A systematic analysis of 100 TikTok videos featuring skin care regimens created by children and adolescents aged 18 years and younger revealed significant dermatologic risks. The routines averaged 6 products per regimen with a mean cost of $168 and frequently included potentially irritating ingredients, according to a new study.

Investigators at Northwestern University Feinberg School of Medicine analyzed videos from 82 creators aged 7 to 18 years. Each video received a mean of 1.1 million views. Content creators were predominantly female (81 of 82) and had light skin tone (73%).

High-Risk Ingredient Exposure

The top 25 most-viewed videos contained an average of 11 and a maximum of 21 potentially irritating active ingredients, of which alpha-hydroxy acids (AHAs) were the most common. The top videos included an average of 3 products that contained AHAs per regimen, but could have up to 7.

“Although ingredients such as retinols and hydroxy acids may help treat acne, only 8 of the 82 content creators had visible blemishes,” the authors reported.

Twenty inactive ingredients identified across all products that appeared in these videos were included in the Pediatric Baseline Series, which is used in patch testing for allergic contact dermatitis. More than half of all products (50.61%) contained added fragrance, a common contact allergen in personal care items.

Sunscreen Neglect Despite Photosensitizing Ingredients

The FDA advises that users of AHAs or beta-hydroxy acids (BHAs) also use sun protection due to the elevated risk of sun sensitivity, but among the 84 videos that demonstrated daytime skin care routines, only 26.2% included sunscreen, despite the widespread use of photosensitizing ingredients.

One cited study found that 4 weeks of AHA application resulted in an 18% increase in skin reddening and a doubling of ultraviolet-induced cellular damage.

The most frequently used product in the top 25 videos was the Glow Recipe Watermelon Glow BHA+PHA Pore-Tight Toner ($35 per 150 mL), which contains hydroxy acids. However, only one-third of the videos featuring this toner also included a sunscreen.

Allergic Reactions Documented in Real Time

At least one instance of allergic contact dermatitis was documented during filming. In the video, a young teenager applies 14 products totaling nearly $350 and develops visible facial inflammation.

“This is what my skin looks like. It is very glowy right now, I love it! But also, I just had some allergic reaction to something that I tried, so ignore how red my face is,” the creator said. “I don’t know what’s happening. But if anybody knows how to get it to stop burning, that would be greatly appreciated, because it actually hurts a lot.”

Methodology and Demographics

Two investigators created TikTok accounts set to age 13 and used the “For You” algorithm to identify relevant content. Videos were collected between April and May 2024 and were published from January 4, 2023, through April 31, 2024.

Creators were categorized by perceived age as either middle school age (less than 13 years; 26 creators) or high school age (at least 14 years; 56 creators). Skin tone was categorized using the 10-point Massey-Martin Skin Color Scale: 60 creators were assigned a light tone, while 15 were medium, and 7 were dark.

Product Cost and Brand Analysis

Product costs ranged from $20 to $621 per routine, with a mean of $168. Investigators identified 260 unique products from brand including Glow, Bubble, Drunk Elephant, and The Ordinary, which appeared frequently.

For comparison, the authors noted that a basic regimen of gentle cleanser and mineral sunscreen could cost around $20 (e.g., Cetaphil Gentle Skin Cleanser, $8.79 per 20 oz; Banana Boat Kids Mineral Sunscreen SPF 50, $10.99 per 6 oz).

Video Genres

Five primary video formats were identified:

• “Get Ready With Me” (52%), featuring unscripted product application

• “Skin Care Routine” (20%), with product descriptions and demonstrations

• “After School” routines (16%), focused on evening regimens

• “Mommy and Me” (9%), involving parent-child participation

• “Sunday Reset” (3%), highlighting weekly or specialized treatments

Clinical Implications

The researchers concluded that pediatric exposure to complex and costly skin care regimens carries limited benefit and meaningful risk.

“For children without acne, the risk of irritant contact dermatitis almost certainly outweighs potential benefits of these active ingredients, particularly when multiple such products are used together,” they wrote.

They also noted that earlier and more frequent use of personal care products may increase the risk of allergic contact dermatitis, especially when they include fragrance and preservatives.

Study Limitations

The Northwestern Institutional Review Board determined this research did not constitute human subjects research. Limitations included reliance on the TikTok algorithm for video selection and complete ingredient list analysis for only the top 25 products.

Funding was provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (award No. 5T32AR060710-11).

The authors declared having no competing interests.

Source: Pediatrics