One day in 2020, Ronda S. Farah, MD, was spending some downtime from her dermatology practice scrolling through social media. When she opened TikTok, she came across something that piqued her interest: a popular content creator was promoting the supplement biotin as a way to grow hair. Farah was immediately alarmed, because not only was the evidence that biotin increases hair growth shoddy, but the FDA had also warned against the use of the vitamin for years.
As a hair loss specialist who was aware of these warnings, Farah was moved to action. She made a brief TikTok stating that use of biotin does not result in hair growth for most patients. Before she knew it, her video had gone viral, shooting up to over half a million views. She was flooded with messages from influencers and people desperate for an answer to their hair growth questions. From that point on, Farah was immersed in the world of hairfluencers, the social media personalities who promote hair care trends.
Her immersion in this world formed the basis of a recently published review she conducted with her colleagues at the University of Minnesota, Minneapolis. Evaluating a wide swath of the most popular trends on social media, including TikTok, the team found that for most of the products being promoted, there was no evidence that they led to hair growth, In addition, many people who were making the recommendations didn't have any hair expertise. It's true, Farah said in an interview with Medscape, that sometimes these trends are relatively harmless. But other times the promotors may exploit people desperate for a hair loss cure, and the methods being promoted may even harm the hair and scalp, the study shows.
In the review, which appears in the Journal of Cosmetic Dermatology, she and her colleagues evaluate five treatments for hair growth that were presented on social media. The five treatments ― rosemary, onion juice, rice water, castor oil, and aloe vera ― represent some of the most frequently discussed hair growth trends on social media. For each, the researchers evaluated recommendations on how the treatments were applied, possible harmful effects to the user, claims that weren't totally based on scientific evidence, and the theoretical mechanism of action.
"Overall," they conclude, "there is little to no literature supporting these social media trends for hair growth."
Of the five, rosemary, applied to the scalp or hair, has perhaps the most significant research behind it, according to Farah and her co-authors. Methods of applying rosemary described on social media included use of prepackaged oil, boiling fresh rosemary leaves, adding leaves to oils and spraying it on or massaging it on the scalp, applying it in the hair, or using it as a rinse. Farah notes that the literature supporting the use of rosemary for hair growth does not represent the most robust science; the studies had small sample sizes and used nonstandardized methods of measuring hair growth.
"It didn't really meet rigorous, strong study methods that a board-certified dermatologist with their expertise would consider a really solid study," she said.
For the remaining methods, there was little research to support their use for hair growth. A few, the authors point out, can cause scalp burns (aloe vera), damage to hair follicles (rice water), contact dermatitis (aloe vera, onion juice), and, in the case of castor oil, hair felting, a disorder of the scalp that turns the base of the hair into a mat, similar to a piece of tangled wool.
To make matters worse, even outside of social media, there's flimsy evidence that any alternative treatment really leads to hair growth, according to Edzard Ernst, MD, professor emeritus, Department of Complementary Medicine, the University of Exeter, United Kingdom. In an interview with Medscape, when asked whether he had discovered any natural hair growth remedies over the course of his long research career, Ernst merely gestured to his head, where he sports a smooth halo of bald skin. "You see the answer? To the best of my knowledge, there's no alternative treatment that enhances hair growth," he said.
So hairfluencers who promote these trends may be sending people desperate for answers down a futile path. Over 80% of men and 50% of women in America will experience hair loss at some point in their life, a condition that brings a heavy emotional toll with it. It's important that this population receives adequate care and verified advice concerning these issues, but these trends on social media may be working against that goal, Farah said.
It's not always easy to differentiate between those people who provide good advice and those selling snake oil. "It can be very tricky, because the internet is full of bad advice," Ernst said. For those interested in taking better care of their hair and scalp, there are reliable resources. Ernst recommends looking for information on government-sponsored websites such as those of the National Institutes of Health, in the United States, or the National Health Service, in the United Kingdom. It is crucial that consumers approach each trend with healthy skepticism, he said, and remember the age-old adage, "If it sounds too good to be true, it probably is."
In addition to these online resources, there's a wide range of people who have expertise in hair disorders, said Farah. People can seek out the advice of board-certified dermatologists who can explain what's going on at scalp level. There are cosmetic chemists who make hair products and hair stylists who are expert in treating one's hair, she said. She also advises checking out the credentials of anyone promoting something for hair growth online to see whether they have actual expertise.
That's Farah's biggest takeaway from the roundabout world of influencing she's found herself in. She thinks social media can be a great tool to reach patients, but that people should be wary of what kind of information they're consuming. "People consuming social media need to be aware of who their hairfluencer is," she says.
As she and her co-authors write in their article, "We call on dermatologists, as hair and scalp disease experts, to serve as authorities on 'hairfluencer' trends and appropriately counsel patients."
The study was independently supported. Farah reports no relevant financial relationships.
J Cosmet Dermatol. Published online May 27. 2022. Abstract
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Cite this: Review Cautions Against Influencer-Promoted Hair Growth Remedies - Medscape - Aug 15, 2022.