INTRODUCTION

Cosmetology is becoming increasingly integrated into the management of skin disorders. Several types of cosmetology exist, including general and medical cosmetology. General cosmetology focuses on minor skin concerns, whereas medical cosmetology falls within the scope of healthcare professionals. In this context, dermatologists are required to respond to growing and increasingly specific demands by incorporating the use of cosmetology into the management of certain dermatological conditions. Two main categories of products are thus distinguished: cosmetics and dermocosmetics [1,2].

The study of dermocosmetics and cosmetics in dermatology holds considerable importance, both clinically and in terms of the patient’s well-being. Previous research in this field remains limited in Africa in general and in Benin in particular. The present study aims to help fill this gap. By examining the indications, acceptability, and direct costs associated with the use of these products, we sought to provide useful insights to improve patient care through this category of therapeutic adjuncts.

MATERIALS AND METHODS

A longitudinal, observational, and prospective analytic study was conducted from April 1 to September 30, 2024, at the University Clinic of Dermatology and Venereology (CUDEV) of the Hubert Koutoukou Maga National University Hospital Center (CNHU-HKM). The study included, using a non-probabilistic exhaustive sampling method, all patients over 10 years of age who had received a prescription for a dermocosmetic and/or cosmetic product. The patients were enrolled after providing free and informed consent. For participants under 18 years of age, both their assent and the informed consent of their parents or legal guardians were obtained.

Acceptability was assessed based on the patients’ self-reported responses. It comprised three main domains:

The cost of the prescribed products was compared with the current guaranteed interprofessional minimum wage (SMIG) in Benin, which stands at 52,000 FCFA (approximately US$92) [3]. Sociodemographic and economic data, dermatological indications for prescription, and characteristics of the cosmetic products were collected using a standardized data collection form during the initial consultation, based on medical records and patient interviews. At the first follow-up visit, data regarding product acceptability and direct cost were added to the form.

All data was anonymized, entered, and analyzed using Epi Info, version 7.2.5.0. Differences were considered statistically significant at p < 0.05.

RESULTS

During the study period, 150 patients were included, receiving a total of 140 cosmetic prescriptions and 50 dermocosmetic prescriptions (Figure 1).

Figure 1: Sampling process.

The mean age of the study population was 34.9 ± 15.8 years (range: 10–80 years), with a predominance of the 18–30-year age group (30.67%). Females accounted for 59.0% of the participants, corresponding to a sex ratio (M/F) of 0.7. Regarding socioeconomic status, most patients belonged to intermediate levels (89.34%), including 42.67% with middle, 24.67% with lower-middle, and 22.00% with upper-middle socioeconomic levels. Married individuals represented 53.3%, while single participants accounted for 42.7%.

Cosmetics were prescribed to 140 patients (93.3%), with two products prescribed in the majority of the cases (84.3%), most often consisting of a cleanser associated with a moisturizer (87.9%). Cleansers were predominantly prescribed as dermatological bars (95.2%), while moisturizers were prescribed as creams (57.3%), balms (25.4%), or lotions (16.7%). Dermocosmetics were prescribed to 50 patients (33.3%), with one or two dermocosmetics prescribed in 38.0% of cases, each. The main active ingredients were, in decreasing order of frequency: sebum regulators (62.0%), antimicrobial agents (38.0%), anti-inflammatory agents (36.0%), and photoprotective agents (14.0%). Dermocosmetics were mainly prescribed as creams (78.0%) and foaming gels (48.0%). Table 1 lists the indications for which cosmetic and dermocosmetic products were prescribed.

Table 1: Distribution of indications for prescribed cosmetics and dermocosmetics at CUDEV/CNHU-HKM in 2024.

The patients reported having received a very good explanation of their condition in 89.3% of cases. Patient acceptability was assessed for each product category (Table 2).

Table 2: Distribution of the patients according to levels of the components of acceptability of cosmetic and dermocosmetic prescriptions at CUDEV/CNHU-HKM in 2024.

The median monthly cost of the products represented 21.8% of the Beninese minimum wage, corresponding to 11,343 FCFA (IQR: 6,410–17,130), with extremes ranging from 3,210 to 64,000 FCFA. The cost of the products represented a median of 7.6% of the patients’ monthly income (IQR: 4–16%), with extremes ranging from 0.2% to 68%.

The degree of explanation regarding the benefit (p = 0.02) and the conviction of the usefulness (p = 0.01) of cosmetics were significantly associated with their purchase. Patients who reported having received a thorough explanation of the benefits of cosmetics, as well as those who had a strong conviction of their usefulness, were more likely to purchase all prescribed products. The purchase of the entire cosmetic prescription (p = 0.003) and dermocosmetic prescription (p = 0.0007) was significantly associated with monthly income; overall, the acquisition of cosmetics and dermocosmetics increased proportionally with a higher monthly income. Factors significantly associated with adherence to cosmetic application included the patient’s sex (p = 0.008), the degree of explanation of benefits (p = 0.02), and the conviction of the usefulness of cosmetics (p = 0.002). Female patients were significantly more likely to adhere to all prescribed applications, as were those who reported having received a thorough explanation and had a strong conviction of the usefulness of the cosmetics. None of these factors was found to be significantly associated with adherence to dermocosmetic application.

DISCUSSION

The indirect assessment of acceptability, based solely on self-reported data, represented one of the limitations of this study. Although this method is affordable and simple, it may have overestimated adherence and is prone to recall bias. The small number of patients who received dermocosmetic prescriptions may have limited the identification of additional factors associated with the acceptability of these prescriptions, beyond product cost. However, none of these limitations compromises the quality or validity of the results, which will be discussed and compared with findings from the literature.

The mean age of the study population was 34.9 years. Our results are comparable to those reported by Korsaga et al. in Burkina Faso [4] and Kaloga et al. in Côte d’Ivoire [5], who found mean ages of 29.5 and 31.1 years, respectively. This trend may be explained by the greater importance placed on physical appearance within this age group. Female subjects were predominant, with a sex ratio of 0.7. This finding is consistent with reports from other African authors, notably Kaloga et al. in Côte d’Ivoire [5] and Fofana et al. in Mali [6], who reported sex ratios of 0.7 and 0.6, respectively. The high proportion of women may be explained by their greater attention to skin care.

Cosmetics were prescribed to the vast majority of patients (93.3%), most commonly as a combination of moisturizer and cleanser in 87.9% of cases. The growing interest in skin health and appearance has led to increased cosmetic use, particularly moisturizers, both in patients with skin disorders and in individuals with normal skin. Moisturizers play a key role not only in correcting dryness but also in restoring and maintaining the skin barrier function, thereby protecting it against internal and external irritants. Appropriately formulated cleansing agents complement this management by removing irritants and pathogens and by temporarily enhancing skin hydration. Moisturizers also confer benefits beyond basic hydration. Potential functions include anti-inflammatory, antipruritic, antimitotic, wound-healing, photoprotective, and sometimes antimicrobial effects [1]. Therefore, moisturizers can be considered both as basic cosmetic products and as therapeutic agents when used in conditions associated with skin dryness.

Common dermatoses for which moisturizers serve as adjuvant therapy include, but are not limited to, atopic dermatitis, seborrheic dermatitis, psoriasis, contact eczema, acne, rosacea, pruritus, and xerosis [1,2,7]. Most of these indications were observed in our study. The instances labeled as “inappropriate cosmetics” in our study typically involved the use of skin-lightening agents or locally produced detergents that caused deleterious effects identified during physical examination. Indeed, skin depigmentation practices are widespread in our context, affecting up to 80% of the population. Such practices expose individuals to barrier disruption due to the long-term use of drying lightening products and antiseptics [8].

Dermocosmetics were prescribed to 33.3% of the patients, most often as one or two products at a time. The term “dermocosmetic” or “cosmeceutical,” coined by Dr. Albert Kligman, is a portmanteau of “cosmetic” and “pharmaceutical,” referring to cosmetic products with partial physiological activity, positioned between conventional cosmetics and medications. These therapeutic agents are indicated in numerous inflammatory dermatoses, with acne being the most frequent, as observed in our study [2].

Acne is the most common inflammatory skin disease during adolescence and also affects many adults, particularly women. It significantly impacts quality of life, and poor treatment adherence remains a major barrier to therapeutic effectiveness. Factors contributing to non-adherence include, among others, treatment inefficacy and adverse effects such as irritation, erythema, and dryness. Dermocosmetics—including moisturizers, cleansers, sebum-regulating agents, anti-inflammatory, and antimicrobial products—used alongside pharmacological regimens, improve adherence and optimize clinical outcomes. They mitigate the side effects of topical medications, restore the skin barrier, and target additional pathogenic pathways of acne, including sebum overproduction, inflammation, and colonization by Cutibacterium acnes [9]. Given their effectiveness, European dermatology panels recommend the use of dermocosmetics containing ingredients specifically targeting acne, either as monotherapy for mild cases or maintenance therapy, or as adjunctive care to complement the mechanism of action of medical treatments or improve their tolerability [10].

In this context, photoprotective agents are also essential due to the frequent occurrence of post-inflammatory hyperpigmentation in darker skin types [11–13]. Beyond post-inflammatory hyperpigmentation, dark skin, although naturally better protected against UVB radiation, is more prone to hyperpigmentation induced by visible light and UVA. Photoprotection against UVA, visible light, and infrared A may, therefore, be beneficial, as these radiations penetrate deeply into the skin and contribute to photoaging [11].

Patient acceptability of prescriptions is a key determinant of therapeutic efficacy and is influenced by several factors, including the physician–patient relationship, and the financial and geographic accessibility of products. In our study, at least 82% of patients reported a thorough explanation of their disease, and all cosmetic products were obtained in the majority of cases, reflecting good primary adherence to treatment. Our results are markedly higher than those reported by Amraoui et al. in Morocco [14]. High levels of explanation regarding the benefits of, and conviction in the usefulness of, cosmetics positively influenced their purchase rates. These findings are consistent with observations by Halioua et al. and Fernandez-Lazaro et al., which demonstrated that clear and detailed communication between clinicians and patients improves prescription acceptability [15,16].

The median monthly cost of the products represented 21.8% of the guaranteed interprofessional minimum wage and accounted for a median of 7.6% of the patients’ monthly income. The patients’ purchasing power for cosmetics and dermocosmetics was proportional to their income. These results align with the conclusions of Nasimi et al., who showed that patients with lower incomes have difficulties purchasing cosmetic products [17].

Regarding adherence to prescriptions, patients strictly followed all applications in 53.9% of the cases for cosmetics and 42.4% for dermocosmetics. Therapeutic adherence remains a major challenge in dermatology, particularly for topical treatments, which are often perceived as burdensome. Compared with oral treatments, adherence to topicals remains low [18,19]. Despite a high purchase rate for cosmetics, adherence is considerably lower for the products themselves, raising the issue of secondary adherence. Barriers to adherence can be classified according to whether they relate to the patient, the prescriber, or the healthcare system, and whether they are intentional or unintentional. The healthcare system encompasses patients, physicians, pharmacies, hospitals, insurance companies, and the pharmaceutical industry. A systematic review by Cirstéa et al. showed that patients with psoriasis adhered, on average, to only 50–60% of the recommended application frequency, with applied quantities reduced to 35–72% of the prescribed dose. Moreover, patient adherence declines over time: after eight weeks, only 51% of patients continued their topical treatment, compared with 84.6% at initiation. The main patient-related causes of non-adherence included perceived inefficacy, the burden and time required for application, and unsatisfactory aesthetic properties (texture, visible residues, staining of clothing or bedding, insufficient absorption). Other barriers included high cost, lack of information, inadequate communication between patients and healthcare providers, perceived low efficacy, as well as forgetfulness or lack of responsibility [19]. These observations are partially confirmed in our study, where the purchase of cosmetics and dermocosmetics was limited by low monthly income, whereas clear communication promoted the purchase of cosmetics.

We observed that adherence to cosmetics was higher than that to dermocosmetics. This may be explained, on one hand, by the fact that cosmetics are often incorporated into a daily routine and are perceived as comfort and aesthetic products, which encourages more regular application. Dermocosmetics, on the other hand, are typically prescribed for specific skin conditions and may be perceived as “medical treatments,” which could influence the regularity of use. On the other hand, the lower purchase rate of dermocosmetics (69.4%) compared with cosmetics may also contribute to these findings. Generally, dermocosmetics are more expensive than conventional cosmetics. Several authors have reported that high product cost is a major barrier to adherence and, consequently, to therapeutic efficacy; many patients cannot afford their treatments. As a result, some do not fill their prescriptions, interrupt treatment prematurely for economic reasons, or reduce doses to prolong usage. Healthcare providers are often unaware of the actual costs borne by patients—which in our study ranged from 0.2% to 68% of the monthly income—and discussions regarding financial considerations are rarely held prior to prescription. Prescribing less expensive alternatives increases the likelihood that treatment will be financially accessible [19–21].

Interventions such as educational workshops, written strategies, reminder systems, early follow-up visits, and substitution with lower-cost generic prescriptions can help improve therapeutic adherence and overcome barriers to acceptability. Beyond physicians, pharmacists, as accessible healthcare professionals, occupy a strategic position to reinforce adherence in patients with dermatological conditions. They play a role in treatment management, therapeutic education, and facilitating access to medications. Future educational initiatives, such as dermatology certification programs offered by the Board of Pharmacy Specialists, could further strengthen their knowledge and confidence in managing skin disorders [19].

A higher adherence was also observed in women compared with men, with a significant association for cosmetics. These findings are consistent with previous studies reporting that women, often more concerned with their appearance and skin health, are more likely to follow treatment regimens diligently. Cirstéa et al. and Salamzadeh et al. observed a similar trend in acne management, where women demonstrated better adherence due to their increased sensitivity to aesthetic outcomes [19,22].

Patient satisfaction is an essential indicator of both adherence and therapeutic efficacy. Overall satisfaction with the prescribed products was high for both cosmetics and dermocosmetics. The high satisfaction with cosmetics can be explained by their perceived role in improving overall appearance and ease of use. Moisturizers and cleansers, which constitute the majority of prescriptions, are often well accepted due to their immediate effect on skin texture and softness. Satisfaction with dermocosmetics was comparatively lower, which may be related to patients’ high expectations regarding either the onset of action or the anticipated results. Unrealistic expectations about the time required for dermocosmetics to show effects in chronic dermatoses appear to be a common cause of frustration and non-adherence [23]. Inadequate emotional regulation strategies among patients with chronic dermatoses, such as acne, may be associated with higher psychopathological symptoms and lower belief in treatment efficacy [24,25].

CONCLUSION

The results of this study reinforce the notion that both cosmetics and dermocosmetics constitute essential components of the therapeutic strategy at the University Dermatology–Venereology Clinic of CNHU-HKM.

These prescriptions were frequently directed toward young adults and women, highlighting their heightened interest in skin care and aesthetic concerns. The main indications were the use of inappropriate cosmetics, acne, and atopic dermatitis. The study also demonstrated that clear communication and guidance by prescribers, as well as improved financial accessibility of products, ensure good acceptability of prescriptions.

Achieving optimal adherence through personalized and multidimensional interventions requires particular attention to the factors identified in this study, as well as those reported in previous research, particularly those related to patient therapeutic education and the involvement of all healthcare system stakeholders.

REFERENCES

1.Sethi A, Kaur T, Malhotra SK, Gambhir ML. Moisturizers:The slippery road. Indian J Dermatol. 2016;61:279-87.

2.Kang SY, Um JY, Chung BY, Lee SY, Park JS, Kim JC, et al. Moisturizer in patients with inflammatory skin diseases. Medicina. 2022;58:888.

3.Décret N°2022-692 du 07 Décembre 2022 portant relèvement du salaire minimum interprofessionnel garanti en République du Bénin. https://sgg.gouv.bj/doc/decret-2022-692

4.Korsaga/SoméN, Ilboudo L, Bado B, Andonaba J-B, Barro/TraoréF, Niamba P, et al. Profil épidémiologique, clinique et thérapeutique des dermatoses observées dans un centre hospitalier régional (CHR) du Burkina Faso. Ann Dermatol Venereol. 2018;145:S243-4.

5.Kaloga M, Kouassi Y, Kourouma S, Ecra E, Gbery I, Gbandama KKP, et al. Aspects épidémiologique et clinique des patients vus en consultation de dermatologie du CHU de Treichville. Ann Dermatol Venereol. 2016;143:S36.

6.Fofana Y, Traore B, Dicko A, Faye O, Berthe S, Cisse L, et al. [Epidemio-clinical profile of dermatoses in children receiving dermatological consultation in the Department of Dermatology at the National Center for Disease Control in Bamako (Mali)]. Pan Afr Med J. 2016;25:238.

7.Purnamawati S, Indrastuti N, Danarti R, Saefudin T. The role of moisturizers in addressing various kinds of dermatitis:A review. Clin Med Res. 2017;15:75-87.

8.Glèlè-Ahanhanzo Y, Kpozehouen A, Maronko B, AzandjèmèC, Mongbo V, Sossa-Jérôme C. [„Getting clear skin ……and why not?“:voluntary depigmentation among women in a southwest region of Benin]. Pan Afr Med J. 2019;33:72.

9.Araviiskaia E, Layton AM, Lopez Estebaranz JL, Ochsendorf F, Micali G. The synergy between pharmacological regimens and dermocosmetics and its impact on adherence in acne treatment. Dermatol Res Pract. 2022:2022:3644720.

10.Thiboutot D, Layton AM, Traore I, Gontijo G, Troielli P, Ju Q, et al. International expert consensus recommendations for the use of dermocosmetics in acne. J Eur Acad Dermatol Venereol. 2025;39:952-66.

11.Passeron T, Lim HW, Goh C-L, Kang HY, Ly F, Morita A, et al. Photoprotection according to skin phototype and dermatoses:Practical recommendations from an expert panel. J Eur Acad Dermatol Venereol. 2021;1460-9.

12.DégboéB, Koudoukpo C, Agbéssi N, Elégbédé-AdégbitèN, Akpadjan F, Adégbidi H, et al. Acne on pigmented skin:Epidemiological, clinical and therapeutic features in dermatology in Benin. J Cosmet Dermatol Sci Appl. 2019;9:305 12.

13.Chiang C, Ward M, Gooderham M. Dermatology:How to manage acne in skin of colour. Drugs Context. 2022;11:2021-10-9.

14.Amraoui N, Gallouj S, Berraho MA, Najjari C, Mernissi FZ. [Adherence to treatment in chronic dermatosis:about 200 cases]. Pan Afr Med J. 2015;22:116.

15.Halioua B. [Adherence:Definitions and measurement methods:Characteristics of adherence to topical treatments]. Ann Dermatol Venereol. 2012;139 Suppl 1:S1-6.

16.Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Mielgo-Ayuso J, Caballero-Garcia A, et al. Adherence to treatment and related factors among patients with chronic conditions in primary care:A cross-sectional study. BMC Family Practice. 2019;20:132.

17.Nasimi M, Abedini R, Ghandi N, Hajinamaki H, Hasan Zadeh M, Ansari M. Topical treatment adherence and associated factors in patients with psoriasis:A single-center, cross-sectional study. Dermatol Ther. 2022;35:e15547.

18.Furue M, Onozuka D, Takeuchi S, Murota H, Sugaya M, Masuda K, et al. Poor adherence to oral and topical medication in 3096 dermatological patients as assessed by the Morisky Medication Adherence Scale-8. Br J Dermatol. 2015;172:272-5.

19.Cîrstea N, Radu A, Vesa C, Radu AF, Bungau AF, Tit DM et al. Current insights on treatment adherence in prevalent dermatological conditions and strategies to optimize adherence rates. Cureus. 2024;16:e69764.

20.Lee S-Q, Raamkumar AS, Li J, Cao Y, Witedwittayanusat K, Chen L, et al. Reasons for primary medication nonadherence:A systematic review and metric analysis. J Manag Care Spec Pharm. 2018;24:778-94.

21.Ryskina KL, Goldberg E, Lott B, Hermann D, Barbieri JS, Lipoff JB. The role of the physician in patient perceptions of barriers to primary adherence with acne medications. JAMA Dermatol. 2018;28;154:456-9.

22.Salamzadeh J, Torabi Kachousangi S, Hamzelou S, Naderi S, Daneshvar E. Medication adherence and its possible associated factors in patients with acne vulgaris:A cross-sectional study of 200 patients in Iran. Dermatol Ther. 2020;33:e14408.

23.Ip A, Muller I, Geraghty A.W.A, McNiven A, Little P, Santer M. Young people’s perceptions of acne and acne treatments:Secondary analysis of qualitative interview data. Br J Dermatol 2020;183:208-9.

24.Turan S, Turan IK, Özbağcıvan Ö. Emotion regulation in adolescents with acne vulgaris:Correlates of medication adherence, clinical dimensions and psychopathology symptoms:A cross-sectional study. Turk J Pediatr. 2020;62:1012-20.

25.Alghofaili A, Alolayan S, Alhowail A, Mobark MA, Alderaibi S, Almogbel Y. The effect of depression on treatment adherence among a sample of Saudi patients diagnosed with acne vulgaris. Clin Cosmet Investig Dermatol. 2021;14:1497-506.