek medical information. Skincare subreddits such as r/SkinCareAddiction, r/Skincare_Addiction, r/SkincareAddicts, and r/Acne have become important hubs of discussion for acne treatments, including the recently US Food and Drug Administration (FDA)-approved drug clascoterone (Winlevi). The objective of this study was to analyze questions and information needs of Reddit users with acne related to clascoterone. Methods. The authors analyzed all clascoterone-related questions posted on the r/SkinCareAddiction, r/Skincare_Addiction, r/SkincareAddicts, and r/Acne subreddits. Questions were categorized and subcategorized for analysis. Results. A total of 301 questions from 223 posts were analyzed. The largest proportion of questions were about concurrent use with other medical interventions or skincare regimens (25.9%) and adverse effects (17.3%). General experiences (14.0%) and usage instructions (12.0%) also made up a significant number of questions. Limitations. A limitation of this study is that Reddit users may not accurately represent the general population of patients with acne using clascoterone. Conclusion. This Reddit analysis of clascoterone therapy reveals key themes in questions and gaps in knowledge among people with acne that may not be readily apparent in clinical settings. This information can guide physicians to better address patient needs and improve patient outcomes. Keywords. Acne, clascoterone, Winlevi, social media, Reddit

Introduction

Acne vulgaris, commonly referred to as acne, is one of the most common skin disorders in the United States (US), affecting up to 50 million Americans annually.¹ In addition to physical symptoms, acne has a significant negative impact on quality of life.² Acne has been associated with increased rates of anxiety, depression, and suicidal ideation.³ Clascoterone (Winlevi) (Sun Pharmaceutical Industries) represents a promising new topical treatment for acne.⁴ Clascoterone competitively inhibits androgen receptors at the level of the sebaceous gland, thereby minimizing hormone-driven sebum overproduction.^4,5 Clascoterone is the first topical product to target the hormonal pathogenesis of acne that is available to both men and women.⁴ It is also the first such agent to receive US Food and Drug Administration (FDA) approval for the treatment of acne in 2020.⁶

Social media usage has continued to increase in recent years, with up to 51% of US adults increasing their social media usage during the COVID-19 pandemic.⁷ The rapid expansion of the internet, specifically social media, has reshaped how patients approach their health and manage their medical conditions.⁸ Patients are increasingly obtaining their healthcare information from the internet and on social media platforms such as Facebook, Instagram, and Reddit.⁸ Research has shown that adolescents tend to favor the internet as their primary source of healthcare information.⁹ In some cases, the internet may be their only source of health information.⁹

Among these platforms, Reddit, a user-driven content-sharing and discussion platform, has developed a significant skincare community. Reddit is ranked as the fifth most visited website in the United States. It has forum-like communities, or “subreddits,” that actively engage in discussion on various skincare topics.¹⁰ Reddit currently has over 100,000 active subreddits, with over 430 million posts made in 2022, a 14% increase from 2021.¹¹ These subreddits serve as spaces for users to ask questions, share experiences, and seek out more information. There has been an increased interest in the role of social media in healthcare.¹² Specifically, there has been a recent interest in research on healthcare content on Reddit.^13-15 The approval of new treatments often sparks discussion among these online communities. One such example is clascoterone, which has generated substantial discussion on dermatology-related subreddits.

Given clascoterone’s novel mechanism of action, recent FDA approval, and growing interest online, this study aimed to analyze Reddit posts to reveal users’ perceptions and questions regarding clascoterone. This valuable insight may allow physicians to better understand patient experiences and needs, thereby leading to improved patient outcomes.

Methods

The authors analyzed all posts related to clascoterone on the r/SkinCareAddiction, r/Skincare_Addiction, r/SkincareAddicts, and r/Acne subreddits, which have approximately 2.0 million, 1.4 million, 862000, and 845000 subscribers, respectively as of July 18, 2023. These four subreddits are all ranked in the top 1% of Reddit communities by size. Each subreddit was searched for the following terms: “Winlevi” and “clascoterone.” The subreddit, username of poster, title, text, comments, and number of upvotes (i.e., “likes”) of each post that met the inclusion criteria were documented. Clascoterone-related questions were placed into the following categories: “general experience,” “efficacy,” “adverse effects,” “usage instructions,” “concurrent use with other medical interventions or skincare regiments,” “costs and insurance,” “obtaining prescription,” “timeline for symptom improvement,” and “miscellaneous.” Duplicate posts and posts not containing questions related to clascoterone were not included. Redundant questions within the same post were also excluded. The SUNY Downstate Institutional Review Board deemed this analysis exempt from review.

Results

We analyzed a total of 301 questions from 223 posts, as some posts contained multiple questions. In terms of the number of questions asked per year, 2 questions (0.7%) were asked in 2018, 2 questions (0.7%) were asked in 2020, 23 questions (7.6%) were asked in 2021, 183 questions (60.8%) were asked in 2022, and 91 questions (30.2%) were asked in 2023 as of July 18, 2023 (Table 1). The average number of upvotes was 3.2 (range: 0-76) and the average number of comments was 7.9 (range: 0-371) for each post. Users posted 1.2 questions on average (range: 1-5). The most popular subreddits for clascoterone questions were r/Acne (45.5%) and r/SkinCareAddiction (40.9%).

The greatest proportion of questions were related to concurrent use with other medical interventions or skincare regimens (25.9%) and adverse effects (17.3%) (Table 2). Regarding concurrent use with other medical interventions or skincare regimens, users most frequently inquired about concurrent use with retinoids (44.9%) and with their normal skin care regimen, such as cleansers, toners, and moisturizers (39.7%). Specifically, out of the retinoid-related questions, the most asked questions concerned concurrent use with tretinoin (48.6%) and tazarotene (22.9%). The third most asked question in this category was about concurrent use of clascoterone with benzoyl peroxide (19.2%). Regarding adverse effects, users most frequently inquired about worsening acne (48.1%) and menstrual irregularities (15.4%). Usage instruction questions (12.0%) most frequently focused on questions about clascoterone’s expiration date of one month (n=7) and application area (i.e., whole face vs. spot treatment only) (n=5). Users also asked questions pertaining to clascoterone efficacy (11.0%), the process for obtaining a prescription (4.7%), the timeline for symptom improvement (4.3%), comparison with other medical interventions (3.3%), cost and insurance (3.0%), and the general patient experience (14.0%).

Of the 1759 comments analyzed, none were posted by verified healthcare providers. Titles and questions of example posts are provided (Table 3).

Discussion

This study aimed to analyze Reddit users’ questions about clascoterone, a recently FDA-approved topical anti-androgen cream for adults with acne. To our knowledge, this is the first study to investigate patients’ questions about clascoterone on an online social media platform.

The subreddits r/SkinCareAddiction, r/Skincare_Addiction, r/SkincareAddicts, and r/Acne are all ranked in the top 1% of Reddit communities by size. Our analysis revealed a large and substantially growing online interest in clascoterone, evident by the eight-fold increase in questions on these subreddits from 2021 to 2022. This trend underscores the need to better understand growing patient interest and questions about clascoterone.

Our study revealed that the most commonly asked questions regarding clascoterone pertained to its concurrent use with other medical interventions or with the patient’s existing skincare regimen. These findings suggest a need for clear guidelines on the combined use of clascoterone with other treatments, particularly retinoids. A literature search on PubMed revealed no clinical studies on clascoterone use with retinoids. Given the high level of patient interest in combining clascoterone with other therapies, further studies should investigate the safety and efficacy of its concurrent use with agents such as retinoids.

The second most asked question category regarding clascoterone involved adverse effects. A notable finding was that of the 52 questions dealing with adverse effects, 8 questions specifically asked about menstrual irregularities. Clascoterone is believed to compete with dihydrotestosterone for binding to the androgen receptor, inhibiting downstream signaling of acne-inducing pathways.¹⁶ Clascoterone is a topical cream that is quickly metabolized to its inactive form at its site of application and, as such, should have limited systemic effects.¹⁶ No systemic adverse effects were observed during two Phase III clinical trials with clascoterone, including no menstrual irregularities.¹⁷ Therefore, theoretically, clascoterone should not induce the menstrual changes reported and questioned by Reddit users. However, these user-reported symptoms might suggest a previously unrecognized adverse effect that merits further study.

Usage instructions were the third most common theme in users’ questions. Understanding the proper use of the medication is crucial for improving treatment outcomes and minimizing potential misuse. We recommend physicians take the time to provide clear and comprehensive instructions to patients to potentially increase patient compliance and maximize the therapeutic benefits and ease of use of clascoterone.

This study highlights the need for physicians to better understand the online discourse regarding clascoterone. With its convenience and accessibility, social media has been increasingly used as a source of healthcare information.¹² A survey found that 94% of patients with acne are unsatisfied with information they receive from healthcare providers, with 46% of patients seeking more information about available treatment options, such as clascoterone.¹⁸ This dissatisfaction may prompt patients to turn to alternative sources such as the internet. A cross-sectional study showed that up to 85% of patients seek out health information through social media.¹⁹ Another survey revealed that 45% of patients with acne use social media to seek out acne treatment advice, which supports previous research.^20,21

While Reddit is a valuable way for patients to share experiences and seek answers, it is important to consider the potential spread of medical misinformation. Only 31% of social media acne treatment advice is fully aligned with the American Academy of Dermatology’s clinical guidelines.²⁰ It is notable that out of all 1759 comments analyzed in this study, none were posted by verified healthcare professionals. This highlights how Reddit skincare communities are predominantly peer-driven. This reliance on information from nonmedical professionals may lead to the potential spread of misinformation, as patients may be relying on anecdotal rather than scientific evidence.²² An analysis of the top 100 TikTok acne videos determined the average content quality to contain “information with serious to potentially important shortcomings.”²³ Similarly, an analysis of top acne-related Instagram posts revealed that only 11% of these posts reference treatment with Grade A evidence based on American Academy of Dermatology guidelines.²⁴ Physicians may consider actively engaging with patients on these online platforms to better provide patients with accurate and evidence-based information. By doing so, physicians may also gain insight into common questions and concerns patients have, which can be addressed preemptively. In addition, patients may not always share with their doctors that they are obtaining medical advice from online communities. One study found that 76% of patients with acne do not share what they see on the internet with their doctor.²¹ It is important for physicians to be aware of the types of discussions that occur online in order to better address patient concerns and potential underlying misunderstandings. By understanding the online discourse about medications such as clascoterone, physicians have the opportunity to provide patients with more tailored and informed care.

Conclusion

Herein, we provide valuable insights into Reddit users’ perceptions and questions related to clascoterone. This study highlights the importance of integrating social media analysis into medical practice to enhance patient-centered care. By better understanding patient questions and concerns, physicians can improve patient experiences and treatment outcomes. A strength of this study is that we used Reddit to directly access questions and perceptions regarding clascoterone. Reddit’s communities provided a diverse range of discussions, and its anonymous nature allows for the expression of authentic patient opinions, which can offer perspectives that may be missed in clinical settings. Limitations of this study include representation bias, as Reddit users may not accurately reflect the larger acne community. Reddit users are, on average, younger and predominately male compared to the general population.²⁵ Another limitation is that the anonymous nature of Reddit poses challenges in verifying users’ posts and questions. However, there is little motivation for users to be dishonest in their posts. Future research could explore the impact of online discussions on patient decision-making and assess the quality and accuracy of acne information shared on Reddit.

Acknowledgements

Ms. Wang and Dr. Jagdeo came up with the idea for the study. Ms. Wang collected and analyzed the data and wrote the main manuscript. All authors helped to revise the manuscript. Dr. Jagdeo supervised the project.

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