Research

Cutaneous sarcoidosis and granuloma annulare are inflammatory granulomatous disorders that affect the skin, and in the case of sarcoidosis, may affect other organs. Sarcoidosis is a disease that disproportionately affects Black individuals in the United States, who also have higher disease-related mortality. There are no FDA approved therapies for GA and prednisone (which has many side effects) remains first-line treatment and the only approved therapy for sarcoidosis. Dr. Damsky’s group discovered and described the utility of a class of medications called JAK inhibitors in treatment of these disorders. Dr. Damsky is the Principal Investigator of several clinical trials in these diseases and also directs the Cutaneous Granulomatous Diseases Program in the Department of Dermatology. We aim to continue to: identify basic pathomechanisms of these diseases, evaluate the efficacy of novel targeted therapies through clinical trials, and 3) use translational immunologic approaches to understand exactly how these therapies are working and why they might work better one some patients than others.

Psoriasis and atopic dermatitis are common inflammatory skin disease with numerous FDA approved, molecularly targeted treatments acting through multiple distinct targets. We (and others) have found that there can be significant immunologic heterogeneity in these diseases, even in patients with the same clinical diagnosis. From clinical practice we know that some patients, with the same clinical diagnosis, may respond much better to one therapeutic mechanism compared to another; yet selection of medications for patients with these diseases remains largely based on trial-and-error. Our lab is interested in developing clinically relevant tools that can be used to bridge this gap and facilitate rapid classification of a patient’s unique immunology in order to help guide selection of the most biologically optimized therapy for patients from the start. We have successfully used chromogenic cytokine RNA in situ hybridization of diagnostic biopsy specimens for this purposes previously and are now developing a high throughput, scalable, noninvasive sampling approach for immune profiling.

Alopecia (hair loss) can have a tremendously negative impact on patients’ quality of life. In this work we collaborate with Dr. Brett King, a world-renowned alopecia expert at Yale who discovered the utility of JAK inhibitors to treat alopecia areata, leading to their recent FDA approval. We are using the latest approaches including single cell RNA sequencing and spatial transcriptomics from patients with various forms of alopecia including alopecia areata, androgenetic alopecia, lichen planopilaris/frontal fibrosing alopecia, and central centrifugal cicatricial alopecia. We aim to understand the basic pathomechanism of understudied alopecias (lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia) without FDA approved therapies. Central centrifugal cicatrical alopecia in particular tends to most commonly affect Black women in the United States. We also aim understand why some patients respond better than others and some patients do not respond to therapy at all. To do this we are analyzing patient samples before and after treatment to see how they are impacted by state of the art alopecia medications including JAK inhibitors and oral minoxidil.