Unique Challenges Highlighted in Pediatric Atopic Dermatitis in Sub-Saharan Africa

The high prevalence of non-mild atopic dermatitis in pediatric patients with atopic dermatitis in Sub-Saharan Africa—intensified by area-specific factors such as cultural stigma and socioeconomic challenges—suggests a greater quality of life burden compared to global statistics.1

These findings were the result of a study conducted to examine the specific trends among children in Sub-Saharan Africa with this inflammatory skin disease. The research was authored by a team of investigators, including Edgar Mandeng Ma Linwa, from the Faculty of Health Sciences at the University of Buea in Cameroon.

“Using the PCC (Population, Concept and Context) framework in drafting a review question, this study aimed to answer the following question: What is the existing evidence on the QoL of pediatric patients with atopic dermatitis in Sub-Saharan Africa (SSA), including key influencing factors and research gaps?” Linwa and coauthors wrote.1,2

Trial Design

Linwa and colleagues implemented the PRISMA-ScR framework, conducting a scoping review of studies published between 2010 and 2025 that explored atopic dermatitis in children and adolescents. The children the investigators assessed were aged 0–18 years and resided in in Sub-Saharan Africa.

Using the Embase, MEDLINE, APA PsycINFO, Google Scholar, ProQuest, African Journals Online (AJOL), and the Health Sciences and Diseases journal, the investigative team reviewed available literature. They sought to capture both high-quality international research and regionally relevant publications. The team specifically prioritized data from PubMed, Embase, PsycINFO, and ProQuest for peer-reviewed sources.

Linwa et al used Google Scholar to access to a broader range of region-specific research. Both Health Sciences and Diseases and AJOL were utilized due to their open access and their focus on Sub-Saharan Africa-based research. Eligible data related to sociodemographic characteristics, trial designs, quality of life outcomes, and atopic dermatitis severity. The information was synthesized by the investigative team via a biopsychological model and narrative approach.

Qualitative, cross-sectional, case-control, cohort, and review articles were considered by the team, whereas case reports, case series, and editorials were not. The data included in this analysis was required to be in English or French and to be released between 2010 - 2025, reflecting the primary scientific reporting languages used in Sub-Saharan Africa. Six trials met Linwa and coauthors' criteria: 5 cross-sectional studies and a single randomized controlled trial (RCT). These 6 studies were conducted in Côte d’Ivoire, Cameroon, South Africa, Madagascar, and Nigeria.

The numbers of trial subjects in these 6 trials ranged from 53 - 381, and they were primarily in urban hospital settings. Findings highlighted regional challenges, most notably the disproportionately high prevalence of non-mild AD.

Findings on Atopic Dermatitis Trends

Across these studies, up to 61.3% of pediatric patients presented with moderate disease and 24.2% with severe disease—figures which were noted to far exceed global estimates.1 Global trends suggest that severe atopic dermatitis is reported in fewer than 15% of cases. The investigators found a consistent link between burden of moderate to severe quality of life impairment to intense itch, disturbed sleep, and psychosocial stress, with SCORAD-assessed symptom severity and younger age (<1 year) being key correlates.

Quality evaluation via the Mixed Methods Appraisal Tool (MMAT) demonstrated to Linwa et al that methodological concerns, including reliance on urban-based samples along with insufficient reporting of nonresponse bias, diagnostic definition variations, and the use of instruments validated internationally but not culturally adapted for Sub-Saharan Africa. Socioeconomic status and comorbidities such as asthma were not frequently addressed, though both were highlighted by the team as likely to worsen the impacts of the disease.

In summary, this review of six Sub-Saharan Africa studies demonstrates that children with atopic dermatitis in the region frequently experience moderate to severe impairment to life quality. Unlike global patterns, where severe atopic dermatitis remains below 15%, they found that region-specific drivers contribute to a disproportionate disease and quality of life burdens in affected populations aged 0 - 18 years.

“The limited representation of only five SSA countries highlights significant research gaps, particularly in rural and East African settings, where cultural contexts may further influence QoL,” the investigators concluded.1 “Future research should prioritise rural, community-based studies using validated, context-specific QoL tools to capture SSA's diverse populations, employing mixed-method approaches to deepen insights into AD's multidimensional impact.”

References

1. Mandeng Ma Linwa E, Eposse Ekoube C, Zoung-Kanyi A. CB, et al (2025). Assessing the Impact of Atopic Dermatitis on the Quality of Life of Paediatric Patients in Sub-Saharan Africa: A Scoping Review. Dermatological Reviews, 6: e70048. https://doi.org/10.1002/der2.70048.

2. MD J. Peters, C Marnie, AC Tricco, et al. “Updated Methodological Guidance for the Conduct of Scoping Reviews,” JBI Evidence Synthesis 18 (2020): 2119–2126.