INTRODUCTION

Globalization has driven an evolution in health professions, particularly pharmacy. Traditionally focused on medication production and distribution, pharmacists are increasingly engaged in clinical care, although their role remains under transition [1–3].

In developing countries, dermatological conditions represent a major public health concern with high prevalence [4–6]. In Benin, access to specialized dermatological care is limited due to a low number of dermatologists (20 for over 14 million people) and economic barriers. Community pharmacies, being geographically accessible and offering free consultations, serve as a critical resource.

Unlike in developed countries, pharmacists in developing settings are often underutilized, and their role as healthcare providers is undervalued by both the public and other professionals [1]. For example, in Australia, fewer than half of patients consult a physician, with pharmacists being the most frequent source of advice [7]. In the UK, advice-only consultations most commonly addressed medications and skin conditions [8].

The extent to which community pharmacists in Benin manage skin-related cases, and the spectrum of dermatological conditions that they encounter, remains poorly documented. This study aimed to assess dermatological care requests in Cotonou pharmacies in 2024, evaluate current service provision, and identify opportunities to optimize care delivery.

MATERIALS AND METHODS

This was a cross-sectional, prospective, descriptive study conducted in twenty high-traffic community pharmacies in Cotonou between April 1 and August 30, 2024. The participants included pharmacy assistants and second-year Master’s pharmacy students (primary targets), patients seeking dermatological care (secondary targets), and a dermatologist evaluating the care provided (tertiary target), all of whom gave informed consent.

Pharmacies were selected via convenience sampling, with one to three pharmacies per district (13 districts total) chosen based on daily dermatological care requests (≥10), as reported by pharmacy assistants.

Data was collected through structured interviews with healthcare providers and patients. The patients were subsequently examined in a designated clinical setting, and lesions were photographed after obtaining informed consent. Clinical, diagnostic (including imaging when available), and therapeutic data was reviewed by a dermatologist. Care evaluation considered the type of dermatological condition, proposed curative treatment (including dosage form and therapeutic class), dosage regimen, treatment duration, and preventive measures when applicable.

Data was analyzed using Epi Info, version 7.2.1.0.

ETHICS STATEMENT

Ethical and professional standards were strictly followed.

RESULTS

A total of 27 healthcare providers and 420 patients (61.2% female) were included. The mean age of the patients was 24.1 ± 1.5 years, with the 20–30-year age group being the most represented (29.5%), followed by children under 10 years (21.9%) and adolescents 10–20 years (19.3%). Most patients were single (64.1%) and had either a high level of education (28.3% university) or very low education (21.7% below compulsory schooling). Among adults (≥18 years, n = 301), 67.1% had an income below three times the Guaranteed Interprofessional Minimum Wage (GIMW).

Pharmacy consultations were sought for diagnostic advice (41.9%), therapeutic advice (30.2%), cosmetic advice (16.2%), prescription dispensing (7.4%), and self-medication (5.0%). The dermatological conditions prompting care were predominantly infectious (47.38%), followed by aesthetic (20.71%), inflammatory (16.19%), immuno-allergic (10.0%), sexually transmitted (4.52%), and tumoral (1.19%) disorders (Fig. 1). The most common conditions were acne (14.04%), furuncles (9.28%), facial imperfections (9.28%), pityriasis versicolor (8.09%), dry skin (7.38%), and genital candidiasis (7.14%) (Table 1). Furuncles were mainly observed in children 0–10 years (79.5%), while acne, facial imperfections, pityriasis versicolor, and genital candidiasis were most frequent in young adults aged 20–30 years. Dry skin was mostly seen in older adults (50–80 years, 74.2%). Prior to consulting the pharmacy, 42.1% had used naturopathy and 39.8% traditional self-medication.

Figure 1: Distribution of the 420 patients/clients surveyed in the twenty selected community pharmacies in Cotonou in 2024 according to the different categories of dermatoses.

Table 1: Distribution of the 420 patients/clients surveyed in the twenty selected pharmacies in Cotonou in 2024 by dermatoses and groups of dermatoses encountered.

Among 113 patients who consented to lesion photography (26.9%), the pharmacy-based diagnoses were correct in 54.0% of cases, while the proposed treatments were appropriate in 40.7%. Dosage forms (44.3%), dosages (61.9%), and treatment duration (88.5%) were often inconsistent with recommended protocols. Preventive treatment was indicated in 91.2% of the cases but was provided to only 12.6%, with nearly half of these being inappropriate (46.2%). Overall, care quality was rated poor in 59.3% of the cases, insufficient in 24.8%, and good in 15.9%.

DISCUSSION

Published studies conducted in developing countries specifically addressing reasons for seeking care in community pharmacies remain highly limited [9]. Therefore, we discuss our findings in the context of broader literature on consultation patterns reported in hospital and community settings, as well as evaluations of pharmaceutical service quality, including dispensing practices, pharmaceutical care, and appropriateness of prescriptions by pharmacy staff.

A major challenge for health systems is to align service provision with treatment needs while considering available resources. In developing countries, skin diseases are often given lower priority due to their relatively low morbidity and mortality; however, their impact on communities is significant. Families allocate a portion of their income to managing these conditions through pharmacies, physicians, or traditional healers. When management fails, the average total cost of ineffective treatments represents a substantial financial burden for families in precarious economic situations [10].

Our study population had a mean age of 24.05 ± 1.48 years, with 41.19% aged 0–20 years, making them younger than the hospital-based population at the Dermatology Department of the Hubert Koutoukou Maga National University Hospital (CNHU-HKM) in 2009 [11] but older than that reported by Mahé et al. in Bamako, Mali [6]. The predominance of the 20–30-year age group aligns with observations in Korle Bu, Ghana, and Edo, Nigeria [4,5], potentially reflecting greater mobility and a higher concern for skin appearance among young adults.

The female predominance (61.19%) observed in our study is consistent with other reports in the subregion [4,5,11,12] and among populations with pigmented skin elsewhere [13,14], reflecting socio-cultural influences whereby women demonstrate greater concern for beauty and skin care.

Educational level did not appear to strongly influence the use of pharmacies for dermatological care in our study, as patients with low education (21.67%) were nearly as represented as those with higher education (28.33%). This contrasts with findings by Soni et al., who reported a predominance of low education levels [13]. However, monthly income may be a determining factor, as the majority of patients (67.11%) had an income below three times the guaranteed minimum wage in Benin. Soni et al. observed that individuals from lower-middle socioeconomic classes sought care more frequently than those from higher classes [13], suggesting that higher-income patients prefer hospital consultations, whereas lower-income patients turn to more affordable local options, such as community pharmacies. Pharmacists must, therefore, acquire adequate knowledge and clinical skills to provide effective, high-quality dermatological care and become an integral, proactive component of the health system, contributing to sustainable development goals in developing countries.

Patient requests in our study were mainly for diagnostic (41.90%) and therapeutic advice (30.24%), which was consistent with Dodds et al. in the UK. However, pharmacy staff in our survey rarely referred clients to physicians for further care [8]. Conversely, studies in Quebec and Malaysia reported that the most frequent requests were for medication purchases, followed by health-related consultations [14–16].

Infectious dermatoses (47.38%) were the leading reason for care-seeking, predominantly mycotic (28.78%) and bacterial (13.56%) infections. Hospital-based series in Cotonou (Benin) and Edo and Esogbo (Nigeria) have reported predominance of immuno-allergic dermatoses [5,11,17]. The normalization of infectious dermatoses, self-medication, consultation costs, and limited hospital accessibility likely drive the population toward more affordable local solutions. Environmental factors, including increased industrialization and pollution in major cities, may increase the prevalence of immuno-allergic dermatoses. Chronicity, high consultation costs in Cotonou dermatology services, and failure of self-medication may also compel patients with immuno-allergic dermatoses to seek hospital care. Studies from other subregional countries report a predominance of infectious dermatoses [4,6,12], which may partly reflect health policies facilitating access to care at affordable costs. A similar pattern is reported in New Delhi [13]. In addition to tropical climate factors, overcrowding, low socioeconomic status, and low education levels contribute to the high frequency of infections observed both at pharmacies and hospitals. The widespread practice of skin depigmentation, reaching up to 96% in some populations, may also explain the high prevalence of infectious dermatoses despite increasing immuno-allergic conditions [18,19].

Aesthetic dermatoses (20.71%) were the second most frequent reason for consultation, mainly including facial imperfections (9.28%), dry skin (7.38%), and post-inflammatory hyperpigmentation (4.04%). These conditions are rarely encountered at hospitals in the region [4,6,12], suggesting that patients perceive them as minor, preferring cosmetic advice in pharmacies or via social media [2,8,20–22]. Acne, the leading inflammatory dermatosis, accounted for 14.04% of consultations, likely reflecting the large proportion of adolescents and young adults in our sample. Acne is a common dermatological complaint in pigmented skin, observed in hospital, pharmacy, and social media contexts [2,4,13,14,22,23].

Prior to consulting the pharmacy, clients often used naturopathy or traditional self-medication. A systematic review by Corrêa Fissmer reported self-medication prevalence ranging from 6.0% to 44.0%, highest in developing countries due to limited financial resources for adequate medical access. Low socioeconomic status is frequently associated with low cultural literacy, complicating self-identification of symptoms and selection of appropriate alternatives [24]. Proper self-medication can reduce healthcare costs but carries risks, including misdiagnosis, inappropriate therapy, improper dosing, excessive duration, dependence or abuse, contraindications, drug interactions, and delayed diagnosis or treatment of serious conditions, often unnoticed by patients [25].

The role of pharmacists in health systems varies widely. In developing countries, they often fail to fully realize their potential and struggle for recognition, which could otherwise enhance health system performance [1]. Our study found that 53.98% of pharmacy diagnoses matched the dermatologist evaluator, whereas 62.83% of treatments were inappropriate. Dosage forms (44.25%), dosages (61.95%), and treatment duration (88.50%) were often incorrect. Tang et al. reported that 16.3% of 1,260 Chinese community pharmacists frequently felt that lack of competence negatively impacted their work, particularly when providing comprehensive medication counseling (39.0%) [26]. Brata identified three main factors influencing current pharmacy practice: patient-staff interactions, pharmacy organizational context, and external environment [10]. Insufficient clinical knowledge and the absence of validated counseling standards promote diagnostic and therapeutic errors, resulting in ineffective medication use and unnecessary expenditure [3,25,27]. Lack of time and absence of private counseling areas further contribute to poor care quality [10].

Preventive treatment was indicated for 91.15% of patients but was provided to only 12.62%, nearly half of which were inappropriate (46.15%). Overall, care quality was rated poor in 59.29%, insufficient in 24.77%, and good in 15.93% of cases. These findings underscore the need for public education programs and healthcare professional training to inform patients about appropriate medical consultation and equip providers with the necessary knowledge [7]. Additionally, strategies to enhance pharmacist-client interactions, create counseling-friendly environments, and implement patient-centered management could strengthen professional performance [28,29]. In Geneva, assisted teleconsultation with a physician for benign dermatoses has been trialed in pharmacies, enhancing collaboration between health workers and pharmacists and improving health system efficiency [30,31].

CONCLUSION

Our study demonstrated that young patients and children, particularly females, most frequently seek dermatological care in community pharmacies. The majority had a monthly income below three times the Guaranteed Interprofessional Minimum Wage (GIMW) in Benin and primarily consulted for diagnostic and therapeutic advice regarding predominantly infectious and aesthetic dermatoses. The quality of care provided by pharmacy staff was generally poor or insufficient. There is an urgent need for further investigations to identify barriers to adequate management of skin conditions in community pharmacies and to implement strategies aimed at improving current pharmacy practice.

REFERENCES

1.Azhar S, Hassali MA, Mohamed Ibrahim MI, Ahmad M, Masood I, Shafie AA. The role of pharmacists in developing countries:The current scenario in Pakistan. Hum Resour Health. 2009;7:54.

2.Tucker R, Stewart D. Why people seek advice from community pharmacies about skin problems. Int J Pharm Pract. 2015;23:150-3.

3.Cassie H, Duncan EM, Gibb EA, Power A, Young L, Newlands R, Watson MC. Qualitative study exploring the key determinants of information gathering to inform the management of over-the-counter (OTC) consultations in community pharmacies. BMJ Open. 2019;9:e029937.

4.Rosenbaum BE, Klein R, Hagan PG, Seadey M-Y, Quarcoo NL, Hoffmann R, et al. Dermatology in Ghana:A retrospective review of skin disease at the Korle Bu Teaching Hospital Dermatology Clinic. Pan Afri Med J. 2017;26:125.

5.Ukonu AB, Eze EU. Pattern of skin diseases at university of Benin teaching hospital, Benin city, Edo State, South-South Nigeria:A 12 month prospective study. Glob J Health Sci. 2012;28;4:148-57.

6.MahéA, CisséIA, Faye O, N’Diaye HT, Niamba P. Skin diseases in Bamako (Mali). Int J Dermatol. 1998;37:673-6.

7.Marks R. The public health approach to the burden of common skin diseases in the community. J Dermatol. 2001;28:602-5.

8.Dodds L, Katusiime B, Shamim A, Fleming G, Thomas T. An investigation into the number and nature of the urgent care consultations managed and referred by community pharmacists in South- East England. Prim Health Care Res Dev. 2020;21:1-7.

9.Brata C, Fisher C, Marjadi B, Schneider CR, Clifford RM. Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies:A qualitative study. BMC Health Serv Res. 2016;16:179.

10.Hay RJ, Estrada Castanon R, Alarcon Hemandez H, Chavez Lopez G, Lopez Fuentes LF, Paredes Solis S, et al. Wastage offamily income on skin disease in Mexico. BMJ. 1994;309:848.

11.Téclessou J, AtadokpédéF, Adégbidi H, Koudoukpo C, Eroume T, N’Dah P, et al. Motifs de consultation en Dermatologie-Vénérologie en 2009 àCotonou. Med Trop. 2011;71:515.

12.Onyekonwu CL, Ojinmah UR, Ozo GAO, Oko NU, Uche-Ejweku, Onyekonwu CG. Epidemiology of skin diseases in University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State. Niger J Med. 2016;25:272-81.

13.Soni S, Garg T, Acharya A, Sarkar R. Clinical spectrum of dermatological disorders at an urban health center in East Delhi. Indian J Community Med. 2024;49:649-53.

14.East-Innis ADC, Chung-Stanley M M, McNish A J S, Fitz-Henley M SA. The spectrum of skin diseases seen in a Jamaican tertiary academic medical center. JAAD Int. 2021;4:59-64.

15.ParéG, Motulsky A, Castonguay A, Boulenger S. Nature and perceived benefits of patient-initiated consultations in community pharmacies:A population survey. Explor Res Clin Soc Pharm. 2022;8:100194.

16.Chua SS, Lim KP, Lee HG. Utilisation of community pharmacists by the general public in Malaysia. Int J Pharm Pract 2013;21:66-9.

17.Akinboro AO, Mejiuni AD, Akinlade MO, Audu BM, Ayodele OE. Spectrum of skin diseases presented at LAUTECH Teaching Hospital, Osogbo, southwest Nigeria. Int J Dermatol. 2014;54:443-50.

18.Ly F, Soko AS, Dione DA, Niang SO, Kane A, Bocoum TI, et al. Aesthetic problems associated with the cosmetic use of bleaching products. Int J Dermatol 2007;46:15 7.

19.Pollock S, Taylor S, Oyerinde O, Nurmohamed S, Dlova N, Sarkar R, et al. The dark side of skin lightening:An international collaboration and review of a public health issue affecting dermatology. Int J Wom Dermatol. 2021;7:158-64.

20.Samaran R, Samaran Q, Kluger N. Les réseaux sociaux en dermatologie. Ann Dermatol Venereol. 2024;FMC4:212-7.

21.Kang J, Szeto MD, Suh L, Olayinka JT, Dellavalle RP. Popular skin-of-color dermatology social media hashtags on TikTok from 2021 to 2022:Content analysis. JMIR Dermatol. 2024;7:e50408.

22.Yousaf A, Hagen BAR, Delaney BSE, Davis BSS, Zinn Z. The influence of social media on acne treatment:A cross-sectional survey. Pediatr Dermatol. 2021;37:301-4.

23.Davis SA, Swetha N, Feldman SR, Huang W, Pichardo-Geisinger RO, McMichael AJ. Top dermatologic conditions in patients of color:An analysis of nationally representative data. J Drugs Dermatol. 2012;11:466-73.

24.Corrêa-Fissmer M, Martins AH, Mendonça MG, Galato D. Prevalence of self-medication for skin diseases:A systematic review. An Bras Dermatol. 2014;89:625-30.

25.Gombos HHM, Krogstad T, Bjorknes MR, Sletvold H, Hagen MC, Svensberg K. A qualitative non-participant observational study of non-prescription counseling in community pharmacies. Explor Res Clin Soc Pharm. 2025;18:100611.

26.Tang Z, Lhamu P, Ye H, Hong L, Xiang X. Current perceptions and improvement approaches of pharmaceutical care capacity of community pharmacists:A quantitative analysis based on survey data at Chinese chain pharmacies. Int J Environ Res Public Health. 2020;17:7482.

27.Egorova SN, Akhmetova T. Pharmaceutical counseling:Between evidence-based medicine and profits. Int J Risk Safety Med. 2015;27:S87-8.

28.van Eikenhorst L, Salema NE, Anderson C. A systematic review in select countries of the role of the pharmacist in consultations and sales of non-prescription medicines in community pharmacy. Res Social Adm Pharm. 2016;13:17-38.

29.Alastalo N, Siitonen P, JyrkkäJ, Hämeen-Anttila K. The quality of non-prescription medicine counselling in Finnish pharmacies:A simulated patient study. Explor Res Clin Soc Pharm. 2023;11:100304.

30.Braillard O, Mazouri Karker S, Djarmouni R, Lafaix R, Guessous I, Schneider MP. Assisted teleconsultation in an outpatient pharmacy:Results of a pilot study in Geneva, Switzerland. J Telemed Telecare. 2024;31:811-7.

31.Backes C, Godot C, Gujer CY, Obegi N, Perez A, Gervaix A, Schneider MP. Digital healthcare services in community pharmacies in Switzerland:Pharmacist and patient acceptability, and pharmacist readiness:The Pneumoscope™pilot study. Digit Health. 2025;11:20552076241313164.