Addressing the Research Gaps in Dermatology will Benefit Africa

The times are changing with African consumers are demanding more from their beauty products. An increasing expectation of high-quality and functional products that are tailored to their needs. The growing demand for products designed for natural African hair exemplifies this movement. Moreover, epidemiological reports show an increasing prevalence of 20-87% of skin diseases in developing countries, motivating a significant proportion of visits and thus burden on the primary care centres. Investment in research is vital to further spark innovation on the continent, guide the creation of guidelines to demotivate harmful grooming practices such as bleaching, which has been linked to skin cancer, and bring relief to the health system,

There are many missing gaps in our knowledge of the physiology of Afro hair and skin, particularly regarding disease states as well as the effect of daily habits. For example, a recent study led by Dr. Kwezikazi Molamodi, an expert on Afro hair science, examined the impact of common hair care practices on Afro hair fibres. The study concludes hair care practices as simple as combing must be accompanied by strength-enhancing or protective hair care routines. Similarly, the age-old myth that black skin is completely protected from the effects of sunlight and does not need sun protection measures has been disproved by recent studies involving black participants in South Africa, Nigeria, and the United Kingdom. These studies found that:

• More than 50% of the 74 Africa-based study participants had experienced sunburn2;
• Sun-induced DNA damage following sunlight exposure is found in black skin with a significant differential gradient of melanin protection in the epidermis of black skin3
• Skin colour has no effect on DNA repair rate in vivo4

Interestingly, sunscreen studies by Verschoore et al5,6 showed that for black skin7, just eight weeks of daily sunscreen application (with high UVA protection) resulted in significant improvement in skin texture and dyschromia; the latter being a major beauty problem in Africa. These studies were for the most part the first of their kind to include black skin and answer pertinent questions that affect the daily personal care habits of black people.

Similarly, the prevalence of atopic dermatitis (AD) is increasing in developing regions, including Africa. In sub-Saharan Africa, the following disorders are most common in children: pyoderma (prevalence range 6.9-35%), and scabies (1.3-17%), viral skin disorders (0.4-9%), pediculosis capitis (0-57%), and dermatitis (0-5%)8. Persons of older age suffer a disability burden from HIV-related skin diseases, fungal skin diseases and dermatitis. There is evidence that cesarean section increases AD risk in certain individuals. In an unpublished Nigerian study, Prof Frances Ajose, University of Lagos, explored newborn skincare practices in rural Nigeria where AD is rare and discovered the microbiome benefits derived from vaginal births and the use of acidic pH skincare to ensure microbiome coverage that supports development of life-long tolerant immune responses.

There is a high prevalence of diseases lacking a specific diagnosis in Africa. These are fundamentally due to the lack of high quality clinical trials to inform treatment approaches, in addition to the very few clinical practice collaborations across African countries. Without guidelines, healthcare professionals in these resource-strapped settings may be compelled to rely on unvalidated information, which can; lead to patient harm, significantly lengthen treatment time, and reduce sufferers’ quality of life. The immediate benefits of increased investment in dermatology research will indirectly reduce functional impairment in professional life and directly benefit patients who, perhaps as estimated for India, spend up to 73% of per capita monthly income on healthcare.

A local advantage

Africa could benefit even more from its dual patient care practices. There is a widespread custom of community-based traditional healers who utilise the incredibly unique flora of plants and animals on the African continent. In a race to offer consumers more nature-based products, the beauty industry is slowly turning to traditional medicine as a source of bioactive components and the pharmaceutical industry for inspiration for the production of synthetic medicine. An improved understanding of the chemistry behind the medicinal mixtures used by the traditional healers would provide additional information on the efficacy of these natural herbal products whilst exposing novel pathways and usage. This research will propel Africa’s reputation as a research power, providing unique opportunities for African-led and African-funded research, in addition to translating into an empowered workforce and economic benefits for the continent. It is worth remembering that the growth of highly industrialised economies is credited to technical innovation not exclusively labour and capital9. A more significant element supporting investment in traditional medicine research is that along with the ease of availability of these remedies, guidelines for efficacy and toxicity will provide empirical evidence to the public and reduce dependence on more expensive Western medicine.

Public governance in Medical Lab Research

The COVID-19 pandemic highlights the importance of investing in strengthening medical laboratories, research, and innovation in Africa. Medical laboratory research is vital for the survival of humanity as it ensures public health, the safety of products, and the detection of toxins in different fields. Medical laboratory research and innovation has undergone a transformation in Africa over the past two decades with an increase in investment from both the public and private sectors. Although in comparison to other continents, Africa continues to lag behind, both with regards to the capital and quality of infrastructure investment and in the ratio of available personnel. Africa accounts for less than 1% of the world’s research. In 2020, the countries in Africa with the most innovations according to the World Health Organization (WHO), were South Africa (13%), Kenya (10%), Nigeria (8%), and Rwanda (6%)10. The World Bank Group also notes that African countries invest less in innovation than any other continent at around 0.01% per capita. In 2018, Low-income countries received only 0.2% of all direct grants for biomedical research by major funders11. African governments’ investment in healthcare requires a deliberate drive. There is also a need for these investments to be accompanied through a patient-centric approach, where medical research should improve the clinical experience and outcome for patients. The goal is to help solve pertinent health problems by facilitating collaboration between laboratory specialists and clinical professionals so that they can share their expertise in the research process and deliver a high-quality service that respects innovation, data reporting, results in rapid and accurate data delivery, and ensures that patients have the best possible care.

Reference

1. Molamodi K, Fajuyigbe D, Sewraj P, Gichuri J, Sijako B, Galliano A, Laurent A. Quantifying the impact of braiding and combing on the integrity of natural African hair. Int J Cosmet Sci. 2021 Jun;43(3):321-331.
2. Diffey BL, Fajuyigbe D, Wright CY. Sunburn and sun protection in black skin. Int J Dermatol.2019 Sep;58(9):1053-1055.
3. Fajuyigbe D, Lwin SM, Diffey BL, Baker R, Tobin DJ, Sarkany RPE, Young AR. Melanin distribution in human epidermis affords localized protection against DNA photodamage and concurs with skin cancer incidence differences in extreme phototypes. FASEB J. 2018 Jul;32(7):3700-3706.
4. Fajuyigbe D, Douki T, van Dijk A, Sarkany RP, Young AR. Dark cyclobutane pyrimidine dimers are formed in the epidermis of Fitzpatrick skin types I/II and VI in vivo after exposure to solar simulated radiation. Pigment Cell Melanoma Res. May;34(3):575-584.
5. Sarkar R, Garg VK, Jain A, Agarwal D, Wagle A, Flament F, Verschoore M. A randomized study to evaluate the efficacy and effectiveness of two sunscreen formulations on Indian skin types IV and V with pigmentation irregularities. Indian J Dermatol Venereol Leprol. 2019 Mar-Apr;85(2):160-168.
6. Grimes P, Halder R, Verschoore M, Wangari-Talbot J, Pillai K, Foltis P, Bouez C, Galdi A, Abdelhalim D, Liao IC, Zheng Q. Long-Term Benefits of Daily Photo-Protection With a Broad-Spectrum Sunscreen in United States Hispanic Female Population. J Drugs Dermatol. 2020 Mar 1;19(3):236-242.
7. Effectiveness of Sunscreen use for even skin pigmentation in skin of color. Halder R, Rodney I, Munhutu M, Foltis P, Nielson M, Verschoore M, Oresajo C. JAAD. 2015 May;72(5 supplement 1): AB215
8. World Health Organization. (‎2005)‎. Epidemiology and management of common skin diseases in children in developing countries. World Health Organization.
9. Rosenberg N (2004) Innovation and economic growth. OECD, Paris
10. Collins Boakye-Agyemang, Saya Oka, WHO Africa Health Emergencies Programme https://www.afro.who.int/news/covid-19-spurs-health-innovation-africa
11. World Health Statistics report 2021, World Health Organisation. https://www.who.int/data/gho/publications/world-health-statistics