What is epidemiology and why is it relevant to dermatology?

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Thinking in terms of populations rather than individuals

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How much of a public health problem is skin disease?

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  • 35  Herd RM, Tidman MJ, Prescott RJ, Hunter JAA. The cost of atopic eczema. Br J Dermatol 1996;135:203. Cross Ref link Pubmed link
  • 36  Mancini AJ, Kaulback K, Chamlin SL. The socioeconomic impact of atopic dermatitis in the United States: a systematic review. Pediatr Dermatol 2008;25:16. Cross Ref link Pubmed link
  • 37  Javitz HS, Ward MM, Farber E, et al. The direct cost of care for psoriasis and psoriatic arthritis in the United States. J Am Acad Dermatol 2002;46:85060. Cross Ref link Pubmed link
  • 38  Bickers DR, Lim HW, Margolis D, et al; American Academy of Dermatology Association; Society for Investigative Dermatology. The burden of skin diseases: 2004, a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol 2006;55:490500. Cross Ref link Pubmed link
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  • 40  Murray CJL, Lopez A, eds. Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Cambridge, MA: Harvard University Press, 1996.
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What determines the frequency of skin disease in populations?

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  • 46  Williams HC. Smoking and psoriasis. BMJ 1994;308:4289. Cross Ref link Pubmed link
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  • 48  Bradford‐Hill A. The environment and disease: association or causation? J R Soc Med 1965;58:295300.
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  • 51  Williams HC, Strachan DP, Hay RJ. Childhood eczema: disease of the advantaged? BMJ 1994;308:11325. Cross Ref link Pubmed link
  • 52  McAleer MA, Irvine AD. The multifunctional role of filaggrin in allergic skin disease. J Allergy Clin Immunol 2013;131:28091. Cross Ref link Pubmed link
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  • 54  Milano A, Pendergrass SA, Sargent JL, et al. Molecular subsets in the gene expression signatures of scleroderma skin. PLOS ONE 2008;3:e2696. Cross Ref link
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  • 58  Williams HC, Pembroke AC, Forsdyke H, et al. London‐born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol 1995;32:21217. Cross Ref link Pubmed link
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  • 60  Silver SE. Melanocytic nevus density in Asian, Indo‐Pakistani, and white children. J Am Acad Dermatol 1992;27:27788. Cross Ref link Pubmed link
  • 61  Bhopal R. Needs of black and ethnic minorities. BMJ 1992;305:11567. Cross Ref link Pubmed link
  • 62  Williams HC. Have you ever seen an Asian/Pacific Islander? Arch Dermatol 2002;138:6734. Pubmed link
  • 63  Worth RM. Atopic dermatitis among Chinese infants in Honolulu and San Francisco. Hawaiian Med J 1962;22:316.
  • 64  Polednak AP. Trends in cancer incidence in Connecticut, 1935–91. Cancer 1994;74:286372. Cross Ref link Pubmed link
  • 65  Williams H, Stewart A, von Mutius E, Cookson B, Anderson HR and the International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study groups. Is eczema really on the increase worldwide? Journal Allergy and Clinical Immunology 2008;121:94754. Cross Ref link
  • 66  Gbakima AA, Lebbie AR. The head louse in Sierra Leone: an epidemiological study among school children, in the Njala area. West Afr J Med 1992;11:16571. Pubmed link
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  • 77  Chuang T‐Y, Perry HO, Ilstrup DM, Kurkland LT. Recent upper respiratory tract infection and pityriasis rosea: a case–control study of 249 matched pairs. Br J Dermatol 1983;108:58791. Cross Ref link Pubmed link
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Describing the natural history and associations of specific skin diseases

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  • 80  Burr ML, Dunstan FD, Hand S, Ingram JR, Jones KP. The natural history of eczema from birth to adult life: a cohort study. Br J Dermatol 2013;168:133942. Cross Ref link Pubmed link
  • 81  Rystedt I. Long term follow‐up in atopic dermatitis. Acta Derm Venereol (Stockh) 1985;114(Suppl.):11721.
  • 82  Williams HC, Strachan DP, Hay RJ. The natural history of childhood eczema. Br J Dermatol 1993;129(Suppl. 42):26. Cross Ref link
  • 83  Williams HC, Wuthrich B. The natural history of atopic dermatitis. In: Williams HC, ed. Atopic Dermatitis: the Epidemiology, Causes and Prevention of Eczema. Cambridge: Cambridge University Press, 2000:4159. Cross Ref link
  • 84  Jorgen HO, Moller H, Frentz G. Malignant tumors in patients with psoriasis. J Am Acad Dermatol 1992;27:71622. Cross Ref link Pubmed link
  • 85  Azfar RS, Gelfand JM. Psoriasis and metabolic disease: epidemiology and pathophysiology. Curr Opin Rheumatol 2008;20:41622. Cross Ref link Pubmed link
  • 86  Armstrong AW, Harskamp CT, Armstrong EJ. Psoriasis and metabolic syndrome: a systematic review and meta‐analysis of observational studies. J Am Acad Dermatol 2013;68:65462. Cross Ref link Pubmed link
  • 87  Henseler T, Ye B, Christophers E. Coincidence of psoriasis and other diseases. Arch Dermatol 1992;284:19.
  • 88  Beer WE, Smith AE, Kassab JY, et al. Concomitance of psoriasis and atopic dermatitis. Dermatology 1992;184:26570. Cross Ref link Pubmed link
  • 89  Williams HC, Strachan DP. Psoriasis and eczema are not mutually exclusive diseases. Dermatology 1994;189:23840. Cross Ref link Pubmed link
  • 90  Gerber LM, Wolf AM, Braham RL, Alderman MH. Effects of sample selection on the coincidence of hypertension and diabetes. JAMA 1982;247:436. Cross Ref link Pubmed link
  • 91  Thomas SL, Minassian C, Ganesan V, Langan SM, Smeeth L. Chickenpox and risk of stroke: a self‐controlled case series analysis. Clin Infect Dis 2014;58:618. Cross Ref link Pubmed link
  • 92  Langan SM, Groves RW, Card TR, Gulliford MC. Incidence, mortality, and disease associations of pyoderma gangrenosum in the United Kingdom: a retrospective cohort study. J Invest Dermatol 2012;132:216670. Cross Ref link Pubmed link
  • 93  Deckert S, Kopkow C, Schmitt J. Nonallergic comorbidities of atopic eczema: an overview of systematic reviews. Allergy 2014;69:3745. Cross Ref link Pubmed link

Health services research in dermatology

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  • 95  Chren MM. Dermatologic health services research. Dermatol Clin 1995;13:68995. Pubmed link
  • 96  Stevens A, Raftery J. Introduction. In: Stevens A, Raftery J, eds. Health Care Needs Assessment, Series I. Oxford: Radcliffe Medical Press, 1994:1130.
  • 97  Williams HC. Dermatology. In: Stevens A, Raftery J, eds. Health Care Needs Assessment, Series II. Oxford: Radcliffe Medical Press, 1997:261348.
  • 98  Schofield J, Grindlay D, Williams H. Skin Conditions in the UK: a Health Care Needs Assessment. Nottingham: Centre of Evidence‐Based Dermatology, University of Nottingham, 2009.
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  • 103  Ferguson JA, Goldacre MJ, Newton JN, Dawber RPR. An epidemiological profile of inpatient workload in dermatology. Clin Exp Dermatol 1992;17:40712. Cross Ref link Pubmed link
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  • 105  Williams HC. Extended role of pharmacists in dermatology. J Clin Pharm Ther 1996;20:31012. Cross Ref link
  • 106  Weber MB, Fontes Neto, Pde T, Prati C, et al. Improvement of pruritus and quality of life of children with atopic dermatitis and their families after joining support groups. J Eur Acad Dermatol Venereol 2008;22:9927. Cross Ref link Pubmed link
  • 107  Lowell BA, Froelich CW, Federman DG, Kirsner RS. Dermatology in primary care: prevalence and patient disposition. J Am Acad Dermatol 2001;45:2505. Cross Ref link Pubmed link
  • 108  Roland M, Morris R. Are referrals by general practitioners influenced by the availability of consultants? BMJ 1988;297:599600. Cross Ref link Pubmed link
  • 109  Johnson MLT. Skin Conditions and Related Need for Medical Care Among Persons 1–74 years, United States, 1971–4. Vital and Health Statistics, Series 11, No. 212; Publication No. (PHS) 79–1660. Washington: US Department of Health, Education and Welfare/National Center for Health Statistics, 1978:172.
  • 110  Ryan TJ. Healthy skin for all. Int J Dermatol 1994;33:82935. Cross Ref link Pubmed link
  • 111  Hay RJ, Hernandez HA, Lopez GC, et al. Wastage of family income on skin disease in Mexico. BMJ 1994;309:848. Cross Ref link Pubmed link

Conclusions

  • 112  Strachan DP. Hay fever, hygiene, and household size. BMJ 1989;299:125960. Cross Ref link Pubmed link
  • 113  Williams HC, Strachan DP, Hay RJ. Childhood eczema: disease of the advantaged? BMJ 1994;308:11325. Cross Ref link Pubmed link
  • 114  Sherriff A, Golding J. Hygiene levels in a contemporary population cohort are associated with wheezing and atopic eczema in preschool infants. Arch Dis Child 2002;87:269. Cross Ref link Pubmed link
  • 115  Kalliomaki M, Salminen S, Arvilommi H, et al. Probiotics in primary prevention of atopic disease: a randomised placebo‐controlled trial. Lancet 2001;357:10769. Cross Ref link Pubmed link
  • 116  Foisy M, Boyle, RJ, Chalmers JR, Simpson EL, Williams HC. The prevention of eczema in infants and children: an overview of Cochrane and non‐Cochrane reviews. Evid Based Child Health 2011;6:132239. Cross Ref link Pubmed link
  • 117  Williams HC. Beyond the year 2000: how may epidemiology influence future clinical practice in dermatology? Clin Dermatol 2001;19:558. Cross Ref link Pubmed link
  • 118  Nijsten T, Stern RS. How epidemiology has contributed to a better understanding of skin disease. J Invest Dermatol 2012;132:9941002. Cross Ref link Pubmed link
  • 119  Langan S, Schmitt J, Coenraads PJ, Svensson A, von Elm E, Williams H; European Dermato‐Epidemiology Network (EDEN). The reporting of observational research studies in dermatology journals: a literature‐based study. Arch Dermatol 2010;146:53441. Cross Ref link Pubmed link
  • 120  Bastuji‐Garin S, Sbidian E, Gaudy‐Marqueste C, et al.; European Dermatology Network (EDEN). Impact of STROBE statement publication on quality of observational study reporting: interrupted time series versus before‐after analysis. PLOS ONE 2013;8(8):e64733. Cross Ref link Pubmed link

Glossary of epidemiological terms

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  • 125  Williams HC, Burney PGJ, Strachan D, Hay RJ. The UK Working Party's diagnostic criteria for atopic dermatitis. 2: Observer variation of clinical diagnosis and signs of atopic dermatitis. Br J Dermatol 1994;131:397405. Cross Ref link Pubmed link
  • 126  Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ 1992;304:14914. Cross Ref link Pubmed link
  • 127  Barker DJP, Rose G. Epidemiology in Medical Practice, 2nd edn. Edinburgh: Churchill Livingstone, 1979:11624.