Glow up

By Emily Margosian, Assistant Editor, February 1, 2025

With the growing popularity of beauty influencers and viral skin care routines, social media is playing an integral role in shaping how people care for their skin — particularly teens and tweens.

“The tide has really turned,” said Randa Khoury, MD, FAAD, a dermatologist with the Mid-Atlantic Permanente Medical Group (MAPMG). “I primarily used to get skin care questions from patients in their 30s and 40s. Now questions about skin care are equal, if not greater, from both parents and children as young as 10 or 11.”

Dallas dermatologist Elizabeth Houshmand, MD, FAAD, recently saw a nine-year-old patient accompanied by her mother. “She came in for a rash that she had developed from a skin care product. I was surprised at how young she was. When I let her know that we would have to discontinue use of the product, she was upset. She asked, ‘When can I have it back? When can I restart?’”

As a growing number of young people seek out skin care products, some may be adopting practices that are ultimately harmful to their skin health. This month, experts discuss what’s driving this trend and how dermatologists can partner with young patients and their parents to promote safe skin habits.

What are dermatologists seeing?

For millennials, xennials, and beyond, intricate skin care routines may seem at odds with the simple scrubs of the past.

“There are certainly still kids who come in with acne that never wash their face, but I’m definitely seeing more who have complex regimens or are experiencing complications related to the products they are using,” said Brooke Jeffy, MD, FAAD, a dermatologist in private practice in Scottsdale, Arizona, and founder of youth skin care brand btwn.

In the case of Dr. Houshmand’s young patient, the product in question contained an active ingredient unknown to the patient and her mother. “Her mother had gone with her to purchase it. The issue was that they had thought they were purchasing a moisturizer but ended up buying something that had an active ingredient in it. I’m seeing more and more of this, and in very young children. At 12 or 13, you don’t need actives like retinol or glycolic acid.”

Carol Cheng, MD, FAAD, a pediatric dermatologist at the University of California, Los Angeles, says shrewd marketing is often a common denominator among products that adolescent patients prefer. “Los Angeles is sort of a hub for skin care trends and what’s popular on social media. I see young patients primarily gravitate toward cleansers, toners, or sunscreen products. They’re also using exfoliants or masks for the skin. Many of these products have a good marketing team. They’re brightly colored, have fun packaging, and come with accessories or stickers.”

“They do not want drugstore brands with bland packaging. Certain brands have become status symbols.”

Dr. Jeffy agrees that young patients want trending brands, mostly choosing sprays, serums, and multi-step kits that promise dewy skin. “They tend to care less about the benefits of a particular product and more about packaging and who they see using the product. They do not want drugstore brands with bland packaging. Certain brands have become status symbols. Even where a product is purchased is important to them as part of the experience when sharing with their social circles,” she said. “I am always asking younger patients why they have chosen a particular product because I find it so interesting. Occasionally, I do run into one who has knowledge about active ingredients fueling their decision, but this is rare.”

While teens and tweens are often lumped together, dermatologists say this trend is especially pronounced among their youngest patients. “Among older teens, I haven’t noticed too much of a change in their level of interest in skin care over the past few years. Pre-teens — as early as eight or nine — are the ones I see coming into the office more,” said Dr. Cheng. “These visits are often driven by the patients themselves rather than the parents. Some bring in all their products and want to know the best routine to optimize their skin care regimen.”

Social media as a driver

Not surprisingly, the rise of social media has played a significant role in propelling adolescent interest in skin care to new heights. A recent JAAD analysis found that up to 91% of teens report using social media to access health information.

When young consumers make decisions about purchasing products, influencers are a key part of the equation, dermatologists say. “Brands using influencers to promote their products is a very successful tactic because kids have such a strong desire to fit in,” said Dr. Jeffy. “The relationship between a brand and an influencer can be hard to appreciate if not disclosed. Even if it is disclosed, kids often do not realize the implications of that relationship.”

“A lot of this interest comes from Instagram and ‘get ready with me’ videos posted by influencers who are sponsored by the companies that make these products,” agreed Dr. Cheng. “They’re tapping into a whole new pre-teen market, whereas previously they were more focused on teens, older adolescents, and people in their 20s and 30s.”

Peer influence and the desire to emulate others is also a major driver. “If your friends have these products or are doing this regimen, you want to try it too. One mom I spoke to said that her 13-year-old daughter wanted to purchase these products, not necessarily to use, but to make YouTube videos,” recalled Dr. Houshmand. “She wanted them in the background, sort of as props to emulate skin care influencers who also have these items in the background of their videos.”

A pervasive emphasis on the value of retaining youth has trickled down to a younger and younger audience, dermatologists say. “Our culture is obsessed with appearance. Kids see and want to emulate what their parents or older siblings are doing,” said Dr. Jeffy. “Virtual meetings and constantly being photographed by parents can feed into this as well. There are also unrealistic expectations set using photo filters resulting in pore-less, flawless skin which is not real.”

“Social media shows a lot of images that are both aspirational, as well as scary, to younger shoppers,” agreed Dr. Khoury. “Marketers jump on that. They’re also pricing these products high enough that pre-teens feel like they’re doing something great by making an investment — or asking their parents to make an investment — in this expensive and laborious thing that they’d like to do for their skin.”

Potential consequences

Aside from heavy social pressure and often hefty price tags, tween desire for skin care can also come with adverse physical reactions due to improper or inappropriate use.

“I’ve seen plenty of patients come in with irritant contact dermatitis on the eyelids, cracked and peeling lips, allergic contact dermatitis on the face, and even chemical burns from using products inappropriately. What they all have in common is that the skin barrier has been broken or compromised for no appreciable benefit,” said Dr. Khoury. “Children’s skin is not hardened in any way. They generally are far too young to have UV damage, and their skin is quite fragile. Using something like an abrasive exfoliator is very likely to create tears and irritation. When you put something on top of that, like an acid or a retinol, it gets into the deeper parts of the skin where it doesn’t belong and further expands upon that trauma.”

“It’s heartbreaking when a young patient, who is already self-conscious about their appearance, realizes that products they thought would give them some benefit have instead given them a visible skin problem,” said Dr. Jeffy. “The worst case I have seen was a tween using a retinol eye cream resulting in severe dermatitis and lichenification. She and her parents had no idea that the eye cream could cause this. I also commonly see kids with acne who are using way too many products and improve when we get on a simpler regimen.”

Silver linings

While tween interest in skin care has prompted some cause for concern, the trend is not wholly negative. Dermatologists say they have noticed an encouraging interest in sun protection and overall health among their younger patients.

“When I was that age, I didn’t have a skin care regimen,” said Dr. Houshmand. “I am very happy that they know to cleanse their skin, use sunscreen, and moisturize if needed.”

“I think this interest is coming from a good place,” agreed Dr. Cheng. “What I’m noticing with Gen Alpha is that they want to have more control over their body and their skin, and they’re more proactive about taking care of themselves. They’re using sunscreen; they want to have a good regimen for their skin. At the same time, it can be a double-edged sword, because some of these products can have adverse reactions,” said Dr. Cheng.

Setting realistic expectations

The best skin care routine for tweens and teens? A simple one. Most dermatologists agree that for adolescents with normal skin free of acne, a gentle cleanser, skin type-appropriate moisturizer, and sunscreen are all that is needed.

“Many younger patients are blessed with beautiful, well-hydrated skin, so they don’t even necessarily need a moisturizer in addition to the sunscreen,” said Dr. Khoury. “If you have a specific skin concern, such as acne, eczema, rosacea, or milia, that changes things. Then you should partner with the dermatologist to find out what additions you should make to that baseline skin care routine to address those specific concerns. However, assuming there are no specific concerns or medical diagnoses, a gentle cleanser twice a day, sunscreen in the morning, and a light moisturizer at night is all you need. This is really all anyone needs at any age to take care of healthy skin.”

“For children ages eight to 13 with regular, healthy skin, they can use a gentle cleanser if they’re playing sports. Otherwise, I think washing with water in the morning is fine,” said Dr. Houshmand. “They should then use a sunscreen if they’re going to be outside or going to school. If they have any dryness, a moisturizer is fine. That is a simple routine I recommend.”

Enter acne: Puberty’s role in skin care habits

Adolescence is an age when many people develop acne. This timing in regard to tweens’ pursuit of skin care is not coincidental, dermatologists say.

“Acne has always been one of the main reasons people go to purchase products,” said Dr. Houshmand. “There’s so much on TikTok and Instagram influencing people to make purchases that might help with their acne. However, it is always best to intervene early and see a dermatologist to have a routine customized for you.”

As a pediatric dermatologist and supervisor of UCLA’s acne clinic, Dr. Cheng is well-versed with this issue. “Often before they get to us in dermatology, they’ve likely tried a lot of things with their pediatrician or products they’ve seen online or recommended by their friends and family,” she said. “However, over-the-counter products can be helpful. I don’t think it’s necessary for everybody to jump straight into seeing a pediatric dermatologist as soon as they get acne because we just don’t have that sort of workforce capability and oftentimes it’s not necessary for mild acne.”

For patients with mild acne, Dr. Cheng recommends over-the-counter products that contain salicylic or glycolic acid, benzoyl peroxide, or adapalene gel. “For patients who don’t respond, have moderate-to-severe acne, are developing scarring, and/or experiencing negative psychosocial effects, at that point, dermatologist evaluation and the option of prescription strength treatment would be appropriate,” she said.

“I think there are excellent products available. However, acne is complex and not everyone’s acne is the same,” said Dr. Houshmand. “If it’s not resolving after a few weeks, then it’s probably time to see a board-certified dermatologist so we can customize an appropriate treatment plan for that patient. There’s nothing wrong with over-the-counter products, and I may be the one incorporating those into their regimen. However, unfortunately a lot of times with acne we see people buy a lot of different products. They may be good products with quality ingredients. However, the combination may be too much for their skin or may not be enough. Acne is something where self-treating and self-diagnosing doesn’t help.”

According to Dr. Jeffy, less is more when it comes to skin care for acne concerns. “I have seen kids using 12-step regimens for acne when they are not doing the basics well or even at all. For example, removing makeup at night. Often kids have no idea how to do these things. They spend five seconds cleansing, or they do not even use cleanser. It’s also important to stress that the patient should match products to their skin type. A 14-year-old with oily skin is not going to like a heavy cream moisturizer.”

Partnering with patients and parents

In a crowded field of online advice and competing influences, dermatologists are uniquely qualified to educate young patients and their parents on appropriate skin care habits. However, navigating a patient’s desire to continue use of a product that isn’t right for them can be a tricky needle to thread.

In the case of Dr. Houshmand’s nine-year-old patient, alternative options at a lower price point were not compelling. “This was really important to her to use a product from the line she selected. We ended up researching and settling on an emollient moisturizer from that specific line, which did not have any active ingredients in it. I think it’s important to speak directly to the patient, because they’re very savvy and want to be involved with their care. They should be part of the discussion.”

Dr. Khoury says she has several tactics to persuade patients to see eye-to-eye. “I usually tell my patients that everybody is a little bit different. That’s why so many fabulous skin care products exist at so many different price points. We’re not trying to tell you that everybody needs to use the same three things,” she explained. “However, if they have become attached to a product that’s causing a negative reaction, we are here to tell you — as expert physicians who specialize in the skin — that doing the most is not doing the best.”

Dr. Cheng occasionally has patients who bring their full collection of products to a visit. “I think it’s important to try to understand what their goals are and try to partner with them. The most important thing is to listen to the patient’s reasons for using a specific product and being non-judgmental about it. I then let them know that it’s great that they’re being proactive about their skin but that I’m trying to help them understand what products are appropriate for them.”

“We are here to tell you — as expert physicians who specialize in the skin — that doing the most is not doing the best.”

Dr. Khoury likes to give patients a weightlifting analogy when discussing skin care — a metaphor she says resonates particularly effectively with Gen Alpha due to their particular interest in fitness. “I say it’s like when you start lifting weights. If you’re feeling a lot of pain, the right thing to do isn’t to add more sessions or increase your weight,” she explained. “You’re just going to hurt yourself. It’s similar for skin care. By no means should you be starting with these aggressive products. That’s like walking into the gym the first day and trying to lift 100 pounds. It’s not necessarily a bad thing that you’re doing; you’re just going about it at the wrong time and too aggressively. If you want to start something like a retinol, there’s an appropriate time to do that, and it’s not when you’re very young.”

Communicating with parents sometimes requires a slightly different approach. Dr. Jeffy maintains an active social media presence (@brookejeffymd) specifically geared toward educating parents about safe skin care for their children. “I just noticed such a need with parents asking more and more questions about how their children should be caring for their skin and which products to use,” she said. “I wanted to help on a larger scale by educating and myth busting which meant going to where the kids and parents are — social media. For parents, I like to point out that this is a great opportunity to talk about social media habits. For example, who to trust for information, and that what we see on social media is not as it appears. It’s important to ask questions like: ‘Is there a filter being used?’ ‘Has the image been altered?’ Or, ‘is the influencer being paid to say a certain thing?’”

“With parents, it’s tricky because they want to do what’s best for their kid,” said Dr. Cheng. “When speaking to parents, I emphasize that they should be watching what their child is purchasing. Make sure you’re supervising what may or may not be appropriate. Also watch them to make sure that they’re using the skin care products that they have appropriately. For example, not using too much or reminding them of key steps of routines.”

According to Dr. Khoury, while guiding adolescents on safe skin care habits is important, parents and physicians should be careful to avoid extinguishing what is ultimately an interest in improving their health. “Something I’d like to share not just as a dermatologist, but as a mom of young children myself, is walking the fine line of not villainizing or discouraging their interest in taking good care of their skin,” she said. “If social media has done anything good for us, it has highlighted the fact that you only get one body; you only get one skin. It is fabulous that they’re so invested in wanting to care for that and protect it from a young age. It’s just gone somewhere dark. Redirecting that energy while keeping their enthusiasm for prioritizing an early interest in skin health is something that I try to do with my own children at home.”

Additional DermWorld Resources