At Women’s College Hospital, our scientists focus on understanding various skin diseases, including atopic dermatitis, psoriasis and skin cancer, and identifying gaps in care. We are also evaluating treatment solutions and developing ways to improve care pathways that can help better patient outcomes in Canada and around the world.
The Skin Investigation Network (SkIN) of Canada is a national research network based at Women’s College Hospital and funded by the Canadian Institutes of Health Research (CIHR). SkIN Canada aims to catalyze high-impact, multicentre skin research that improves the lives of patients with dermatologic conditions.
Atopic Dermatitis
Atopic dermatitis (eczema) is a common, chronic condition that makes the skin red and itchy. Our scientists are investigating the population and patient-level burden of eczema, including its impact on mental health. Our scientists work with international collaborators, including patient organizations, to evaluate how treatment strategies can be optimized to improve eczema outcomes in Canada and around the world. Our Atopic Dermatitis Specialty Clinic provides advanced care, including phototherapy and oral and injectable medications, for adults with severe eczema.
Hidradenitis Suppurativa and Psoriasis
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease, predominantly affecting women, that is under-recognized and has an average delay in diagnosis of eight years,. Our scientists are developing solutions to improve care pathways including a new multidisciplinary clinic at Women’s College Hospital, a first of its kind in Canada. The clinic will serve an unmet need within the healthcare system to improve the health and well-being of patient with hidradenitis suppurativa.
Psoriasis affects more than one million Canadians. It is a chronic, immune-mediated disorder with cutaneous and systemic manifestations and substantial negative effects on patients’ quality of life. The pathology of psoriasis is characterized by abnormal skin cells proliferation and immune cell infiltration in all layers of the skin. In collaboration with the Cardio-Rheumatology group at Women’s College Hospital (Dr. Paula Harvey and Dr Lihi Eder), our scientists are developing a unique and novel method of multi-parameter analysis of skin from patients suffering from different forms of psoriasis to yield new and rich information on psoriasis and its variants.
COVID-19, biologics and skin diseases: We evaluate the treatments that affect the immune system (e.g. biologics) in patients with severe skin diseases (psoriasis and HS) on COVID-19 immune responses (IMPACT).
Skin Cancer
Skin cancer, including melanoma, basal cell, squamous cell and Merkel cell carcinoma, is the most common type of cancer in Canada. Our scientists study risk factors and patterns of care for these cancers to identify gaps and propose solutions to improve outcomes for skin cancer patients. This includes work to understand how to prevent and treat skin cancers in organ transplant recipients, who are at particularly high risk of developing and dying from skin cancer.
Scientists & Their Teams
Dr. Aaron Drucker
Scientist, Women’s College Hospital Research and Innovation Institute
Dermatologist, Women’s College Hospital
Associate Professor, Division of Dermatology, Department of Medicine, University of Toronto
Adjunct Scientist, ICES
Dr. Drucker is a dermatologist and researcher focusing on epidemiology and evidenced-based treatment of skin disease. Through his research, Dr. Drucker aims to improve the lives of people with or at risk for inflammatory and neoplastic skin disease by evaluating risk factors, comorbidities, health service utilization and evidence-based treatments.
Dr. Drucker’s research is currently helping patients and clinicians navigate new treatments available for eczema (atopic dermatitis). This is an exciting time for individuals with eczema as there are many new treatments being studied to help those with more severe disease, where topical treatments are not enough. Dr. Drucker leads an international team conducting a living network meta-analysis of systemic immunomodulatory treatments for eczema. Through EczemaTherapies.com, this team is committed to providing the most up-to-date information on treatments for eczema to share with patients and clinicians.
Dr. Drucker is also focused on the safety of medications used in dermatology, particularly in older adults. He is currently studying potential adverse effects of topical and oral steroids used for people with eczema and is conducting a Canadian Institutes of Health Research (CIHR) funded study to evaluate the safety of biologic medications for older adults with psoriasis and psoriatic arthritis.
Karen Lau is a Research Coordinator in Dr. Aaron Drucker’s research program, where she oversees project coordination and training. With an MA in psychology from TMU and over a decade of research experience, she plays a crucial role in advancing research initiatives. Karen is the lead on multiple projects, manages the operation of the program and facilitates communication among research teams. Looking ahead, she aims to expand patient engagement and enhance the impact of research findings through various knowledge translation (KT) strategies.
Dr. Rita Iskandar is a post-doctoral research fellow at the Research and Innovation Institute, Women’s College Hospital, the Leslie Dan Faculty of Pharmacy, University of Toronto, and ICES. She received the Patient-Oriented Research (POR)-Mitacs Fellowship, supervised by Drs. Aaron Drucker and Mina Tadrous. Dr. Iskandar holds a medical degree from the Lebanese American University and an MSc in Epidemiology from the London School of Hygiene and Tropical Medicine. She also serves as a trainee on the Skin Investigation Network of Canada steering committee.
Dr. Iskandar’s research aims to improve patients’ well-being by providing evidence-based guidance for policy and healthcare strategies through a better understanding of skin disease epidemiology. Her current work evaluates skin-related minor ailment services and dermatologic drug safety using Ontario’s linked administrative health data. She additionally leads a network meta-analysis of the cardiovascular safety of systemic medications used for adults with psoriasis.
Dr. Merilleno is a clinical research fellow at the University of Toronto and the Women’s College Research and Innovation Institute. She earned her medical degree from the University of the East Ramon Magsaysay Memorial Medical Center and completed her dermatology residency training at Rizal Medical Center in the Philippines. She is a diplomate of the Philippine Dermatological Society and received the Montreal Dermatology Research Institute/International Eczema Council (MDRI/IEC) Canadian Research Fellowship. Dr. Merilleno works closely with Dr. Drucker on impactful research related to atopic dermatitis.
Chantel Walwyn is a Research Assistant on the Dermatology team. She received her Master of Science in Epidemiology and Biostatistics from Western University and holds a Bachelor of Public Health from Brock University. Chantel has experience in evidence synthesis, clinical research and community-based research. Chantel is dedicated to applying her expertise to support high quality research, and advancing her knowledge in the field.
Dr. An-Wen Chan
Phelan Senior Scientist, Women’s College Hospital Research and Innovation Institute
Staff Consultant in Dermatology & Mohs Surgery, Women’s College Hospital
Professor, Division of Dermatology, Department of Medicine, University of Toronto
Professor, Institute of Health Policy, Management and Evaluation, University of Toronto
Adjunct Scientist, ICES
Health research is a global enterprise that has produced vital advances in reducing mortality and burden of disease. However, much can be done to improve the value and return on investment of funds spent on conducting research. Dr. An-Wen Chan is developing research system solutions to improve the quality and efficiency of research while enhancing patient care. These solutions aim to improve how research is designed, conducted and reported to ensure that healthcare decisions are based on the best evidence.
As a dermatologist and skin cancer surgeon, Dr. Chan sees first-hand how the increasing prevalence of skin cancer affects the lives of his patients. Access to high-quality research evidence is essential to providing the best care to and improving outcomes for these patients through novel prevention and treatment strategies. To accomplish this, Dr. Chan is focused on ensuring that research is conducted and reported in a way that minimizes bias and promotes quality for the benefit of patients and providers
Nihilkumar is a Central Trial Coordinator with extensive experience in managing multicenter Phase III dermatology, oncology and solid organ transplant clinical trials. He leads and coordinate cross-functional teams to ensure seamless execution of clinical research projects, overseeing tasks such as study protocol development, EDC database management (REDCap, Medidata RAVE), and ensuring regulatory and ethical compliance.
With an MS in Regulatory Affairs from Northeastern University, Toronto, and certifications in GCP and Health Canada regulations, his expertise spans steering committee coordination, site monitoring, ethics board submissions, and study documentation management. My background in pharmacy further strengthens my knowledge in new drug development, clinical data management, and regulatory processes. He is passionate about advancing research through overseeing complex trials, fostering collaboration among diverse teams, and contributing to the development of study materials and knowledge translation.
Stephanie Jewell is a Research Coordinator with the Dermatology team, working with Dr. An-Wen Chan. She holds an Honours Bachelor of Science in Psychology from the University of Toronto where she graduated with High Distinction. She brings more than 20 years of research and has coordinated multiple clinical trials, including the CIHR-funded multicentre SPRINTR trial that investigates the efficacy of nicotinamide for skin cancer prevention in solid organ transplant recipients.
Josephine’s academic background was in Kinesiology and rehabilitation science. After working as a research coordinator for 3 years at the Rehabilitation Hospital in Montreal she decided to shift her focus to Skin Research. She started working with Dr. Chan’s team in 2022.
Marsida Stafa is a dedicated research assistant working with Dr. An-Wen Chan, contributing significantly to the pivotal phase of the SPRINTR clinical trial since 2023. Her primary responsibilities include the meticulous screening of eligible patients, obtaining informed consent, and conducting thorough follow-up procedures until the completion of the study.
Marsida holds a medical degree and has accumulated substantial experience across acute hospital settings and community care health centers. Her diverse clinical background has strengthened her skills in patient interaction, an aspect of her work she finds deeply rewarding.
Her professional interests lie in advancing the field of evidence-based medicine and shaping innovative health policy reforms. Marsida is committed to exploring research methodologies that contribute to improved patient outcomes and healthcare delivery systems.
Outside her professional endeavors, she dedicates time to her family, particularly to her young son. She is also passionate about the arts, with a strong interest in dance and painting, which serve as creative
Dr. Vincent Piguet
Scientist, Women’s College Hospital Research and Innovation Institute
Professor and Director of the Division of Dermatology, Department of Medicine, University of Toronto
Head of Dermatology, Women’s College Hospital
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease affecting approximately one per cent of the global population. Currently, there is a decentralization of care for patients with HS resulting in highly variable approaches to diagnosing the signs and symptoms, as well as treatment of the condition. Dr. Vincent Piguet’s research aims to better understand this debilitating disease and close the health gaps within our healthcare system.
HS is under recognized, with the average Canadian patient seeing five doctors, spanning eight years, before being diagnosed. The fragmentation of health services is reflected in the significant diagnostic delay of the condition, and leaves patients with unsatisfactory treatments and care. To address this health gap, Dr. Piguet is developing solutions that will improve care pathways and reduce the condition’s impact on patients’ functional impairment due to pain, discharge and scarring. These impairments are similar in scale to the effects of cardiovascular disease, type 2 diabetes and renal failure. Dr. Piguet recently secured funding to establish a multidisciplinary HS clinic at Women’s College Hospital, a first of its kind in Canada, to manage these complex patients. The clinic will serve an unmet need in the healthcare system to improve the health and well-being of patients with HS, where women are also disproportionally affected.
Dr. Piguet also conducts research on viral interactions between skin dendritic cells, key immune cells and viruses such as HIV and HTLV-1. His research studying the interactions between the dendritic cells, as well as mucosal transmission of these pathogens has enhanced understanding of disease mechanisms and potential prevention strategies. These findings also have important implications in establishing vaccination strategies such as intradermal vaccination.
Dr. David Croitoru is a full-time Clinician Investigator at WCH, specializing in inflammatory dermatoses and wound care. He serves as the medical lead and principal investigator of the Pyoderma Gangrenosum wound clinic, which boasts the largest cohort of this rare disease in Canada. In addition, Dr. Croitoru established the Hidradenitis Suppurativa procedure clinic at WCH, providing surgical interventions for this chronic, destructive, and underserved inflammatory condition. To enhance resident engagement in research, he co-chairs the CIHR-funded SKiN Canada’s Trainee Development Committee and the Canadian Dermatology Association’s basic science program (SPoT, Skin Pathophysiology Therapeutics).
Dr. Stephan Caucheteux completed his PhD with Dr. Colette Kanellopoulos at the Jacques Monod Institute in Paris, where he focused on feto-maternal immune relationships. His research aimed to understand why the fetus, which carries paternal allo-antigens, is not rejected by the maternal immune system during pregnancy. He specifically studied the influences of major histocompatibility allo-antigens on both the fetus and the maternal immune system. His findings revealed key mechanisms that contribute to immune tolerance during pregnancy, adding to the understanding of how the maternal immune system adapts to support fetal development without triggering an immune rejection.
Dr. Caucheteux joined Professor Vincent Piguet at Cardiff University’s Institute of Infection and Immunity, where his work expanded into the development of an HIV-1 vaccine using nanoparticle technology. This innovative approach aimed to enhance immune responses to HIV-1, offering new strategies for vaccine design. Dr. Caucheteux followed Professor Piguet to the University of Toronto, where he has continued his research on various skin diseases, including psoriasis, paradoxical psoriasis, hidradenitis suppurativa, and atopic dermatitis. Employing cutting-edge techniques such as Spatial RNA sequencing and Imaging Mass Cytometry, his research focuses on understanding the molecular mechanisms of these diseases and developing novel therapeutic approaches.
Dr. Caucheteux’s expertise spans immunology, from reproductive immunology to mucosal and skin immune responses, positioning him as a leader in translational research aimed at bridging the gap between basic science and clinical applications.
Lily Acheampong is a Research Assistant in the Department of Dermatology, bringing over eight years of valuable experience to the team. She holds a Master of Science in Medicine, specializing in Clinical Epidemiology from Memorial University of Newfoundland. Her research focuses on challenging skin conditions like hidradenitis suppurativa and psoriasis. Outside of work, Lily enjoys hiking and brings a strong commitment to service and academic excellence, making her a key contributor to the dermatology team.
Dr. Saeed Khalili earned his PhD in Stem Cell Biology and Tissue Regeneration at McGill University. His research developed a two-prong therapy to eradicate autoreactive T cells using Freund’s Complete Adjuvant and regenerate pancreatic and salivary glands through adult stem cell transplantation.
Dr. Khalili completed his postdoctoral training with Professor Derek van der Kooy at the University of Toronto, specializing in stem cell biology and tissue regeneration. He is an expert in stem cell differentiation and scale up, he pioneered a highly scalable and reproducible method for human cone photoreceptor differentiation, validated through whole transcriptome analysis.
Since 2019, as the Laboratory Manager for Dr. Vincent Piguet’s at the University of Toronto, Dr. Khalili has focused on developing R and Python based pipelines for analyzing human skin transcriptome data. At Women’s College Hospital, Dr. Khalili is actively involved in the Canadian Atopic Dermatitis Cohort for Translational Immunology and Imaging (CACTI) clinical trial, contributing to biospecimen collection and data analysis.
Living network meta-analysis of systemic treatments for atopic dermatitis
Canadian Atopic dermatitis Cohort for Translational Immunology and Imaging (CACTI): a cohort study evaluating advanced treatments for atopic dermatitis, including a randomized controlled trial comparing two types of phototherapy.
Immune response after COVID-19 vaccination during maintenance therapy in immune-mediated inflammatory diseases: an observational cohort study (IMPACT).
Understanding IL-23-mediated inflammation in Plaque Psoriasis using Tissue Imaging Mass Cytometry (IMC).
Tissue Imaging Mass Cytometry to Decipher Psoriasis Inflammation in Plaque and Paradoxical Psoriasis.
Safety immUnogenicity of Covid-19 vaCcines in systEmic immunE mediated inflammatory Diseases (SUCCEED).
Skin cancer prevention with nicotinamide in solid organ transplant recipients (SPRINTR trial)
Patterns of care and outcomes for early stage melanoma and Merkel cell carcinoma
Artificial intelligence to track population-based incidence of basal and squamous cell carcinoma
Study Spotlight
Background:
- People with eczema, asthma and COPD are often treated with oral steroids (e.g., prednisone).
- High cumulative doses of oral steroids put people at risk for fractures, so fracture preventive care is recommended for those patients.
- Eczema, asthma and COPD are often characterized by intermittent flares, and so steroids are often prescribed in intermittent bursts to treat those flares.
- When steroids are prescribed intermittently, as opposed to as part of a long-term plan, fracture prevention may be missed.
Study Findings:
- Dr. Drucker and team found that among older adults in Ontario and the UK with eczema, asthma and COPD, being prescribed large cumulative doses of oral steroids intermittently (compared to large cumulative doses prescribed steadily spread over time) was associated with approximately half the rates of being prescribed fracture prevention.
- As a result, physicians might miss opportunities to prescribe fracture prevention medications if they think of a short burst of oral steroids to treat a flare in isolation. Those short bursts can add up and be difficult to keep track of in the context of a large cumulative dose.
- Physicians should be more aware of this issue and consider fracture prevention in people who are receiving high doses of steroids in discontinuous bursts.
Notable Publications
https://pubmed.ncbi.nlm.nih.gov/33846199/
https://pubmed.ncbi.nlm.nih.gov/32320001/
https://pubmed.ncbi.nlm.nih.gov/34787649/
Naderi-Azad S, Croitoru D, Khalili S, Eder L, Piguet V. Research Techniques Made Simple: Experimental Methodology for Imaging Mass Cytometry. J Invest Dermatol. 2021 Mar;141(3):467-473
Frew JW, Marzano AV, Wolk K, Join-Lambert O, Alavi A, Lowes MA, Piguet V. A Systematic Review of Promising Therapeutic Targets in Hidradenitis Suppurativa: A Critical Evaluation of Mechanistic and Clinical Relevance. J Invest Dermatol. 2020 Sep 9;141(2):316-324
Kendall TJ, Robinson M, Brierley DJ, Lim SJ, O’Connor DJ, Shaaban AM, Lewis I, Chan A-W, Harrison DJ, SPIRIT-Path group. Guidelines for cellular and molecular pathology content in clinical trial protocols: the SPIRIT-Path extension. The Lancet Oncology. 2021 Oct 22;22(10):e435-e445. Impact Factor 41.3. Coauthor or Collaborator.
Tang E, Fung K, Chan A-W. Incidence and mortality rates of keratinocyte carcinoma from 1998-2017: a population-based study of sex differences in Ontario, Canada. CMAJ. 2021 Oct 4;193(39):E1516-E1524
Kendall TJ, Robinson M, Brierley DJ, Lim SJ, O’Connor DJ, Shaaban AM, Lewis I, Chan A-W, Harrison DJ, SPIRIT-Path group. Guidelines for cellular and molecular pathology content in clinical trial protocols: the SPIRIT-Path extension. The Lancet Oncology. 2021 Oct 22;22(10):e435-e445. Impact Factor 41.3. Coauthor or Collaborator.
Tang E, Fung K, Chan A-W. Incidence and mortality rates of keratinocyte carcinoma from 1998-2017: a population-based study of sex differences in Ontario, Canada. CMAJ. 2021 Oct 4;193(39):E1516-E1524
Orkin AM, Gill PJ, Ghersi D, Campbell L, Sugarman J, Emsley R, Steg PG, Weijer C, Simes J, Rombey T, Williams HC, Wittes J, Moher D, Richards DP, Kasamon Y, Getz K, Hopewell S, Dickersin K, Wu T, Ayala AP, Schulz KF, Calleja S, Boutron I, Ross JS, Golub RM, Khan KM, Mulrow C, Siegfried N, Heber J, Lee N, Kearney PR, Wanyenze RK, Hróbjartsson A, Williams R, Bhandari N, Jüni P, Chan A-W; CONSERVE Group. Guidelines for Reporting Trial Protocols and Completed Trials Modified Due to the COVID-19 Pandemic and Other Extenuating Circumstances: The CONSERVE 2021 Statement. JAMA. 2021 Jun 21;326(3):257-265
Cruz Rivera S, Liu X, Chan, A-W, Denniston AK, Calvert MJ, SPIRIT-AI and CONSORT-AI Working Group, SPIRIT-AI and CONSORT-AI Steering Group, SPIRIT-AI and CONSORT-AI Consensus Group. Guidelines for clinical trial protocols for interventions involving artificial intelligence: the SPIRIT-AI extension. Nature Med. 2020 Sep 9;26:1351-1363.
Park CK, Dahlke EJ, Fung K, Kitchen J, Austin P, Rochon PA, Chan A-W. Melanoma incidence, stage, and survival after solid organ transplant: A population-based cohort study in Ontario, Canada. J Am Acad Dermatol. 2020 Sep 1;83(3):754-761