RESEARCH ARTICLE

Epidemio-clinical Profile of Atopic Dermatitis in

Children in General Population in Parakou (Benin)
Nadège Agbessi1, Fabrice Akpadjan2, Bérénice Dégboé2, Gloria Nouhoumon1,
Christiane Koudoukpo1, Hugues Adegbidi2, Félix Atadokpédé2

Department of Dermatology-Venereology, Faculty of Medicine of Parakou, University of Parakou, Benin,

1

Department of Dermatology-Venereology, Faculty of Health Sciences of Cotonou, University of Abomey-Calavi,

2

Benin

ABSTRACT

Introduction: The aim of this study was to determine the epidemiological and clinical profile of atopic dermatitis (AD)
in children in Parakou (Benin). Materials and Methods: This was a cross-sectional, descriptive, and analytical study
of children aged 0–15 years old, selected after a two-stage cluster survey carried out. The diagnosis of AD was laid the
basis of the criteria of the working group of the United Kingdom (UKWP). Data were analyzed with the Epi-info version
3.5.1. Results: A total of 157 children with AD were selected between 2160 (7.27%). Their mean age was 4.74 ± 4.33
years old. The sex ratio was 1.57 and the majority of children (80.25%) were doing their pushes regardless of the climatic
season. The predominant elemental lesions were erythema (91.97%), crusts, erosions (74.45%), and vesicles (40.88%).
Some children had at least two lesions. The most recognized minor signs of atopy were cutaneous xerosis (91.97%) and
Dennie-Morgan sign (76.64%). Lesions were predominant in the retroauricular folds (41.61%). The dominant clinical forms
were vulgar eczema (48.18%), lichenified forms (32.85%), and impetiginized forms (24.09%). According to the Scoring
Atopic Dermatitis (SCORAD), 67.15% had moderate AD. Conclusion: The frequency of AD in children in Parakou is not
negligible and the clinical manifestations are varied.

Key words: Epidemiology, Clinical, Atopic dermatitis, Children, Parakou

INTRODUCTION A preliminary census of all cases of AD received in

A
the dermatology-venereology department at Borgou-
topic dermatitis (AD) is a pruritic inflammatory Alibori CHU in Parakou (Benin) since its creation
dermatosis with a genetic predisposition that (from January 2009 to December 2017, i.e., 8 years)
evolves by recurrent flare-ups affecting mainly concluded that the hospital incidence was 1.6%,[7] and
infants and small children.[1] Worldwide, its prevalence led us to carry out the study in the general population.
has doubled or tripled over the past 30 years.[2] In Africa,
the disease is increasingly reported.[3-5] Although AD MATERIALS AND METHODS
is not lethal, it can result in significant morbidity and
societal cost.[6] Thus, AD is now a real public health This was a transversal descriptive and analytical study that
problem. In Parakou, in the north of Benin, no data took place from April 30 to July 28, 2018. It was conducted
on AD were known. The aim of this study was to in thirty neighborhoods/villages of the township of Parakou,
determine the epidemiological and clinical profile of capital of the Department of Borgou in the Republic of
atopic dermatitis (AD) in children in Parakou, Benin. Benin. Children aged 0–15 years at the time of the survey

Address for correspondence: Fabrice Akpadjan, Department of Dermatology, Venereology, National Hospital and
University Centre of Cotonou, Faculty of Health Sciences, 09BP: 441 Cotonou, Benin
https://doi.org/10.33309/2639-8524.030102 www.asclepiusopen.com
© 2020 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

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 Agbessi: Atopic dermatitis in children in Parakou (Benin)

were included in the study, selected after a two-stage cluster

survey. The minimum sample size was determined using the
Schwartz formula. The diagnosis of AD was selected on the
basis of the UKWP diagnostic criteria:

An itchy skin condition (or parental report of scratching or

rubbing in a child)

Plus three or more of the following

1. History of involvement of the skin creases such as folds
of elbows, behind the knees, fronts of ankles, or around
the neck (including cheeks in children under 10).
2. A personal history of asthma or hay fever (or history of
atopic disease in a 1st-degree relative in children under 4).
3. A history of a general dry skin in the last year.
4. Visible flexural eczema (or eczema involving the cheeks/ Figure 1: Localized dermatosis on the wrist and back of the
forehead and outer limbs in children under 4). hand vesicles + erosions
5. Onset under the age of 2 (not used if child is under 4).
Table 1: Different objectified elementary lesions
Clinical and epidemiological data were collected using a pre-
Elementary lesions (n =137) Number Percentage
established and pre-validated questionnaire in two villages
in the township of Tchaourou not included in this study. All Cracks 2 1.46
children were examined by a dermatologist. The data were Pustules 8 5.84
entered using Epi data 3.5.1 software and analyzed using Epi- Papules 12 8.76
info version 3.5.1 software. Edema 13 9.49
Excoriations 18 13.14
RESULTS Scales 23 16.79
Oozing vesicles 54 39.42
A total of 157 children with AD were diagnosed among 2160
interviewed and examined, a prevalence of 7.27% (95% Non oozing vesicles 58 42.34
CI of 6.23–8.42). Their average age was 4.74 ± 4.33 years Scabs and erosions 102 74.45
with a sex ratio of 1.57 (96 males to 61 females). Most of Erythema 126 91.97
the children (80.25%) had relapses regardless of the climatic
season (dry or rainy).
Table 2: Different stigmas of atopy noticed
Among the 157 children, the physical exam was abnormal in Minor signs (n=137) Number Percentage
137 children, that is, 87.26%, with four having generalized White demography 0 0.00
pruritic dermatosis and 133 having localized pruritic
Cheilitis 2 1.46
dermatosis [Figure 1]. Erythema (91.97%), and scabs and
erosions (74.45%) were the predominant primary lesions Ichthyosis 2 1.46
[Table 1]. The minor signs of atopy noted in these 137 Achromians eczematides 3 2.19
children were cutaneous xerosis (91.97%) and Dennie- Periorbital hyperpigmentation 4 2.92
Morgan’s sign (76.64%). No white demography was noted None 4 2.92
[Table 2].
Palmoplantar hyperlinearity 9 6.57
Retro auricular groove was the predominant site (41.61%), Low hair implantation 9 6.57
followed by the elbow fold (25.55%). Simple follicular keratosis 25 18.25
• Before the age of 2 years (n=46), the top 5 sites were Retroauricular cracks 50 36.50
retroauricular groove (18.98%); forehead (13.14%); Dennie-Morgan’s sign 105 76.64
cheeks (12.41%); elbow folds (10.22%); neck (8.76%);
Xerosis 126 91.97
arm (8.76%); and forearm (7.30%).
• After 2 years (n=91), the first 5 sites are the retroauricular
grooves (22.63%); the feet (17.52%); the elbow folds Lichenification was the leading complication [Table 3]
(15.33%); the axillary regions (14.60%); and the (32.85%), followed by impetiginization (24.09%) [Figure 2].
buttocks (13.87%). Eczema vulgaris (48.18%) was the predominant clinical

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 Agbessi: Atopic dermatitis in children in Parakou (Benin)

Table 3: Various complications observed Table 4: Clinical forms

Complications (C) (n=137) Number Percentage Clinical forms (n=137) Number Percentage
Growth retardation 0 0.00 Nummular eczema 0 0.00
Ophthalmology 0 0.00 Juvenile dermatitis plantar 0 0.00
Psychic impact 1 0.73 Nipple eczema 0 0.00
Contact dermatitis 2 1.46 Prurigo of Besnier 1 0.73
Impetiginization 33 24.09 Atopic cheilitis 2 1.46
Lichenification 45 32.85 Erythrodermal eczema 4 2.92
Dysidrosic eczema 4 2.92
Impetiginized eczema 33 24.09
Lichenified eczema 45 32.85
Eczema vulgar 66 48.18

studies in Cameroon,[9] Togo (Lome),[10] and Cotonou (Benin)

noted female predominance. This significant difference with
the results of these three studies could be related to the action
of certain factors considered to protect or promote atopic risk
influenced by gender as suggested by Hagendorens et al.[12]

A total of 61.15% of children began the disease before the

age of 2 years. An onset before the age of 2 years in all
sick children (100%) was also noticed in Marrakech.[8] In
Cotonou, on the other hand, in 2009, only 25.7% of patients
Figure 2: Lichenified and impetiginized eczema started the AD before the age of two.[4]

form [Table 4], followed by lichenified (32.85%) and Erythema (91.97%) and scabs and erosions (74.45%) were the
impetiginized (24.09%) forms. According to the AD severity predominant basic lesions. These results are similar to those
score (SCORAD), 41 children (29.93%) had mild AD, 92 found in Cotonou in 2009[4] as concerns xerosis (90%) and
(67.15%) had moderate AD, and 4 (2.92%) had severe AD. scabs and erosions (67.65%). However, erythema was present
in only 50% of their patients. Furthermore, the presence of
erythema was noted in 78.6% of patients in Marrakech in
DISCUSSION 2015,[8] but scabs and erosions were less frequent in their
context (35.7%). This proportion of erythema found by the
The main limitation of this study is inherent to the fact that
present study compared to the study conducted in Cotonou
allergological tests are not carried out due to the lack of
calls into question the difficulty of assessing (in defect or
access to reagents.
excess) erythema on black skin.
The prevalence of AD determined by our study is close to
The site of lesions varied according to age in our study.
that found in Marrakech in 2015.[8] The one found in 2009
Before the age of 2 years, the predominant site was the
in Cotonou[4] is lower than ours (5.5%). However, it is much
retroauricular groove, followed by the forehead and cheeks.
lower than those found in studies conducted in Yaoundé[9] and
The same observation was made in Marrakech in 2015.[8]
Togo.[10] This variability in results could be explained by the
On the other hand, Atadokpédé et al.[4] found that the limbs
different methodologies adopted and the study populations.
were the predominant site at this age. After 2 years, the
The average age of children with AD (4.74 ± 4.33 years) was predominant site was the retroauricular groove, followed by
similar to that found in Lomé in 2015[10] and Marrakech in the feet and elbow folds. In Marrakech in 2015, Baino et al.[8]
2015.[8] However, it is different from that found in Cotonou in found 100% localization in the cheeks at this age.
2009,[4] who reported an average age of 247.2 months (20.6
years). This difference could be related to the choice of age CONCLUSION
groups in the conduct of epidemiological studies on AD.
This study allowed us to observe that AD is a reality among
Male predominance was noted in the present study as well children in Parakou in the north of Benin and that it should
as in the Maghreb and Moroccan series.[8,11] In contrast, the not be neglected. Contrary to the study carried out in the south

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 Agbessi: Atopic dermatitis in children in Parakou (Benin)

of Benin (in Cotonou in 2009) in the hospital population, this 2016;27:50-8.

one had the merit of taking stock of the situation of AD in 7. Koudoukpo C, Akpadjan F, Agbessi N, Dégboé B,
the general pediatric population. A better knowledge of the Nouhoumon G, Adégbidi H, et al. Epidemiological aspects
manifestations of AD would help physicians in general and of atopic dermatitis in Borgou-Alibori Teaching Hospital of
Parakou (Benin). Health Sci Dis 2019;20:94-7.
pediatricians in particular to better manage it. The majority
8. Baino A, Hocar O, Akhdari N, Amal S. Prevalence and clinical-
of these children do not come to the dermatologist’s office as
epidemiological profile of dermatitis atopic in Morocco. Ann
a first-line treatment; especially in our sub-Saharan African Dermatol Venereol 2016;143 Suppl 1:S43-4.
countries where access to specialized care is still a luxury for 9. Djénabou A. Atopic eczema in adolescents in Yaoundé,
the most vulnerable populations. Cameroon. Rev Fr Allergol 2017;57:265-83.
10. Técléssou JN, Mouhari-Toure A, Akakpo S, Bayaki S,
REFERENCES Boukari OB, Gnassingbe W, et al. Risk factors and allergic
manifestations associated with atopic dermatitis in Lomé
(Togo): A multicenter study of 476 children aged 0-15 years.
1. Dammak A, Guillet G. Atopic dermatitis in children. J Pediatr
Méd Santé Trop 2016;26:88-91.
Child Care 2011;24:84-102.
11. Baghou S, Bensaad D, Taieb A, Ammar-Khodja A. Prevalence
2. Catteau B. Atopic dermatitis: Epidemiology and current
and clinical profile of atopic dermatitis in Algeria. Ann
clinical data. Rev Fr Allergol Immunol Clin 2002;42:373-7.
Dermatol Venereol 2012;139:140.
3. Kobangué L, Piamalé G, Bureau JJ, Sépou A. Epidemiological
12. Hagendorens MM, Bridts CH, Lauwers K. Perinatal risk
and clinical aspects of atopic dermatitis at the National Hospital
factors for sensitization, atopic dermatitis and wheezing
and University Centre of Bangui. Ann Dermatol Venereol
during the first year of life (PIPO study). Clin Exp Allergy
2007;134 Suppl 1:S98.
2005;35:733-40.
4. Atadokpédé F, Adégbidi H, Koudoukpo C, Agbessi N,
Yedomon H, do-Ango-Padonou F, et al. Atopic dermatitis in
Cotonou, Benin: Clinical and therapeutic aspects. Dakar Med How to cite this article: Agbessi N, Akpadjan F,
2012;57:1-7. Dégboé B, Nouhoumon G, Koudoukpo C, Adegbidi H,
5. Nnoruka EN. Current epidemiology of atopic dermatitis in Atadokpédé F. Epidemio-clinical Profile of Atopic
South-Eastern Nigeria. Int J Dermatol 2004 43:739-44. Dermatitis in Children in General Population in Parakou
6. Yu SH, Attarian H, Zee P, Silverberg JI. Burden of sleep (Benin). Clinic Res Dermatol 2020;3(1):6-9.
and fatigue in US adults with atopic dermatitis. Dermatitis

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