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Shawn Cowper, MD

Professor of Dermatology
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About

Titles

Professor of Dermatology

Appointments

Education & Training

Fellow
University of California, San Francisco (2001)
Resident
University of South Florida (1999)
Chief Resident
University of South Florida (1999)
Resident
Henry Ford Hospital (1991)
MD
Michigan State University, Human Medicine (1990)
BS
University of Michigan, English Literature (1986)
BS
University of Michigan, Cellular and Molecular Biology (1986)

Research

Overview

Nephrogenic Systemic Fibrosis and its relevance in other fibrosing disorders

My initial research interest (from 1999 to 2010) was in the mechanism of nephrogenic systemic fibrosis (formerly nephrogenic fibrosing dermopathy). This was an emerging fibrosing disorder seen in patients with renal disease. Compelling epidemiological, microanalytical, and animal studies linked the disease to the use of gadolinium-based contrast agents (GBCA) used in MRI imaging. Evidence presented to the US FDA led to changes in contrast agent labeling as well as accelerated approval of less risky GBCAs. Because of these interventions, NSF has essentially disappeared.

The mechanism of fibrosis induction in NSF remains of interest as it may offer insights into pathways activated in other fibrosing conditions. Current thinking continues to suggest that these renally-excreted compounds are ineffectively removed in the renally-impaired, leading to a novel toxicity reaction. The findings manifest themselves most dramatically in the skin and soft-tissue of affected patients by increased production of matrix elements (collagen, elastin, mucin). These excess components reduce the flexibility and compliance of skin, leading to decreased range of motion in affected limbs. Questions still being examined include effects in non-cutaneous tissues and factors that may contribute to a propensity to develop NSF (genetic, medical cofactors, other toxicities, etc).
Yale remains the home of the International NSF Registry, housing clinical records and pathology specimens from nearly 400 NSF patients. This registry serves as a source of basic information for investigations into the clinical and histological aspects of NSF.

Yale is also the home base for a core of interested clinical and basic science researchers actively engaged in understanding all aspects of fibrosis. Periodically, this team hosts the Yale Fibrosis Symposium.


Dermatohematopathology and Alopecia

Beyond NSF, I am interested in cutaneous lymphomas and alopecias, and the appropriate use of histopathology in diagnosing these disorders. I regularly speak and teach on the topic of the biopsy diagnosis of alopecia and have created a four hour curriculum on the topic that is part of the basic education of dermatology residents at Yale. In addition, specialized in-depth training on this topic is provided to Yale dermatopathology fellows. Lastly, I have coauthored a book on the subject and look forward to spearheading the next edition of this book in the near future.

The birth of pathology informatics and "virtual" slides

My primary and preferred instructional tool is the networked computer. I have been involved with web-based pathology education for some time. My largest project Pathmax, was one of the first web-based resource for pathology professionals on the internet. Beginning in 1997, this site ran continuously until 2018. I am also one of the cofounders of the Dermatopathology Master Class Series, a web-based streaming lecture series on topics of relevance in dermatopathology. In recent years I have been the chairman of the Virtual Slide Library of the American Society of Dermatopathology (ASDP) where I manage 50 volunteers interested in optimizing and vetting over 10,000 scanned dermatopathology whole slide images. This virtual library serves as one of the core teaching tools of the ASDP.

Medical Subject Headings (MeSH)

Alopecia; Dermatology; Fibrosis; Medical Informatics; Nephrogenic Fibrosing Dermopathy; Pathology; Scleroderma, Systemic; Skin Neoplasms

Research at a Glance

Yale Co-Authors

Frequent collaborators of Shawn Cowper's published research.

Publications

2024

2023

2021

2020

Academic Achievements & Community Involvement

  • activity

    American Society of Dermatopathology

  • honor

    Medal for Service Above and Beyond

  • honor

    Distinguished Dermatopathologist

  • honor

    Annual Saul Farber Lecturer

  • honor

    Certificate of Appreciation

Clinical Care

Overview

Shawn E. Cowper, MD, specializes in using microscopy to diagnose skin diseases and conditions, as well as hair loss, or alopecia. His expertise on the latter runs beyond skin deep. Dr. Cowper is co-author of a textbook on the topic, called An Atlas of Hair Pathology with Clinical Corrections, and regularly fields alopecia-related questions from Yale Medicine dermatologists and physicians around the world.

Dr. Cowper’s interest in dermatopathology (a pathology subspecialty that focuses on skin biopsies only) developed after he spent time as a family doctor treating dermatologic conditions. Dermatopathologists have been trained to recognize structural changes that occur on a cellular level in skin diseases. Dr. Cowper says he chose the subspecialty because it joined two interests: a patient’s symptoms and the science-intensive nature of pathology. “In dermatopathology, it’s a team sport between the dermatologists and family physicians who provide the patient history and clinical impressions, and the dermatopathologists who correlate this with the microscope findings to reach a final diagnosis,” he says.

During his time as a fellow at the University of California San Francisco, Dr. Cowper’s passion for combining patient stories and scientific evidence resulted in the discovery of a new disorder. Dr. Cowper, and a team of physicians and researchers, described a mysterious disease they called “nephrogenic systemic fibrosis” (NSF). The disease, which developed only in people with kidney disease, was eventually found to be caused by gadolinium-based contrast agents, which are used in magnetic resonance imaging (MRI) procedures. “While the number of new cases of NSF grew steadily in the early 2000s, since about 2010, the number of new cases has been reduced to essentially zero,” Dr. Cowper says. “Before the cause was determined, people were dying of this disorder. It freezes people’s limbs, so they cannot flex their knees, hands, or feet.” Dr. Cowper presented evidence to the Food and Drug Administration (FDA) that led to new guidance for gadolinium use so that people at high risk for NSF could be recognized before receiving this potentially disabling—or deadly—agent.

At Yale School of Medicine, Dr. Cowper is an associate professor of dermatology and pathology. Besides NSF, his research interests include adnexal tumors, and the pathological findings in hair loss. Dr. Cowper routinely teaches peers and resident physicians in dermatology and pathology how to best interpret hair biopsy specimens.

Clinical Specialties

Dermatopathology

Board Certifications

  • Dermatopathology

    Certification Organization
    AB of Pathology
    Original Certification Date
    2002
  • Anatomic & Clinical Pathology

    Certification Organization
    AB of Pathology
    Original Certification Date
    2001

Get In Touch

Contacts

Academic Office Number
Office Fax Number
Mailing Address

Dermatology

PO Box 208059

New Haven, CT 06520-8059

United States

Administrative Support

Locations

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