Dermatologists’ Perspectives on Skincare Routine Trends

Background

Skincare routines refer to the structured and repeated use of topical products intended to maintain or improve skin health. In this study, skincare routines specifically refer to commonly used product categories, including cleansers, moisturizers, sunscreens, exfoliants (eg, alpha- and beta-hydroxy acids), and topical active ingredients such as retinoids and anti-aging products, consistent with recent Delphi consensus recommendations from cosmetic dermatologists.¹ Over the past two decades, and particularly in recent years, multi-step skincare routines have gained substantial popularity across all age groups, with particularly high uptake among adolescents and young adults.^2,3 These routines often involve the sequential application of multiple products, sometimes comprising extensive multi-step regimens that may include ten or more steps, many of which are costly and heavily marketed.^4,5

This growing interest in skincare is reflected in the rapid expansion of the global skincare market, a multi-billion-dollar industry driven by aggressive marketing, frequent product launches, and social media exposure.^5–7 The popularity of multi-step routines has been further amplified by the global rise of Korean beauty (K-beauty), which is characterized by highly layered skincare regimens, sometimes comprising ten or more steps, and which have been widely adopted in Western skincare culture.⁴ Social media platforms such as TikTok and Instagram play a central role in disseminating these routines. Influencers and commercial brands frequently promote elaborate regimens as essential for achieving flawless or “healthy” skin, often using marketing claims that are not supported by scientific evidence.^2,4

Numerous studies have evaluated the efficacy of individual skincare ingredients, particularly UV protection, moisturizers and active compounds such as retinoids. However, clinical evidence supporting the effectiveness of complete multi-step skincare routines as a whole remain limited.^4,8–10 Existing research primarily focuses on specific dermatological conditions, including acne, atopic dermatitis, photoaging, and rosacea, rather than on routine skincare use in otherwise healthy skin.^8,10,11 As a result, the necessity and added value of elaborate routines for the general population remain largely unknown.

In addition, excessive or improper use of skincare products may lead to adverse effects, including skin irritation, barrier disruption, allergic contact dermatitis, photosensitivity, perioral dermatitis, and acneiform eruptions.^2–4,12,13 These risks may be amplified when multiple products containing active ingredients are layered simultaneously, a phenomenon sometimes referred to as “ingredient overload.”

Social media not only shapes consumer preferences but also increasingly influences health-related decision-making. Previous studies have shown that a substantial proportion of individuals consult social media for information on skin conditions, often prior to seeking professional medical advice, and in some cases instead of consulting a physician altogether.⁶

This influence is particularly concerning in younger populations. Pediatric-focused analyses of skincare-related TikTok videos have described complex routines and frequent promotion of active ingredients, often with limited alignment to evidence-based dermatologic recommendations.² More broadly, analyses of dermatology-related TikTok content have demonstrated that a substantial proportion of posts are created by non-specialists, with variable reliability and limited involvement of board-certified dermatologists.^6,14 Together, these findings raise concerns about potential misinformation and its impact on younger audiences. In addition to dermatologic risks, social media–driven skincare trends may contribute to unrealistic appearance standards and appearance-based comparison, potentially influencing self-perception and skincare behaviors among children and adolescents.^13,15 Given the immature and developing skin barrier in children, inappropriate skincare practices may increase susceptibility to irritation and other adverse effects.³

In response to the growing skincare hype, dermatologists have increasingly taken to media platforms to share professional insights and counter misinformation.¹⁴ Despite their rising public visibility, the collective opinion of dermatologists on this trend has not yet been systematically studied. To our knowledge, this is the first study to evaluate the perspectives of dermatologists on the current skincare movement, its perceived clinical consequences, and the role of social media in shaping skincare behavior.

Objectives

This study aimed to explore dermatologists’ perspectives on multi‑step skincare routines, the influence of social media on skincare behavior, and the perceived benefits and risks associated with these increasingly popular practices.

Materials and Methods

This cross‑sectional survey‑based study was conducted in accordance with the ethical standards of the institutional research committee. The study was carried out by Alrijne Hospital in the Netherlands. A digital questionnaire was distributed between May and June 2025 to Dutch practicing dermatologists and dermatology residents via the Dutch Society for Dermatology and Venereology (NVDV). A total of 749 individuals were invited to participate. Participation was voluntary, and only respondents who completed the full survey were included in the analysis. Eligible participants were practicing dermatologists and dermatology residents; non-practicing individuals and incomplete responses were excluded. All participants provided informed consent.

The survey was developed by the research team based on the study objectives and existing literature, and pilot‑tested among three dermatologists prior to distribution to assess clarity and relevance. The questionnaire included items on demographic characteristics, attitudes toward multi‑step skincare routines, perceived risks and benefits, observed skincare‑related dermatoses in clinical practice, commonly implicated ingredients, recommended routine complexity, suggested starting age, and the perceived influence of social media. The full questionnaire is provided in the Supplementary Material (Supplement 1 and 2). The survey was administered using Castor EDC (version 2023.4.0.1).

Descriptive statistics were used to summarize respondent characteristics and survey outcomes. Associations between respondent characteristics, attitudes, and clinical observations were explored using Fisher’s Exact Test and Mann–Whitney U-test and Spearman’s rank correlation. Statistical analyses were performed using SPSS version 28.0.1.0. A P‑value <0.05 was considered statistically significant.

Results

A total of 168 dermatologists participated in the survey (response rate 22.4%), including 146 board-certified dermatologists (86.9%) and 22 residents (13.1%). Respondents represented a broad range of ages and practice settings (Table 1).

Table 1 Characteristics of Participating Dermatologists (N = 168)

The vast majority of respondents (91.6%) expressed concern about the increasing popularity of multi-step skincare routines. Frequently cited concerns included an increased risk of skin irritation (64.9%), unrealistic expectations regarding skin outcomes (57.1%), limited scientific evidence supporting certain products (51.2%), allergic contact dermatitis (54.8%), and high financial costs for patients (45.8%) (Table 2). Additional concerns included the use of products unsuitable for skin type (20.2%), environmental impact (1.2%), and increased societal inequality related to access to expensive skincare products (0.6%).

Table 2 Summary of Key Survey Findings on Attitudes, Observed Complications, and Social Media Influence (N = 168)

Despite these concerns, 79.8% acknowledged potential positive aspects of the trend, particularly increased awareness of skin health (75.0%) and sun protection (29.2%). However, only 12.5% actively recommended structured multi-step routines in clinical practice.

Most dermatologists (88.1%) reported regularly encountering patients with skincare-related skin problems. The most commonly observed conditions were irritant eczema (69.6%), perioral dermatitis (53.0%), allergic contact dermatitis (52.4%), and acne exogenica (42.3%).

Retinoids (41.7%) and fragrances (53.0%) were most frequently identified as ingredients associated with these complaints. Associations between reported ingredients and specific dermatoses are presented in Table 3. Within dermatologists’ reports, retinoid-containing products were significantly associated with irritant eczema and acne exogenica. Alpha- and beta-hydroxy acids (AHAs and BHAs) were significantly associated with perioral dermatitis, and BHAs were additionally associated with acne exogenica and allergic contact dermatitis. Fragrances and products marketed as containing natural ingredients were most commonly linked to allergic contact dermatitis. No significant associations were observed for niacinamide.

Table 3 Associations Between Reported Problematic Ingredients and Dermatologists’ Observations of Specific Skin Conditions

Only 12.5% of respondents actively recommended structured multi-step skincare routines. Most dermatologists favored simple regimens, commonly recommending three steps [IQR 2–4] for women with healthy skin (40.5%) and individuals with dry skin (36.3%), and two steps [IQR 2–3] for men with healthy skin (39.3%). The median recommended starting age for a basic skincare routine was 15.5 years [IQR 12.3–16.0]. Notably, 45.8% of the dermatologists themselves followed multi-step routines.

Social media was perceived as highly influential on skincare behavior, with 86.3% of respondents rating its impact as 8 or higher on a 10-point scale. All dermatologists reported encountering skincare-related misinformation in clinical practice, with 44.0% observing misinformation weekly and 41.7% monthly. In addition, 81.0% believed that social media promoted inappropriate self-treatment, and 23.2% observed delays in dermatological consultation due to online skincare advice. Moreover, 89.3% noted adolescents starting routines at younger ages. Higher perceived social media influence was significantly associated with noticing younger individuals starting extensive skincare routines (Spearman’s rho = 0.174, p = 0.024), but not with general worries about the skincare trend (Spearman’s rho = 0.123, p = 0.113).

Women were more likely than men to express concern about the skincare trend (OR 4.1, 95% CI 1.3–12.7; p = 0.015). Observing younger individuals initiating skincare routines was also associated with higher odds of concern (OR 4.0, 95% CI 1.1–14.4; p = 0.047). No significant associations were found between concern and age, professional position, or reporting of skincare-related complications.

Discussion

This nationwide survey provides the first systematic overview of dermatologists’ perspectives on the rapidly growing trend of multi-step skincare routines and its clinical consequences. The high level of concern among dermatologists suggests that the rapid expansion of these routines may not be aligned with clinical practice or evidence-based recommendations, which is further supported by the frequent reporting of skincare-related dermatoses in daily clinical practice.

These findings are consistent with previous studies reporting increasing concerns about the safety and necessity of complex skincare routines, particularly in the absence of medical indication.^8–10 While individual ingredients such as retinoids, exfoliating acids, and antioxidants have demonstrated efficacy in specific dermatological conditions, evidence supporting their routine combined use in otherwise healthy skin remains limited.^3,8,9 The high prevalence of reported patients with irritant and inflammatory dermatoses suggests that cumulative exposure to multiple active ingredients may contribute to skin barrier disruption and subsequent clinical complaints.^4,10

Retinoids warrant particular consideration. Although they are among the most extensively studied and effective topical agents for acne and photoaging, they are also well known to cause irritation, especially when introduced at high concentrations, used too frequently, or combined with other active ingredients.^4,16 In this study, retinoid-containing products were significantly associated with irritant eczema and acne exogenica, suggesting that unsupervised use—often guided by social media rather than medical advice—may increase the risk of adverse effects rather than therapeutic benefit.^2,6,15 Given their established comedolytic properties, the observed association with acne exogenica likely reflects patterns of overuse, combination with occlusive products, or clinical attribution within complex skincare routines rather than a direct comedogenic effect of retinoids themselves. Importantly, this does not diminish the well-established role of cosmetic actives in improving functionally impaired skin, such as photodamaged or intrinsically aged skin, when used appropriately and under professional guidance.^4,8

Similarly, exfoliating agents such as alpha- and beta-hydroxy acids were strongly associated with perioral dermatitis, irritant eczema, and allergic contact dermatitis. These findings further support concerns regarding combining multiple exfoliating products within a single routine, a practice commonly promoted in online skincare content.^2,12

In addition to active ingredients, other formulation components may contribute to skin irritation. Surfactants, which are widely used in cleansers and some topical formulations, can impair skin barrier function and contribute to dryness and irritation, particularly with frequent or excessive use.¹⁷ Although not specifically assessed in this study, cumulative exposure to surfactants within multi-step routines may further contribute to the development of irritant dermatoses.

Social media emerged as a prominent theme in the results of this study. The vast majority of respondents rated its influence on skincare behavior as high, and nearly one quarter reported observing delayed dermatological consultation due to online advice. These observations suggest that social media is not merely shaping consumer preferences, but may also influence clinical decision-making and healthcare-seeking behavior. Similar patterns of public reliance on online dermatologic advice have been described previously.^6,15

Prior analyses of dermatology-related TikTok content have demonstrated limited involvement of board-certified dermatologists and variable alignment with evidence-based recommendations.^6,14 In our survey, dermatologists reported frequent encounters with misinformation and inappropriate self-treatment, suggesting that online skincare content may influence patient behavior in clinical practice.

In addition, respondents noted that adolescents are initiating complex skincare routines at increasingly younger ages. This aligns with pediatric-focused analyses describing complex, commercially driven skincare regimens on social media platforms.^2,3 Beyond dermatologic risks, social media–driven skincare trends may contribute to unrealistic appearance standards and appearance-based comparison, potentially influencing self-perception and skincare behaviors among children and adolescents.¹⁵ While social media platforms offer opportunities for education and professional engagement, our findings suggest that professional input may not yet adequately offset commercially driven or non–evidence-based content.

Although nearly 80% of dermatologists acknowledged potential positive aspects of the skincare trend, such as increased awareness of skin health and sun protection, only a minority actively recommended structured multi-step routines. Instead, professional recommendations consistently emphasized simplicity and daily sunscreen use as the cornerstone of skincare. While daily sunscreen use is widely recommended, appropriate use tailored to individual skin type, exposure patterns, and environmental context remains important. In contrast, components heavily promoted on social media, such as serums and exfoliants, were rarely considered essential by respondents. This strong emphasis on sunscreen contrasts with recent analyses of online skincare routines, which report that sun protection is included in only about a quarter of videos featuring commonly promoted regimens.² Together, these findings highlight a disconnect between professional recommendations and consumer-driven skincare practices and are consistent with recent expert consensus statements, including a Delphi-based consensus on holistic skincare routines emphasizing simplified, evidence-based regimens designed for specific dermatological conditions rather than elaborate multi-step routines for the general population.⁸

Addressing this disconnect may require improved patient education, clearer public messaging from dermatological societies, and greater professional engagement on widely used digital platforms to counter misinformation and promote simple, safe, and evidence-based skincare practices. Future research should focus on prospective studies and patient-level data to better quantify the risks and benefits of commonly promoted skincare routines, particularly in adolescents and other vulnerable populations.

A major strength of this study is its nationwide scope and focus on dermatologists’ clinical experiences. However, limitations should be acknowledged. A convenience sampling approach was used, which may limit the representativeness of the study population. Response bias is possible, as dermatologists with strong opinions may have been more inclined to participate. Nevertheless, the relatively large sample size and the inclusion of respondents across a broad range of ages and practice settings strengthen the relevance of the findings. The study did not account for differences in skin type or pigmentation, which may influence skincare practices and susceptibility to certain adverse effects. Finally, as the study was conducted in a single Western European country, generalizability to other regions may be limited, although the global nature of social media suggests broader relevance. While the response rate was modest, it is comparable to other physician survey studies. These findings reflect professional perceptions rather than objectively measured clinical outcomes and should be interpreted accordingly.

Conclusions

This study provides the first systematic assessment of dermatologists’ perspectives on the current multi-step skincare hype. Dermatologists expressed substantial concern regarding the widespread adoption of complex skincare routines, frequently reporting associated skin irritation and allergic reactions in clinical practice. While some benefits were acknowledged, particularly increased awareness of sun protection, only a minority of dermatologists recommended multi-step routines. Instead, simplicity and daily sunscreen use were consistently emphasized. These findings suggest a growing disconnect between popular skincare trends and evidence-based dermatologic guidance. Bridging this gap will likely require improved public education, stronger professional communication, and further research into safe and effective skincare practices.