Content Analysis of Psoriasis and Eczema Direct-to-Consumer Advertisements
Direct-to-consumer (DTC) advertisements have been associated with both beneficial and detrimental effects on real-world health care utilization. We aimed to evaluate advertisement placement, character representation, and disease-related content in psoriasis and eczema DTC advertisements. We conducted a content analysis of DTC advertisements televised on 4 major networks over 14 consecutive days in July 2018. In total, 13 advertisements for psoriasis and 27 advertisements for eczema were identified. Among psoriasis advertisements, 81 affected characters were shown, and among eczema advertisements, 80 affected characters were shown. Our findings suggest missed opportunities for education and patient reach among psoriasis and eczema DTC advertisements. Lack of diversity of characters among advertisements for psoriasis and eczema may reinforce existing and emerging treatment disparities.
Practice Points
- Racial/ethnic minorities and older adults are underrepresented in direct-to-consumer (DTC) advertisements for psoriasis and eczema.
- Character representation in psoriasis DTC advertisements, in particular, mirrors existing age and racial disparities in treatment with biologics.
- Disease-specific factual content was sparse, and obvious depictions of skin disease and symptoms were uncommon, especially among psoriasis DTC advertisements.
- Dermatologists should be aware of these deficiencies in psoriasis and eczema DTC advertisements and take care not to further reinforce existing knowledge gaps and inequitable treatment patterns among patients.
Psoriasis DTC Advertisements
There were 5 unique psoriasis DTC advertisements, all of which were product-claim advertisements, with 1 each for secukinumab (Cosentyx [Novartis]), ixekizumab (Taltz [Eli Lilly and Company]), and guselkumab (Tremfya [Janssen Biotech, Inc]), and 2 for adalimumab (Humira [AbbVie Inc]). The advertisements aired on ABC (n=5 [38.5%]), CBS (n=5 [38.5%]), and NBC (n=3 [23.1%]). Most advertisements aired on weekdays (61.5%) between 6
Psoriasis Character Portrayal and Disease-Related Content
We identified 81 main characters who were depicted as having psoriasis among all advertisements. Characteristics of the affected characters are summarized in the Table. All affected characters were perceived to be younger adults, and there was a slight female predominance (58.0% [47/81]). Most characters were perceived to be White (92.6% [75/81]). Black and Asian characters only represented 6.2% (5/81) and 1.2% (1/81) of all affected individuals, respectively. Notably, the advertisements that featured only White main characters were aired 2.75 times more frequently than the advertisements that included non-White characters.
Psoriasis was shown on the skin of at least 1 character in an obvious depiction (ie, did not require more than 1 viewing) in 84.6% (11/13) of the advertisements. Symptoms of psoriasis (communicated either verbally or visually) were included in only 15.4% (2/13) of advertisements. No advertisements included information on the epidemiology of (ie, prevalence, subpopulations at risk), risk factors for, pathophysiology of, or comorbid diseases associated with psoriasis.
Eczema DTC Advertisements
Among the 27 eczema advertisements aired, there were 4 unique advertisements, of which 3 were product-claim advertisements (all for crisaborole [Eucrisa (Pfizer Inc)]), and 1 was a help-seeking advertisement that was sponsored by Sanofi Genzyme and Regeneron Pharmaceuticals. The advertisements aired on ABC (n=2 [7.4%]), CBS (n=17 [63.0%]), and NBC (n=8 [29.6%]). All advertisements aired on weekdays between 7
Eczema Character Portrayal and Disease-Related Content
We identified 80 main characters who were depicted to be affected by eczema among all advertisements. Characteristics of the affected characters are summarized in the Table. Most of the affected characters were perceived to be White (53.8% [43/80]) and female (71.3% [57/80]). Other races depicted included Black (28.8% [23/80]) and Asian (17.5% [14/80]). Each unique eczema advertisement included at least 1 non-White main character. Most eczema main characters were perceived to be children (66.3% [53/80]), followed by younger adults (33.8% [27/80]). No infants, teenagers, or older adults were shown as being affected by eczema.
Skin manifestations of eczema were portrayed on at least 1 character in all of the advertisements; 77.8% (21/27) of the advertisements had at least 1 obvious depiction. Symptoms of eczema and the mechanism of disease (pathophysiology) were each included in 44.4% (12/27) of advertisements. This information was included exclusively in the single help-seeking advertisement, which also referenced a website for additional disease-related information. No advertisements included information on the epidemiology of, risk factors for, or comorbid diseases associated with eczema.
