INTRODUCTION

Children’s use of cosmetics is a special case, with the development of what is known as infant cosmetics. It is significant to note that, from birth, children often use cosmetics through the habits of their parents, particularly their mothers. In France between 2013 and 2016, the cosmetics most commonly used by children were shampoo (70%), washing gel (67%), seat wipes (67%), moisturizer (28%), and sun cream (50%) [1,2]. In Togo, nearly 90% of mothers used cosmetic products on their children from birth [3]. The harmful effects of children’s cosmetics may be a source of numerous complications [4–6]. According to Rance et al., out of 202 children, 2.4% had contact allergies due to emollients made from oat extract [4]. In Côte d’Ivoire, there is a paucity of data on the use of cosmetic products in children and their possible complications. It, therefore, seemed appropriate to conduct this study on the use of cosmetic products in children and their medical complications, particularly dermatological. The aim of this study were to describe the socio-demographic profile of black children using cosmetics, to determine the cosmetic practices of black African children, and to describe the dermatological complications associated with the use of cosmetic products in black African children.

METHODS

RESULTS

Initially, the minimum size of our sample was 139 children, distributed as follows: 93 at the pediatrics department and 46 at the dermatology department. However, during the course of our survey, which was conducted over a period of one month, we were able to collect a sample of 285 children (215 at pediatrics and 70 at dermatology) who used cosmetic products.

Skin Complications

Complications were found in 32 children, giving a prevalence of 11.23% (32/285). Complications were attributed to soap in one case (0.35%), to perfumes in 18 cases (6.35%), and to powders in 13 cases (4.53%). Children (3.1%) developed rhinitis (4.2%) and skin allergy (2.16%) after using a cosmetic product.

These children were seen in consultation for a non-dermatological reason in 210 cases (73.5%) and a dermatological reason in 73 cases (25.2%). The most frequent dermatoses were scabies (21 cases) and acne (14 cases) (Table 1) (Figs. 1a – 1c). There was a statistically significant relationship between the appearance of lesions, the diagnosis made and the use of children’s cosmetics (p < 0.05) (Table 2).

Table 1: Distribution of the 285 children participating in the study on the use and complications of cosmetic products in sub-Saharan Africa, according to the dermatoses observed.

Figure 1: (a) Allergic contact dermatitis in a child. (b) Scabies nodule on the back of an infant. (c) Tinea corporis in a child.

Table 2: Associations between the appearance of skin lesions, diagnosis, and cosmetic practices in the children.

DISCUSSION

In our study, 52% of the cases were male, giving a sex ratio of 1.09. This result is contrary to that of Kourouma et al., who noted a predominance of girls (54.06%), with a sex ratio (F/H) of 1.17 [5].

Our study showed that 98.6% of the parents used soap regularly (twice a day) with their children. Most of these soaps were Marseille soap, generally bought in supermarkets by mothers or grandmothers at prices ranging from 100 francs CFA to 1.000 francs CFA. This may be explained by the fact that soap is a basic product for personal hygiene, especially for children. Mothers who already receive advice from their friends or relatives simply copy these practices [2]. Dermatologists often recommend the use of Marseille soaps because they comply with recommended standards.

Like soap, almost all our respondents used body ointment on their children. Shea butter was used by more than half (65.49%). This purely natural product has been used by mothers for many years because of its therapeutic properties, but above all because of tradition. Its use is, therefore, handed down from generation to generation and may be obtained easily at a low cost (100–1,000 francs CFA).

The parents used perfumes on their children in 66.7% of the cases, and most of them bought them in supermarkets at affordable prices. Our results are superimposed on those by Marie et al, where supermarkets were the main source of cosmetics for children (46.2%). Soaps and toilet milks were the most commonly used cosmetics, as were talcs in 25.7% and perfumes in 38.8% [3]. In contrast, Ficheux et al. found that the most commonly used cosmetics were shampoo (70%), washing gel (67%), seat wipes (67%), moisturizer (28%), and sun cream (50%) [1]. This difference in proportions could be explained by the frequency of use and the number of products, which stands at five.

It was noted that 4.2% of the children developed rhinitis after using the product, and 2.16% developed a skin allergy. These results show that certain cosmetic products are highly allergenic and may, therefore, cause skin reactions, especially in atopic subjects [4,6–9]. Ficheux et al. agreed, stating that many mothers (88.9%) used at least one cosmetic product containing at least one allergen; the most common allergens were preservatives (49.7%) and fragrances (32.9%) [1]. Our results are also similar to those by Rance et al. in France, who reported that 2.4% of contact allergies were due to emollients made from oat extract [4].

This finding of an allergic reaction is also reported when a powder is used on children. Our study shows that contact eczema and rhinitis occur in 2.5% and 1% of the cases, respectively. The composition of children’s powder requires several chemical substances, some of which are allergenic [2,6,7,9–12].

Our study showed that some products were also used less frequently than others, such as shampoos. The use of this product is infrequent because of its cost, and it is not part of parents’ traditional habits compared to other products.

In order to highlight dermatological complications in children, we found it essential to look for certain correlations between the different variables studied. There was a statistically significant relationship between the appearance of lesions and the use of children’s cosmetics (p = 0.0118). Cosmetics are applied to the body. This is why many people think that cosmetics, being minimally invasive, are apparently harmless. However, some substances cross the skin barrier or are metabolized and absorbed into the systemic circulation. Skin penetration sometimes determines the efficacy of cosmetics, yet always their toxicity. This toxicity may lead to pathologies that can create a morbid state or, worse yet, mortality in children [6,7,11,13–15].

This is also explained by the fact that there is a statistically significant relationship between diagnosis and the use of children’s cosmetics (p = 0.0191). It is important to know the fate of chemical substances applied to the skin in order to assess the extent of the dose actually absorbed and available for systemic pharmacological or toxic activity [9,16]. Contact allergies to cosmetic products are highly common and include eczema. These allergies are most often due to the fragrances contained in cosmetic products, followed by preservatives and emulsifiers [6–8,11].

CONCLUSION

Cosmetic products are widely used by children. The most commonly used products were soap, body lotion, and perfume. Most of the products were purchased at the market or supermarket. Dermatological complications were reported by the parents. The most common dermatological complaints were rashes and pruritus, with an average duration of four months. The most common diagnoses were scabies and acne.