2023 — Erin Grinich, M.D. — Bathing Frequency and the Development of Atopic Dermatitis  

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease with the highest disability-adjusted-life-years of any dermatologic disease. The development of AD in early life can trigger the atopic march, whereby infants and children may progress to develop comorbid food allergies, asthma, and/or allergic rhinitis. Prevention of AD is critical for both the individual patient and our public healthcare system.  

A key driver in the pathogenesis of AD is epidermal barrier dysfunction. Overall, epidermal barrier dysfunction leaves skin susceptible to entry of allergens and microbes and prone to increased water loss and reduced hydration. Repeated washing and drying have been associated with increased skin barrier dysfunction. With barrier dysfunction as a hallmark of AD pathogenesis, there is a strong plausible link between bathing and AD development. Scientific confirmation of the link between bathing and AD, however, has not been well established. A comprehensive study on bathing practices is needed to understand the relationship between bathing and the development of AD. 

The goal of this study is to understand the impact of bathing on the development of AD during childhood to inform clinician recommendations, prevention methods, and patient education.  

2021 — Alex G Ortega-Loayza, M.D., M.C.R. — PyGaS (Pyoderma Gangrenosum Study) 

Pyoderma gangrenosum (PG) is a chronic inflammatory disease characterized by painful skin ulcers of the lower extremities. This disease is often misdiagnosed due to a lack of a diagnostic gold standard testing. The diagnosis is made by exclusion and thorough testing is required in all patients suspected of having PG in order to rule out other similar conditions such as chronic venous ulcers (CVU) — the most common cause of lower extremity ulcers.

The pathogenesis of PG is unknown but is likely mediated by immune dysregulation mechanisms given its histological findings, associations with other inflammatory conditions and response to immunosuppressive therapy.

Studying the transcriptomic profiling of PG can help reveal the underlying molecular processes and may be able to provide a rational basis for developing novel diagnostic approaches. Using RNA-Seq we will be able to identify molecular inflammatory markers in formalin-fixed paraffin-embedded (FFPE) biopsies of skin of patients with PG to have a better understanding of the pathogenetic mechanisms. The standardization of FFPE-derived RNA-Seq data would expand the number of samples available for larger PG studies to identify and prioritize leads in the development of potential biomarkers.

2021 — Jesse Keller, M.D., M.C.R. — Debugging Morgellon's Disease 

Morgellon’s disease is a common condition estimated to affect approximately 20,000 to 30,000 patients in the U.S. This is a controversial condition, consisting of bizarre fibers, filaments, and dots emanating from the skin. Due to a surge of this condition in the early 2000s, a CDC investigation was initiated but failed to demonstrate an infectious agent.

Research performed by Morgellon’s advocates have demonstrated Borrelia bacteria in skin of patients suffering from Morgellon’s, however a causal link has not been firmly established as the studies did not include skin of healthy controls for comparison. Though the question of chronic Lyme disease has been raised, treatment with antibiotics has not provided a definitive cure.  

Understanding and targeting the inflammatory cascade has led to breakthrough treatments for common conditions like psoriasis (TNF, IL-17, IL-23), atopic dermatitis/eczema (IL-4, IL-13), and prurigo nodularis (IL-31). We aim to characterize the inflammatory cascade in the skin of patients with Morgellon’s disease so that appropriate targeted therapy can be developed.

2020 — Meghan Woody, M.D. — Establishing the OHSU Dermatology Free Clinic, in collaboration with the student-run Bridges Collaborative Care Clinic

Together with Drs. Nicole Fett and Sancy Leachman, Dr. Meghan Woody re-established an OHSU Dermatology Free clinic collaborating with the student-run Bridges Collaborative Care Clinic. The Bridges Collaborative Care Clinic (BCCC) is an interprofessional, student-led free clinic started in 2017. It aims to provide holistic health care to vulnerable populations in the Portland Metro Area. 

It provides general medical care two Saturdays each month and now provides Dermatology care one Saturday morning every other month. Volunteer physicians, residents, nurses, medical students, health professions students, and translators staff the clinic. 

We estimate that the greater Portland Area has an unmet need for free dermatologic services. We will assess if the need/interest for dermatologic services increases in volume and track the diagnoses that we treat in the clinic. Looking forward, we could consider increasing our involvement to monthly clinics

Megan Woody is currently a dermatology resident at OHSU.

2019 — Sabra Leitenberger, M.D. — Inter-SPORE and International Pediatric Melanoma Outcomes Project

Pediatric melanoma is a rare, and poorly understood disease. Children, adolescents and young adults are thought to likely have different outcomes than older adults with melanoma, but this has not yet been well characterized. It is of the utmost importance to learn how to best determine the true risk of melanoma subtypes in children to develop the safest, most effective treatment and follow-up guidelines. 

To learn more about this rare disease, an Inter-SPORE pediatric melanoma database is being created. The goal of the Inter-SPORE and International Pediatric Melanoma Outcomes project is to describe the clinical, pathologic and genetic spectrum of melanoma in people 25 years of age and younger. For the project, ten institutions with expertise in melanoma, are contributing to this project. This is very likely to be the largest and most comprehensive study of its kind for pediatric melanoma and the Ettleson Fund will help make it possible for OHSU to be a contributing member.  

Sabra Leitenberger is currently an Assistant Professor of Dermatology at OHSU.

2019 - Annalise Abiodun, M.D. — Evaluating suction epidermal blister grafting technique using an automated and minimally invasive tool for treatment of vitiligo: A pilot study

Since medical school, the treatment of vitiligo has been one of Dr. Abiodun's passions. Vitiligo affects roughly 1-2% of the world population and is the most common acquired disorder of depigmentation. Vitiligo affects individuals of all skin types, but is most apparent in those with darkly pigmented skin. In addition to the cosmetic significance of this condition, vitiligo also has psychological consequences due to the associated stigma. Dr. Abiodun noticed that there are some patients with vitiligo who despite aggressive medical therapy were not able to have repigmentation of their skin. Given the psychological consequences of vitiligo and how bothered her patients were about their skin, she sought effective surgical procedures to augment medical therapies. 

Suction epidermal blister grafting involves the removal of very thin skin grafts obtained from the epidermis of skin with normal pigmentation, and transferring the grafts to vitiliginous skin. Dr. Abiodun has collaborated with her mentor, Dr. Sancy Leachman, to develop a clinical study using a commercially available automated suction epidermal blister grafting tool to treat vitiligo. They have also developed a novel technique of recipient site preparation which they anticipate will increase engraftment (i.e. survival of the epidermal grafts). Through this pilot study, Dr. Abiodun hopes to expand on the current use of the automated epidermal blister grafting tool and develop a more effective, well-tolerated and easily replicable way of treating medically-intractable vitiligo.

Dr. Abiodun is currently a Mohs surgery and advanced cosmetic dermatology fellow at the California Skin Institute.

2018 — Julie Dhossche, M,D, — An examination of patient care — allopathic versus naturopathic providers in treatment of Atopic Dermatitis

In pediatric dermatology clinic, second-year resident Dr. Dhossche noticed that patients were often being cared for by both allopathic and naturopathic providers, especially for atopic dermatitis. She was curious about the similarities and differences between the medical fields and how that impacts patient care.

Complementary and alternative medicine (CAM) is a heterogenous collection of schools of medical thought and therapy that stands apart from allopathic medicine, or what is often called conventional Western medicine. Naturopathy is a popular form of CAM. In collaboration with the National University of Natural Medicine (NUNM) here in Portland and with the support of her mentor Dr. Tracy Funk, Dr. Dhossche has designed a survey study to explore the beliefs and treatment approaches of allopathic and naturopathic physicians on the etiology and treatment of atopic dermatitis in children. She hopes the survey results will give a better idea on how allopathic and naturopathic providers differ and overlap, aiding in more complete counseling of the patient and opening the door for future collaboration and studies.

Dr. Dhossche is currently a pediatric dermatology fellow at OHSU.

2018 — Tamar Hajar-Serviansky, M.D. — Laboratory monitoring in dermatology and rheumatology patients treated with low dose methotrexate

Methotrexate (MTX) has been approved for use in patients with some types of cancer, psoriasis, psoriatic arthritis and Rheumatoid arthritis. In dermatology we use this medication for atopic dermatitis, autoimmune connective tissue diseases, proliferative dermatoses and other immunobollous dermatoses.

The use of MTX has been associated with potential severe adverse effects such as liver, kidney and lung damage, increased risk of infection, and some laboratory abnormalities. Because of this we check patient's labs frequently; the current guidelines recommend laboratory monitoring 1 week after the first dose and then every 2 weeks for the first month and monthly thereafter.

Our objective is to determine the necessary interval of laboratory testing in patients in dermatology and rheumatology that are being treated with low doses of methotrexate. Furthermore we plan to determine how frequently we see these laboratory abnormalities. We think that frequent monitoring labs shortly after initiation of low dose methotrexate therapy may not be necessary if patients do not have a history of moderate to severe alcohol consumption, have normal baseline lab values, and receive proper concomitant folic acid supplementation. The ultimate goal and if we are able to find enough evidence to support less frequent laboratory monitoring in specific populations (for example young healthy individuals) we could have a positive impact in the quality of life and the quality of care provided to our patients.

Dr. Hajar-Serviansky has completed her residency training and is currently undergoing a fellowship in Mohs dermatologic surgery.

2017 — Kelly Griffith-Bauer, M.D. — The SCAR Project

Kelly Griffith-Bauer, M.D., a third-year resident physician — and a lifelong photographer — captured the stories and images of twenty-five people from around Oregon who were diagnosed with Stage 0 to Stage 4 melanoma.

As a dermatology resident she snapped hundreds of photos documenting patients' skin as part of their clinical exams. She noticed that "some tried to hide their scar — some were proud of it, but no one liked the photos I took in clinic." She decided to use her photography background to take portraits that better reflected patients and their relationships to their scars, thus the SCAR project was born.

Dr. Griffith Bauer displayed her photographs at the 2017 Department of Dermatology's War on Skin Cancer Event. She also has plans of publishing a paper focusing on how an individuals scar's and their perception of them affects their quality of life. The portrait series, she says, was deeply moving and fulfilling. "It kept me grounded about what's important in medicine: people and their stories."

"Each patient experience was so touching and so different, because everyone had a different story. Some were fighting for their lives so they could be there for kids or grandkids. What was most striking for me was how willing everyone was to go there with me. To be vulnerable. They bared their souls and bared their skin for me, which was really profound. I'm so grateful."

Dr. Griffith-Bauer is currently a dermatologist and Mohs surgeon at the Polyclinic in Seattle, WA.

2015 — Alla Yarmosh - Identifying Obstacles and Barriers to Melanoma Diagnosis and Treatment

Alla Yarmosh, a medical student at OHSU (currently working on a Masters in Clinical Research), was awarded the Ettelson Award for her work on identifying obstacles or barriers that patients in Oregon face when being diagnosed and treated for melanoma. Melanoma is the deadliest of the three main skin cancers, and early detection of melanoma can be lifesaving. The long term goal for this project is to not only pinpoint the hurdles patients overcome, but use that information to develop a statewide educational campaign to help prevent those obstacles from occurring in the future. 

The incidence of melanoma has been increasing nationally; melanoma is currently the 5^th leading cancer in males and 7^th in females in the united states for incidence. According to the United States Cancer Statistics provided through the Center for Disease Control from 2008-2012 Oregon had an elevated incidence and mortality rate compared to the rest of the United States. For men, Oregon was 9^th in incidence and 10^th in mortality. For women, Oregon was 3^rd for incidence and 1^st for mortality. Since Oregon is not known to be a particularly sunny state, this raises the question as to why it has high incidence and mortality, especially for women compared to the rest of the country. How can we fix it? Alla envisions overcoming obstacles to early detection that will allow Oregonians to be diagnosed early, at the most treatable stage.

Dr. Yarmosh is currently a resident of the clinical anesthesia program at UT Southwestern Medical Center.

2013 — Amala Soumyanath, Ph.D. — Exploring a role for piperine in the treatment of vitiligo

Piperine, an extract of black pepper, has been demonstrated to safely enhance melanocyte growth in vivo. The goal of this innovative research is to offer people with vitiligo a new and effective treatment option.

To fully understand the promise of this science, it helps to understand a bit more not only about vitiligo, but also about melanoma. Vitiligo and melanoma have been described by some scientists as two sides of the same coin. Both are caused by dysfunction of melanocytes in skin. Vitiligo is caused when the immune system destroys melanocytes, leaving the skin white, splotchy and disfigured. While not life threatening, the chronic nature of vitiligo, its long term need for treatment, lack of uniform effective therapy and unpredictable course of the disease can be very demoralizing. On the flip side of the coin, melanoma results when melanocytes grow out of control.

Extensive preclinical data has demonstrated that while piperine may offer the ability to enhance melanocyte growth to benefit people with vitiligo, it also may reduce oxygenated stress in the melanocyte, which could serve as a candidate agent for melanoma prevention, as well.

Dr. Soumyanath is currently an Associate Professor of Neurology at OHSU.

2011 — Melissa Wong, Ph.D. — Researching epithelial cell differentiation, stem cells and β-catenin signaling in development and cancer

Melissa Wong, Ph.D., associate professor of dermatology and cell and developmental biology, has a focus on epithelial cell differentiation, stem cells and ß-catenin signaling in development and cancer. Wong plans to use the funds to advance the understanding of how normal tissue stem cells are related to cancer stem cells. This is an important physiologic distinction since cancer stem cells are thought to be resistant to current therapies that are designed to eradicate cancer. Therefore, novel therapies designed to target cancer stem cells must also be designed to preserve normal tissue stem cell function.

Additional funds were granted to support research experiments by third year dermatology residents, Gretchen Vanderbeek, M.D., and Farnaz Fakhari, M.D., Ph.D., who spent their three month research rotations conducting experiments that supported the first definitive identification of cell fusion between hematopoietic cells and any epithelial cell type in human tissue. A manuscript of the findings has been submitted for publication.

Melissa Wong is currently an Associate Professor in the Departments of Cell, Developmental, and Cancer Biology, Dermatology, the Oregon Stem Cell Center, and is a member of the Knight Cancer Institute.

2011 — Steven Jacques, Ph.D. — Mobile Confocal Microscope Non-invasive Skin Monitoring

Steven Jacques, Ph.D., professor of dermatology and biomedical engineering, is a leader in utilizing lasers and light in medicine and biology. The scientific projects of the Jacques lab include efforts to find better therapies and better ways to diagnose disease. The funds received were used toward the purchase a mobile clinical confocal microscope that allows dermatologists, biomedical engineers, and mathematicians to employ novel non-invasive imaging technology to visualize below the surface of the skin to greatly facilitate detection and treatment of skin disease. While existing technology has shown proof of principle in an ability to identify margins of tumors of the skin, including basal cell carcinoma, squamous cell carcinoma and melanoma, even for spreading of single melanoma cells within the epidermis, a mobile confocal microscope with an articulating arm for practical use in the clinic was imperative for future projects that will impact patient care.

Dr. Jacques is currently a professor of Biomedical Engineering at Tufts School of Engineering.