In Korea, the proportion of internet users relative to the entire population has rapidly increased, and the effects of the internet are becoming more apparent1. As quality of life improves, people's interest in their own outward appearance has also been increasing, in turn increasing programs or articles about dermatological diseases23. However, studies evaluating information on dermatological diseases presented to the general public through freely available domestic newspapers or broadcasting programs have indicated that the information was often obtained from uncertain sources or differed from established facts23. Kilkenny et al.4 reported that <50% of patients with skin disease sought doctors' advice regarding the disease.

The purpose of this study was to analyze the content and level of reliability of newspaper articles issued by many domestic media regarding alopecia, and to assess differences in recognition between dermatologists and common readers.

As quality of life has been enhanced, dermatologic disease has become a subject of interest. In line with these changes, related articles by various mass media outlets have been increasing. Cho et al.3 analyzed domestic television broadcasting programs dealing with dermatology-related issues and reported that hair-related content accounted for 10.1% of all broadcasted content. According to data from the Korea Press Foundation (http://www.kpf.or.kr/), although the readership of domestic print newspapers decreased by approximately 50% over the past 10 years, consumption of news obtained through the internet increased such that, overall, news readership has increased. The effects of these media outlets on public recognition of hair loss diseases are expected to further increase.

Our analysis of article titles showed that three newspapers mostly used titles containing both information and interest. When information in titles was analyzed, the majority of them were medically indeterminate or contained irrelevant information. In particular, newspaper C showed a significantly different distribution in the accuracy analysis. The ranking of online newspapers, as determined by the view count and number of clicks, is dependent on the title. Thus, authors prefer enticing titles that arouse readers' interest, and may even revise titles irrelevant to contents5. Because titles are exposed more frequently than articles in online newspapers, their importance cannot be overlooked.

Chang et al.6 found that, in judgments of article quality, the author is the most easily recognizable and important element. In particular, for subjects requiring expertise, such as health, the reliability of the article is largely dependent on whether the author is an expert in the field, or a reporter who specializes in a particular area. Articles in newspapers A and B specified the author and, in the case of articles written by reporters, they had sufficient relevant experience. On the other hand, none of the articles in newspaper C revealed the author identities.

“Alopecia” was mentioned in most articles in all three newspapers, but it can be easily misunderstood as referring only to certain hair loss diseases; our study showed that a large proportion of newspaper articles equated alopecia with specific diseases, usually MPHL. To prevent confusion, this generally used, ambiguous term should be substituted with a more accurate one. The prevalence of MPHL is higher than that of any other hair loss diseases. However, considering the fact that 73.7% of patients who visited the hospital for alopecia had AA in a previous study, the excessive emphasis on MPHL in media should be addressed7.

According to results of our analysis of article tone, whereas articles in newspapers A and C showed a positive tone, newspaper B had more articles with a neutral tone. Among articles in which the name of specific products, institutions, or company names were given, a positive tone was detected in 58.8% and there was no article with a negative tone. If articles are considered as kinds of indirect advertisement, it is possible that they will be concerned mainly with advantages of products, to maximize advertising effects, consequently affecting the overall tone of the articles. If the term “alopecia” is entered into Google or Yahoo search engines, scientific organizations and trustworthy patient guidance sites based in the US or UK appear first, alongside the dictionary definition of alopecia. However, if an individual searches the term “talmo,” which means alopecia in Korean, on Naver or Daum, the most popular portal site in Korea, advertisements appear first followed by dictionary meanings. This clearly shows differences in the recognition of alopecia on the internet among countries.

When the accuracy of the article contents was analyzed, in newspaper B, the ratio of articles with a low level of accuracy was the lowest (17.3%) and that with a high level of accuracy was the highest (47.2%), while the reverse situation was found in newspaper C. This difference between the two newspapers might be associated with differences in authors, terms, distributions of cited experts, and frequencies of advertisement exposure, as shown in the present study. From our viewpoint, as a whole, neither the ratio of articles with a high level of accuracy (40.8%) nor that of each newspaper was considered sufficient.

Expert opinions represented the most frequent type of evidence presented in articles. Dermatologists were the most frequently cited experts in newspapers A and B. Non-dermatological specialists constituted the highest proportion of cited experts in newspaper C. We performed a further analysis of the accuracy of article content according to type of quoted expert: among articles that quoted dermatologists, 63.4% were rated as high-grade for accuracy and 7.0% were low-grade; for articles that quoted experts other than dermatologists, 26.7% and 40.0%, respectively. Selecting articles that identify quoted experts may be one of the best ways for readers to avoid articles with low accuracy.

People in Korea commonly obtain information on alopecia from the internet, hospitals, beauty shops, or scalp care centers. Many studies have been conducted on the reliability of the health information currently available on the internet, and most of them showed low reliability68910. In our questionnaire survey, scores assessed by dermatologists were highest for newspaper A, followed by newspapers B and C; differences among the three newspapers were statistically significant. Although scores for reliability given by common readers showed a similar pattern, the difference among the newspapers was much smaller than that in the dermatologist group. Additionally, in the comparison of reliability scores of each newspaper, scores given by common readers were higher than those given by dermatologists for all newspapers; the difference in reliability score was statistically significant between each two groups. These results indicate that common readers tend to give higher grades, indicating an insufficient discernment capacity and higher possibility of accepting article contents at face value. Therefore, more emphasis should be placed on enhancing the accuracy of articles.

A limitation of this study was that it concerned articles published in only three newspapers. In addition, because some items on the evaluation form required subjective judgments, subjectivity could not be completely eliminated despite the fact that conclusions were drawn according to agreement among three dermatologists.

In conclusion, considering that common readers showed a tendency to uncritically trust articles, writers should make an effort to use proper terms and provide accurate evidence. Moreover, physicians should endeavor to correct inaccurate information.