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  1. Article ; Online: Perceived psychological stress and risk of herpes zoster: a nationwide population-based cohort study.

    Schmidt, S A J / Sørensen, H T / Langan, S M / Vestergaard, M

    The British journal of dermatology

    2021  Volume 185, Issue 1, Page(s) 130–138

    Abstract: Background: Psychological stress may reduce cellular immunity, but its role in triggering latent infections, including herpes zoster (HZ), is controversial.: Objectives: To examine the association between perceived psychological stress and risk of HZ. ...

    Abstract Background: Psychological stress may reduce cellular immunity, but its role in triggering latent infections, including herpes zoster (HZ), is controversial.
    Objectives: To examine the association between perceived psychological stress and risk of HZ.
    Methods: In a linked registry-based cohort study, we followed 77 310 persons aged 40 years or older who participated in the 2010 Danish National Health Survey from 1 May 2010 until HZ diagnosis, death, emigration or 1 July 2014, whichever occurred first. We computed hazard ratios (HRs) of HZ associated with Cohen's Perceived Stress Scale (PSS) score (range 0-40) using Cox regression with age as the timescale, adjusted for sex, immunosuppressive and selected chronic conditions, immunosuppressive drugs, and sociodemographic, lifestyle and anthropometric factors. The PSS measures chronic stress perceived by an individual in response to various demands of daily life. We modelled the PSS score using quintiles and a restricted cubic spline function.
    Results: The unadjusted rate of HZ varied from 5·53 to 7·20 per 1000 person-years from the lowest to the highest PSS score quintile. Compared with the lowest PSS score quintile, the adjusted HR for HZ was 1·00 [95% confidence interval (CI) 0·86-1·16], 1·08 (95% CI 0·92-1·26), 1·05 (95% CI 0·90-1·23) and 1·14 (95% CI 0·97-1·34) for the second to the fifth quintile, respectively. In cubic spline analyses, PSS scores < 20 were not associated with increased HR of HZ, but thereafter the HR increased linearly from 1·10 (95% CI 0·85-1·41) to 2·22 (95% CI 1·32-3·75).
    Conclusions: Our study indicated that high levels of psychological stress are associated with increased risk of HZ.
    MeSH term(s) Cohort Studies ; Herpes Zoster/epidemiology ; Herpesvirus 3, Human ; Humans ; Incidence ; Risk Factors ; Stress, Psychological/epidemiology
    Language English
    Publishing date 2021-05-07
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1111/bjd.19832
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  2. Article ; Online: The need to improve reporting of routinely collected dermatology data for patient benefit.

    Langan, S M / Benchimol, E I

    The British journal of dermatology

    2016  Volume 174, Issue 3, Page(s) 477–480

    MeSH term(s) Checklist ; Data Collection/standards ; Dermatology/standards ; Electronic Health Records/standards ; Humans ; Observational Studies as Topic/standards ; Practice Guidelines as Topic ; Quality Improvement ; Registries/standards ; Research Design/standards ; Skin Diseases/epidemiology ; Skin Diseases/therapy
    Language English
    Publishing date 2016-03-22
    Publishing country England
    Document type Editorial ; Research Support, Non-U.S. Gov't
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1111/bjd.14433
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  3. Article: Flares in childhood eczema.

    Langan, S M

    Skin therapy letter

    2009  Volume 14, Issue 8, Page(s) 4–5

    Abstract: Eczema is a major public health problem affecting children worldwide. Few studies have directly assessed triggers for disease flares. This paper presents evidence from a published systematic review and a prospective cohort study looking at flare factors ... ...

    Abstract Eczema is a major public health problem affecting children worldwide. Few studies have directly assessed triggers for disease flares. This paper presents evidence from a published systematic review and a prospective cohort study looking at flare factors in eczema. This systematic review suggested that foodstuffs in selected groups, dust exposure, unfamiliar pets, seasonal variation, stress, and irritants may be important in eczema flares. We performed a prospective cohort study that focused on environmental factors and identified associations between exposure to nylon clothing, dust, unfamiliar pets, sweating, shampoo, and eczema flares. Results from this study also demonstrated some new key findings. First, the effect of shampoo was found to increase in cold weather, and second, combinations of environmental factors were associated with disease exacerbation, supporting a multiple component disease model. This information is likely to be useful to families and may lead to the ability to reduce disease flares in the future.
    MeSH term(s) Adolescent ; Child ; Child, Preschool ; Cohort Studies ; Cold Temperature/adverse effects ; Eczema/etiology ; Eczema/physiopathology ; Environmental Exposure/adverse effects ; Hair Preparations/adverse effects ; Humans ; Infant ; Prospective Studies ; Severity of Illness Index ; Weather
    Chemical Substances Hair Preparations
    Language English
    Publishing date 2009-11
    Publishing country Canada
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2065394-3
    ISSN 1201-5989
    ISSN 1201-5989
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  4. Article ; Online: Inflammatory skin diseases and the risk of chronic kidney disease: population-based case-control and cohort analyses.

    Schonmann, Y / Mansfield, K E / Mulick, A / Roberts, A / Smeeth, L / Langan, S M / Nitsch, D

    The British journal of dermatology

    2021  Volume 185, Issue 4, Page(s) 772–780

    Abstract: Background: Emerging evidence suggests an association between common inflammatory skin diseases and chronic kidney disease (CKD).: Objectives: To explore the association between CKD stages 3-5 (CKD3-5) and atopic eczema, psoriasis, rosacea and ... ...

    Abstract Background: Emerging evidence suggests an association between common inflammatory skin diseases and chronic kidney disease (CKD).
    Objectives: To explore the association between CKD stages 3-5 (CKD3-5) and atopic eczema, psoriasis, rosacea and hidradenitis suppurativa.
    Methods: We undertook two complementary analyses; a prevalent case-control study and a cohort study using routinely collected primary care data [UK Clinical Practice Research Datalink (CPRD)]. We matched individuals with CKD3-5 in CPRD in March 2018 with up to five individuals without CKD for general practitioner practice, age and sex. We compared the prevalence of CKD3-5 among individuals with and without each inflammatory skin disease. We included individuals in CPRD with diabetes mellitus (2004-2018) in a cohort analysis to compare the incidence of CKD3-5 among people with and without atopic eczema and psoriasis.
    Results: Our study included 56 602 cases with CKD3-5 and 268 305 controls. Cases were more likely than controls to have a history of atopic eczema [odds ratio (OR) 1·14, 99% confidence interval (CI) 1·11-1·17], psoriasis (OR 1·13, 99% CI 1·08-1·19) or hidradenitis suppurativa (OR 1·49, 99% CI 1·19-1·85), but were slightly less likely to have been diagnosed with rosacea (OR 0·92, 99% CI 0·87-0·97), after adjusting for age, sex, practice (matching factors), index of multiple deprivation, diabetes, smoking, harmful alcohol use and obesity. Results remained similar after adjusting for hypertension and cardiovascular disease. In the cohort with diabetes (N = 335 827), there was no evidence that CKD3-5 incidence was associated with atopic eczema or psoriasis.
    Conclusions: Atopic eczema, psoriasis and hidradenitis suppurativa are weakly associated with CKD3-5. Future research is needed to elucidate potential mechanisms and the clinical significance of our findings.
    MeSH term(s) Case-Control Studies ; Cohort Studies ; Dermatitis, Atopic/epidemiology ; Humans ; Psoriasis/complications ; Psoriasis/epidemiology ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/etiology
    Language English
    Publishing date 2021-06-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1111/bjd.20067
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  5. Article ; Online: Using electronic health records to inform trial feasibility in a rare autoimmune blistering skin disease in England.

    Persson, M S M / Harman, K E / Thomas, K S / Chalmers, J R / Vinogradova, Y / Langan, S M / Hippisley-Cox, J / Gran, S

    BMC medical research methodology

    2021  Volume 21, Issue 1, Page(s) 22

    Abstract: Background: Trials of novel agents are required to improve the care of patients with rare diseases, but trial feasibility may be uncertain due to concerns over insufficient patient numbers. We aimed to determine the size of the pool of potential ... ...

    Abstract Background: Trials of novel agents are required to improve the care of patients with rare diseases, but trial feasibility may be uncertain due to concerns over insufficient patient numbers. We aimed to determine the size of the pool of potential participants in England 2015-2017 for trials in the autoimmune blistering skin disease bullous pemphigoid.
    Methods: The size of the pool of potential participants was estimated using routinely collected healthcare data from linked primary care (Clinical Practice Research Datalink; CPRD) and secondary care (Hospital Episode Statistics; HES) databases. Thirteen consultant dermatologists were surveyed to determine the likelihood that a patient would be eligible for a trial based on the presence of cautions or contra-indications to prednisolone use. These criteria were applied to determine how they influenced the potential pool of participants.
    Results: Extrapolated to the population of England, we would expect approximately 10,800 (point estimate 10,747; 95% CI 7191 to 17,239) new cases of bullous pemphigoid to be identified in a three-year period. For a future trial involving oral prednisolone (standard care), the application of cautions to its use as exclusion criteria would result in approximately 365 potential participants unlikely to be recruited, a further 5332 could be recruited with caution, and 5104 in whom recruitment is still possible. 11-17% of potential participants may have pre-existing dementia and require an alternative consent process.
    Conclusions: Routinely collected electronic health records can be used to inform the feasibility of clinical trials in rare diseases, such as whether recruitment is feasible nationally and how long recruitment might take to meet recruitment targets. Future trials of bullous pemphigoid in England may use the data presented to inform trial design, including eligibility criteria and consent processes for enrolling people with dementia.
    MeSH term(s) Electronic Health Records ; England ; Feasibility Studies ; Humans ; Pemphigoid, Bullous/diagnosis ; Pemphigoid, Bullous/drug therapy ; Prednisolone/therapeutic use
    Chemical Substances Prednisolone (9PHQ9Y1OLM)
    Language English
    Publishing date 2021-02-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1471-2288
    ISSN (online) 1471-2288
    DOI 10.1186/s12874-021-01212-1
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  6. Article ; Online: Priority research questions in atopic dermatitis: an International Eczema Council eDelphi consensus.

    Abuabara, K / Nicholls, S G / Langan, S M / Guttman-Yassky, E / Reynolds, N J / Paller, A S / Brown, S J

    The British journal of dermatology

    2021  Volume 185, Issue 1, Page(s) 203–205

    MeSH term(s) Consensus ; Dermatitis, Atopic/diagnosis ; Dermatitis, Atopic/therapy ; Eczema/diagnosis ; Eczema/therapy ; Humans ; Research ; Severity of Illness Index
    Language English
    Publishing date 2021-04-07
    Publishing country England
    Document type Letter
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1111/bjd.19874
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  7. Article ; Online: Reply to: Validation of database search strategies for the epidemiological study of pemphigus and pemphigoid.

    Langan, S M / Smeeth, L / West, J

    The British journal of dermatology

    2016  Volume 174, Issue 3, Page(s) 696–697

    MeSH term(s) Databases, Factual ; Epidemiologic Studies ; Humans ; Pemphigoid, Bullous ; Pemphigus
    Language English
    Publishing date 2016-02-08
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1111/bjd.14397
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  8. Article ; Online: Classifying atopic dermatitis: a systematic review of phenotypes and associated characteristics.

    Bosma, A L / Ascott, A / Iskandar, R / Farquhar, K / Matthewman, J / Langendam, M W / Mulick, A / Abuabara, K / Williams, H C / Spuls, P I / Langan, S M / Middelkamp-Hup, M A

    Journal of the European Academy of Dermatology and Venereology : JEADV

    2022  Volume 36, Issue 6, Page(s) 807–819

    Abstract: Atopic dermatitis is a heterogeneous disease, accompanied by a wide variation in disease presentation and the potential to identify many phenotypes that may be relevant for prognosis and treatment. We aimed to systematically review previously reported ... ...

    Abstract Atopic dermatitis is a heterogeneous disease, accompanied by a wide variation in disease presentation and the potential to identify many phenotypes that may be relevant for prognosis and treatment. We aimed to systematically review previously reported phenotypes of atopic dermatitis and any characteristics associated with them. Ovid EMBASE, Ovid MEDLINE and Web of Science were searched from inception till 12 February 2021 for studies attempting to classify atopic dermatitis. Primary outcomes are atopic dermatitis phenotypes and characteristics associated with them in subsequent analyses. A secondary outcome is the methodological approach used to derive them. In total, 8511 records were found. By focussing only on certain clinical phenotypes, 186 studies were eligible for inclusion. The majority of studies were hospital-based (59%, 109/186) and cross-sectional (76%, 141/186). The number of included patients ranged from seven to 526 808. Data-driven approaches to identify phenotypes were only used in a minority of studies (7%, 13/186). Ninety-one studies (49%) investigated a phenotype based on disease severity. A phenotype based on disease trajectory, morphology and eczema herpeticum was investigated in 56 (30%), 22 (12%) and 11 (6%) studies respectively. Thirty-six studies (19%) investigated morphological characteristics in other phenotypes. Investigated associated characteristics differed between studies. In conclusion, we present an overview of phenotype definitions used in literature for severity, trajectory, morphology and eczema herpeticum, including associated characteristics. There is a lack of uniform and consistent use of atopic dermatitis phenotypes across studies.
    MeSH term(s) Cross-Sectional Studies ; Dermatitis, Atopic/therapy ; Eczema ; Humans ; Kaposi Varicelliform Eruption ; Phenotype ; Severity of Illness Index
    Language English
    Publishing date 2022-02-25
    Publishing country England
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 1128828-0
    ISSN 1468-3083 ; 0926-9959
    ISSN (online) 1468-3083
    ISSN 0926-9959
    DOI 10.1111/jdv.18008
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    Zs.A 3492: Show issues Location:
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    Zs.MO 413: Show issues

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  9. Article ; Online: The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990-2017.

    Laughter, M R / Maymone, M B C / Mashayekhi, S / Arents, B W M / Karimkhani, C / Langan, S M / Dellavalle, R P / Flohr, C

    The British journal of dermatology

    2020  Volume 184, Issue 2, Page(s) 304–309

    Abstract: Background: The Global Burden of Disease (GBD) Study provides an annually updated resource to study disease-related morbidity and mortality worldwide.: Objectives: Here we present the burden estimates for atopic dermatitis (AD), including data from ... ...

    Abstract Background: The Global Burden of Disease (GBD) Study provides an annually updated resource to study disease-related morbidity and mortality worldwide.
    Objectives: Here we present the burden estimates for atopic dermatitis (AD), including data from inception of the GBD project in 1990 until 2017.
    Methods: Data on the burden of AD were obtained from the GBD Study.
    Results: Atopic dermatitis (AD) ranks 15th among all nonfatal diseases and has the highest disease burden among skin diseases as measured by disability-adjusted life-years (DALYs). Overall, the global DALY rate for AD in 1990 was 121 [95% uncertainty interval (UI) 65·4-201] and remained similar in 2017 at 123 (95% UI 66·8-205). The three countries with the highest DALY rates of AD were Sweden (327, 95% UI 178-547), the UK (284, 95% UI 155-478) and Iceland (277, 95% UI 149-465), whereas Uzbekistan (85·1, 95% UI 45·2-144), Armenia (85·1, 95% UI 45·8-143) and Tajikistan (85·1, 95% UI 46·1-143) ranked lowest.
    Conclusions: The global prevalence rate of AD has remained stable from 1990 to 2017. However, the distribution of AD by age groups shows a bimodal curve with the highest peak in early childhood, decreasing in prevalence among young adults, and a second peak in middle-aged and older populations. We also found a moderate positive correlation between a country's gross domestic product and disease burden. GBD data confirm the substantial worldwide burden of AD, which has remained stable since 1990 but shows significant geographical variation. Lifestyle factors, partially linked to affluence, are likely important disease drivers. However, the GBD methodology needs to be developed further to incorporate environmental risk factors, such as ultraviolet exposure, to understand better the geographical and age-related variations in disease burden.
    MeSH term(s) Aged ; Child, Preschool ; Dermatitis, Atopic/epidemiology ; Global Burden of Disease ; Global Health ; Humans ; Incidence ; Middle Aged ; Prevalence ; Quality-Adjusted Life Years ; Risk Factors ; Sweden ; Young Adult
    Language English
    Publishing date 2020-11-29
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1111/bjd.19580
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  10. Article ; Online: Does breastfeeding protect against the development of eczema?

    Langan, S M / Fewtrell, M

    The British journal of dermatology

    2011  Volume 165, Issue 6, Page(s) 1157–1158

    MeSH term(s) Breast Feeding/statistics & numerical data ; Eczema/prevention & control ; Female ; Humans ; Male
    Language English
    Publishing date 2011-11-25
    Publishing country England
    Document type Journal Article ; Comment
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1111/j.1365-2133.2011.10589.x
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