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Research Article | DOI: https://doi.org/10.31579/2578-8949/152
1Associate professor of Dermatology, department of internal medicine, College of Medicine, Umm Al-Qura University, Al- Abdia Main Campus, Makkah, Saudi Arabia
1Medical intern, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia, Email: Daniah.allbdi@gmail.com
2 Medical Intern, Collage of Medicine, University of Tabuk, Tabuk, Saudi Arabia, tahani.fahad45@gmail.com
3 Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia, Email: alhumaidanlama@gmail.com, Orcid id:0009-0004-3628-7944
4 Medical intern,collage of medicine, University of Hail,Hail, Saudi Arabia, Email: sarah7899@outlook.com, ORCID ID:0000-0001-6271-0161
5 Department of Dermatology, Armed Forces Hospital, Al-Dhahran, Saudi Arabia, Email: hamadjbaar@gmail.com
*Corresponding Author: Ahmed Zahr Allayali, Associate Professor of Dermatology, College of internal medicine, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, Saudi Arab, Email amzahrallayali@uqu.edu.sa, ORCID 0000-0001-6863-2774.
Citation: Ahmed M. ZahrAllayali, Daniah S. Allbdi, Tahani F. Alanazi, Lama S. Alhumaidan, Sarah K. Albarrak, Hamad J. Aldhafiri, (2024), The Prevalence, Knowledge and Attitude Regarding Atopic Dermatitis among Adult Population in Saudi Arabia, Dermatology and Dermatitis, 11(2); DOI:10.31579/2578-8949/152
Copyright: © 2024, Ahmed Zahr Allayali. This is an open-access article distributed under the terms of The Creative Commons. Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 21 March 2024 | Accepted: 27 August 2024 | Published: 29 October 2024
Keywords: atopic dermatitis; eczema; asthma; allergic rhinitis; steroids
Background: Atopic dermatitis (AD), or allergic dermatitis or atopic eczema, is a common, chronic, relapsing, and inflammatory skin disease characterized by dry and itchy skin and increased and recurring lesions affecting the general population of all ages.
Aim: The aim of the study is to investigate the prevalence, knowledge, and attitude associated with the factors affecting AD in the adult population of Saudi Arabia.
Materials and Methods: A Cross-sectional study was conducted in Saudi Arabia from January to March 2023, and 922 participants were recruited. An online questionnaire was designed by Google Forms and distributed digitally via social media applications. Logistic regression analysis was conducted to investigate the associated factors affecting AD in the population.
Results: The findings revealed a 30% prevalence of AD among the adult population in Saudi Arabia. This indicates a significant burden of the disease in the country. The knowledge level on AD was fair in 43% of participants, good in 25.9%, and poor in 31.1%. Similarly, the attitude towards AD was fair in 53% of participants, good in 2.6%, and poor in 44.4%. These results suggest a need for improving the understanding and perception of AD among the population. Conclusion: The study findings an immediate requirement for better public education about AD in Saudi Arabia. This education should increase awareness of AD’s symptoms, causes, and treatments.
Atopic dermatitis (AD), or allergic dermatitis or atopic eczema, is a common, recurring, inflammatory, and chronic skin condition particularly frequent in developed countries [1]. AD incidences are common in the adult population of all countries, ranging from 2.1% to 4.9% [2]. These incidences are generally higher in females than males and lower in older age groups, with a peak prevalence mostly observed in the age groups of 25-44 years [3]. Although the pathophysiology of AD is not yet fully known, numerous study findings observe immunological dysregulation and skin barrier disruption as a cause [4].
Severe dryness of the skin, episodes of intense pruritus, lichenification, and susceptibility to skin infections form the disease characteristics. Full remission may occur during adolescence, followed by a recurrence during adulthood [5]. Most patients’ conditions improve, which can occur for people of all ages. AD follows a chronic cycle and flares up periodically. AD affects the body’s different parts in adults compared to manifestations in children. Managing AD involves relieving symptoms and increasing the time period between periodical flare-ups [6].
Most patients with AD do not present a common allergen immunoglobulin E (IgE) reaction. “Atopic eczema” or “atopic dermatitis” is still often used to describe a poorly defined inflammatory skin condition with surface changes, flexures, and a history of asthma or allergic rhinitis [7]. A family history of eczema or asthma is correlated with a higher risk of having eczema. In addition, no significant association could be observed between smoking or breastfeeding and the risk of having eczema [8].
AD is common in Saudi Arabia as primary health care providers’ (PHCPs) knowledge about the skin condition disease is inadequate [9]. A study conducted among the adult population in Saudi Arabia on knowledge and attitude reported a lack of knowledge and skills among physicians for managing AD. AD is mostly treated with topical corticosteroids once daily, and a continuous dose can help reduce the recurrent relapse in patients with moderate to serious forms. A lack of knowledge for managing dermatological issues was noted [10], also observed in England, Wales and Northern Ireland [11].
Information on the prevalence and awareness of AD in Saudi Arabia is scarce in our area, yet significant studies were found when other Kingdom regions were investigated. Hence, our study aimed to evaluate the prevalence, knowledge, attitude, and factors associated with AD among the adult population in Saudi Arabia.
Study design, setting, and time period:
A cross-sectional study was conducted in Saudi Arabia from January to March 2023.
Study population:
The inclusion criteria for the study were Saudi Arabian adults aged 18 - 30 years. The exclusion criteria were non-Saudi Arabian citizens and age, excluding the specified range [12].
Sample size:
A sample size was calculated [13], and a total of 922 participants were selected.
Data collection:
An online questionnaire was designed by Google Forms and distributed digitally via social media applications. Participants’ demographics, knowledge, and attitudes regarding eczema and previous diagnosis with eczema by a physician and related conditions were included in the questionnaire to collect data [14,15]. A participant was considered to have a poor knowledge level if they scored less than 50% of the correct answers on knowledge items, a fair knowledge level if they scored 50-75%, and a good knowledge level if they scored more than 75%. The same scoring was followed for the attitude scoring (negative, fair, and positive attitudes) [14,16].
Ethical approval:
Ethical approval was obtained for conducting the study from the Umm Al-Qura University, KSA, research ethics committee, approval no. HAPO-02-K-012-2022-11-1350
Statistical analysis:
Data were analyzed by applying the SPSS software version 26. Qualitative data were expressed as numbers and percentages to test the relationship between variables, and the Chi-squared test (χ2) was applied. The mean and standard deviation (Mean + SD) were applied to express quantitative data. Spearman’s test was used to analyze the correlations, and a p-value of less than 0.05 was considered statistically significant. A logistic regression analysis was conducted to find the associated factors of AD in the study population.
An overview of the socioeconomic and demographic traits of the population under study is given by the data that has been made available. A lesser percentage of respondents are male (19.8%), while the majority of respondents are female (80.2%). The majority of respondents (89.9%) are single, and the ratio of married people (10.1%) is less. Most have completed high school or more, with bachelor's degree holders accounting up the largest group (58.6%). Students make up the majority (74.2%), followed by employers (11.5%), and the unemployed and retirees account for minor percentages. A significant fraction of respondents fell into the 10000–20000 SR range, with respondents being spread evenly across various income levels. The respondents are dispersed over several regions, with a marginally higher presence in the Western and Central regions than in the other regions.
| Variable | No. (%) |
Gender Female Male |
739 (80.2) 183 (19.8) |
Marital status Single Married |
829 (89.9) 93 (10.1) |
Education Illiterate Elementary or middle school High school Bachelor's degree Diploma PhD Master's |
7 (0.8) 15 (1.6) 291 (31.6) 540 (58.6) 53 (5.7) 4 (0.4) 12 (1.3) |
Employment Student Unemployed Retired Employee |
684 (74.2) 130 (14.1) 2 (0.2) 106 (11.5) |
Monthly family income (SR) less than 5000 5000-10000 10000-20000 More than 20000 |
239 (25.9) 254 (27.5) 259 (28.1) 170 (18.4) |
KSA region Southern Eastern North western Central |
136 (14.8) 206 (22.3) 94 (10.2) 244 (26.5) 242 (26.5) |
Table 1: Distribution of studied participants based on their demographic features (No. 922).
Table 2 demonstrates the participants’ responses to knowledge and attitude items concerning eczema. Of the participants, 90.8% knew atopic dermatitis or atopic eczema, and 67.4% understood that eczema is not contagious. Also, 62% (62.3%) knew about therapy’s role in controlling the disease, and 82.8% knew the importance of constant daily moisturization for treating and managing eczema. About 56% (56.4%) knew that a patient with eczema could pass the disease from them to their children, 34.2% were aware that a person with eczema could develop asthma, and 82.1% knew that perfumes and scented soaps could worsen eczema. Only 29.9% understood that not every child with eczema suffers all of life. Only 20.2% did not agree that topical steroids are not a safe treatment for eczema, even if prescribed and followed up by a dermatologist. About 35% (35.5%) agreed that every case doesn’t worsen eczema in patients if they ate certain foods (Table 2).
| Variable | No. (%) |
Do you know the skin disease called atopic Dermatitis? No Yes* |
85 (9.2) 837 (90.8) |
Is eczema contagious? No* I don’t know Yes |
621 (67.4) 210 (22.8) 91 (9.9) |
What is the role of therapy in eczema? Control the disease * Cure the disease I don’t know exactly |
574 (62.3) 229 (24.8) 119 (12.9) |
What is the importance of constant daily moisturization in the treatment of eczema? Not important Somewhat important Very important * I don’t know exactly |
1 (0.1) 91 (9.9) 763 (82.8) 67 (7.3) |
Can the offspring of a patient with eczema inherit the disease from their parent? No I don’t know Yes* |
132 (14.3) 270 (29.3) 520 (56.4) |
Can a person with eczema develop asthma? No I don’t know Yes* |
123 (13.3) 484 (52.5) 315 (34.2) |
Can a person with eczema develop allergic rhinitis? No I don’t know Yes* |
76 (8.2) 511 (55.4) 335 (36.3) |
Can perfumes and scented soaps worsen eczema No I don’t know Yes* |
23 (2.5) 142 (15.4) 757 (82.1) |
Will every child with eczema suffer all their life from eczema? No I don’t know Yes Not every case* |
251 (27.2) 258 (28) 137 (14.9) 276 (29.9) |
Do you agree or disagree Topical steroids are not a safe treatment for eczema, even if prescribed and followed up by a dermatologist? I don’t know No, I don’t agree * Yes, its not safe |
549 (59.5) 186 (20.2) 187 (20.3) |
Do you agree or disagree that certain foods always make eczema worse in every patient? I don’t know Not in every case * Yes, I agree food always causes flare ups |
279 (22.2) 445 (35.5) 530 (42.3) |
Table 2: Distribution of studied participants based on their knowledge and attitude concerning eczema (No.922).
Figure 1: Illustrates that 277 (30%) of all studied participants were diagnosed with eczema by a physician.
Table 3 demonstrates that out of all 277 patients diagnosed with eczema, 23.4% were diagnosed with a dermatologist, 36.9% had a parental history of atopic dermatitis, and 31.5% had eczema in the elbow. More than half (50.7%) had reported recurring symptoms more than one night/week a week. Of them, 56% also affected their daily activities or work performance. Also, 30% revealed that atopic dermatitis affects their close relationships, and 73.7% reported severity of itching has direct effects on night sleep.
| Variable | No. (%) |
What is the specialty of that doctor? (No.: 277) Pharmacist Family doctor pediatrician Dermatologist Allergist and immunologist General Doctor What I remember |
4 (0.4) 15 (1.6) 12 (1.3) 216 (23.4) 2 (0.2) 25 (2.7) 3 (0.3) |
Parental history of atopic dermatitis (No.:277) No Yes |
175 (63.1) 102 (36.9) |
Where is the most common site of lesions? (No.:277) Knee Chest or back Neck Ankle Elbow Face |
23 (8.3) 30 (10.8) 23 (8.3) 58 (20.9) 87 (31.5) 56 (20.2) |
How many times do symptoms occur in a week? (No.:277) More than one night/ week Once per month One night/ week Rarely |
140 (50.7) 40 (14.4) 42 (15.1) 55 (19.8) |
Do you think that atopic dermatitis affects your daily activities or work performance? No Yes |
122 (44) 155 (56) |
Do you think that atopic dermatitis affects your close relationships? No Yes |
194 (70) 83 (30) |
Does the severity of itching affect your sleeping at night? No Yes |
73 (26.3)
|
| 204 (73.7) |
Table 3: Distribution of participants with eczema based on disease circumstances (No. 277).
The mean knowledge and attitude scores were considered 4.3 ± 1.71 and 1.66 ± 0.93, respectively. Figure 2 illustrates the participants’ knowledge levels, with 31.1%, 43% and 25.9% having a poor, fair and good knowledge level, respectively. However, 44.4%, 53% and 2.6% of the participants had negative, fair and positive attitudes, respectively (Figure 3).
Figure 2: Distribution (%) of studied participants based on their knowledge of eczema.
Figure 3: Distribution (%) of studied participants based on their attitude level towards eczema (No.922).
Table 4 shows the prevalence of females with previous diagnoses of eczema by a physician to be significantly higher compared to male participants (84.1% vs. 15.9%), and prevalence is higher in students as well (p=<0 p=0.048).>0.05), although there were varying prevalence rates across categories within each variable. Employment status showed a statistically significant association with previous eczema diagnosis (p=0.036), with employed individuals having a higher prevalence of eczema diagnosis compared to students, unemployed, and retired individuals.
| Variable | No previous physician diagnosis with eczema No. (%) | Previous physician diagnosis with eczema No. (%) | χ2 | p-value |
Gender Female Male |
506 (78.4) 139 (21.6) |
233 (84.1) 44 (15.9) |
3.91 |
0.048 |
Marital status Single Married |
585 (90.7) 60 (9.3) |
244 (88.1) 33 (11.9) |
1.45 |
0.227 |
Education Illiterate Elementary or middle school High school Bachelor's degree Diploma PhD Master's |
4 (0.6) 9 (1.4) 211 (32.7) 374 (58) 37 (5.7) 4 (0.6) 6 (0.9) |
3 (1.1) 6 (2.2) 80 (28.9) 166 (59.9) 16 (5.8) 0 (0.0) 6 (2.2) |
6.27 |
0.393 |
Employment Student Unemployed Retired Employee |
494 (76.6) 79 (12.2) 2 (0.3) 70 (10.9) |
190 (68.6) 51 (18.4) 0 (0.0) 36 (13) |
8.52 |
0.036 |
Monthly family income (SR) less than 5000 5000-10000 10000-20000 More than 20000 |
172 (26.7) 168 (26) 182 (28.2) 123 (19.1) |
67 (24.2) 86 (31) 77 (27.8) 47 (17) |
2.69 |
0.441 |
KSA region Southern Eastern North western Central |
97 (15) 145 (22.2) 67 (10.4) 156 (25.6) 171 (26.5) |
39 (14.1) 61 (22) 27 (9.7) 79 (28.5) 71 (25.6) |
0.9 |
0.924 |
Table 4: Relationship between previous diagnosis of eczema by a physician and participants’ demographics (No.:922).
Table 5 demonstrates a good knowledge level about eczema and reveals it to be significantly higher among females, single, had a bachelor’s degree of education, a monthly income of 10000-20000 SR, and among participants previously diagnosed with eczema by a physician (59.4%) (p=<0 xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed>
Variable | Knowledge level | χ2 | p-value | ||
Poor No. (%) | Fair No. (%) | Good No. (%) | |||
Gender Female Male |
204 (71.1) 83 (28.9) |
341 (86.1) 55 (13.9) |
194 (81.2) 45 (18.8) |
23.84 |
<0> |
Marital status Single Married |
249 (86.8) 38 (13.2) |
354 (89.4) 42 (10.6) |
226 (94.6) 13 (5.4) |
8.59 |
0.011 |
Education Illiterate Elementary or middle school High school Bachelor's degree Diploma PhD Master's |
4 (1.4) 8 (2.8) 102 (35.5) 143 (49.8) 25 (8.7) 2 (0.7) 4 (1.4) |
3 (0.8) 3 (0.8) 116 (29.3) 247 (62.4) 22 (5.6) 1 (0.3) 3 (0.8) |
0 (0.0) 4 (1.7) 73 (30.5) 150 (62.8) 6 (2.5) 1 (0.4) 0 (0.0) |
26.23 |
0.01 |
Employment Student Unemployed Retired Employee |
206 (71.8) 44 (15.1) 1 (0.3) 36 (12.5) |
292 (73.7) 63 (15.9) 1 (0.3) 40 (10.1) |
186 (77.8) 23 (9.6) 0 (0.0) 30 (12.6) |
7.23 |
0.3 |
Monthly family income (SR) less than 5000 5000-10000 10000-20000 More than 20000 |
80 (27.9) 87 (30.3) 71 (24.7) 49 (17.1) |
106 (26.8) 110 (27.8) 124 (31.3) 56 (14.1) |
53 (22.2) 57 (23.8) 64 (26.8) 65 (27.2) |
20.77 |
0.002 |
KSA region Southern Eastern North western Central |
46 (16) 72 (25.1) 28 (9.8) 79 (27.5) 62 (21.6) |
62 (15.7) 93 (23.5) 44 (11.1) 98 (24.7) 99 (25) |
28 (11.7) 41 (17.2) 22 (9.2) 67 (28) 81 (33.9) |
15.41 |
0.052 |
Have you ever been diagnosed with eczema by a physician? No Yes |
234 (81.5) 53 (18.5) |
269 (67.9) 127 (32.1) |
142 (59.4) 97 (40.6) |
31.71 |
<0> |
Table 5: Relationship between participants’ knowledge level about eczema and their demographic features (No. 922).
Table 6 shows the attitude levels of all participants. A positive attitude towards understanding and knowing eczema was significantly higher among females, those having a bachelor’s degree in education, and residents of the Central KSA region (p=<0>
Variable | Attitude level | χ2 | p-value | ||
Negative No. (%) | Fair No. (%) | Positive No. (%) | |||
Gender Female Male |
315 (77) 94 (23) |
408 (83.4) 81 (16.6) |
16 (66.7) 8 (33.3) |
8.58 |
0.014 |
Marital status Single Married |
370 (90.5) 39 (9.5) |
437 (89.4) 52 (10.6) |
22 (91.7) 2 (8.3) |
0.38 |
0.827 |
Education Illiterate Elementary or middle school High school Bachelor's degree Diploma PhD Master's |
3 (0.7) 13 (3.2) 141 (34.5) 216 (52.8) 28 (6.8) 2 (0.5) 3 (0.7) |
4 (0.8) 2 (0.4) 142 (29) 313 (64) 23 (4.7) 1 (0.2) 2 (0.8) |
0 (0.0) 0 (0.0) 8 (33.3) 11 (45.8) 2 (8.3) 1 (4.2) 2 (8.3) |
39.14 |
<0> |
Employment Student Unemployed Retired Employee |
299 (73.1) 58 (14.2) 1 (0.2) 51 (12.5) |
369 (75.5) 69 (14.1) 1 (0.2) 50 (10.2) |
16 (66.7) 3 (12.5) 0 (0.0) 5 (20.8) |
3.31 |
0.769 |
Monthly family income (SR) less than 5000 5000-10000 10000-20000 More than 20000 |
103 (25.2) 102 (24.9) 129 (31.5) 75 (18.3) |
128 (26.2) 144 (29.4) 124 (25.4) 93 (19) |
8 (33.3) 8 (33.3) 6 (25) 2 (8.3) |
7.08 |
0.313 |
KSA region Southern Eastern North western Central |
79 (19.3) 85 (20.8) 38 (9.3) 112 (27.4) 95 (23.2) |
56 (11.5) 118 (24.1) 52 (10.6) 126 (25.8) 137 (28) |
1 (4.2) 3 (12.5) 4 (16.7) 6 (25) 10 (41.7) |
19.21 |
0.014 |
Have you ever been diagnosed with eczema by a physician? No Yes |
278 (68) 131 (32) |
350 (71.6) 139 (28.4) |
17 (70.8) 7 (29.2) |
1.38
|
0.5 |
Table 6: Relationship between participants’ attitude level for eczema and their demographic features (No. 922).
The figure demonstrating a significant positive correlation between knowledge and attitude scores indicates that as knowledge levels increase, attitude scores also tend to increase, and vice versa. the correlation coefficient is 0.31, indicating a moderate positive correlation. Essentially, this p-value suggests that the observed correlation between knowledge and attitude scores is highly unlikely to be due to chance alone. With a positive correlation coefficient (r = 0.31) and a significant p-value (<0>
Figure 4 demonstrates a significant positive correlation between the knowledge and attitude scores (r = 0.31, p-value = <0>Logistic regression analysis:
Our study focused on identifying AD’s prevalence and exploring its knowledge and attitude among the adult population in Saudi Arabia. Our research centered on determining the prevalence of AD and delving into the knowledge and attitudes toward it among adults in Saudi Arabia. These findings hold particular importance when compared to prevalence rates in other regions. For instance, recent studies in the United States have shown a prevalence of 7.5% among adults [17], while Canada, the EU, and Japan report rates of 3.5%, 4.4%, and 2.1%, respectively [2].
A survey in Danish reported prevalence among adults aged 30 to 89 during the first year was 14% [18]. In Sweden, the prevalence was 11
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