Steven R Feldman

Wake Forest School of Medicine, Winston-Salem, North Carolina, United States

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Publications (812)2008.43 Total impact

  • Toral S Vaidya · Kathryn L Anderson · Steven R Feldman
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    ABSTRACT: Background: Though psoriasis is chronic and recurring, current options can help many patients achieve good disease control.New treatments could provide greater improvement in objective disease, but it is not clear that there is room for improving subjective outcomes, particularly for patients who are already "well-controlled." Objective: To analyze treatment satisfaction of well-controlled patients with psoriasis in two patient populations of very different disease severity. Methods: Patients with well-controlled psoriasis on topicals (mild psoriasis) only or on biologics (moderate-to-severe psoriasis) were queried by telephone about perceptions of disease control, improvement level, overall treatment satisfaction, and consideration for trying new treatments. Satisfaction scores and feedback were analyzed to assess treatment type and satisfaction level associations. Results: The majority of patients, regardless of disease severity, would consider trying new treatments for psoriasis, though patients with mild psoriasis were less satisfied with their disease control, level of improvement, and overall treatment. Patient feedback revealed widespread treatment dissatisfaction, non-adherence, and inconvenience. Limitations: The patient population was from one university setting. Conclusion: 16% of patients with psoriasis meet study definition for "well-controlled" disease. Less than 20% of these well- controlled patients with psoriasis are satisfied with their current level of control and clearance and would not consider trying new treatments, suggesting the majority of well-controlled patients, regardless of disease severity, still have unmet needs. Strongerpatient-physician communication may contribute to patient-based, comprehensive care in concordance with a health system that isheaded towards financial incentives for better patient satisfaction.
    Dermatology online journal 10/2015; 21(9).
  • Sean McGregor · Michael E Farhangian · Steven R Feldman
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    ABSTRACT: Introduction: Current treatment options for moderate-to-severe atopic dermatitis (AD) are limited and have potentially dangerous side effects. Dupilumab is a novel monoclonal antibody that was recently studied in adult patients with moderate-to-severe AD. Dupilumab inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling and was previously found to be effective in asthma. Considering that both AD and asthma are Th2 cell-mediated inflammatory processes, it is reasonable to suspect that dupilumab would be beneficial in AD.` Areas covered: This article is a review of the one major clinical trial that assessed the efficacy of dupilumab in patients with AD. Its goal is to provide a comparison to the current modalities for the treatment of AD and expert insight regarding future studies. Expert opinion: The results of this study are a significant therapeutic advancement. Dupilumab was shown to provide a mean percent change in Eczema Area and Severity Index score of -74% ± 3.6, in addition to, statistically and clinically significant reductions the severity, symptomatology, and morbidity associated with AD. However, the small sample size makes it difficult to assess the magnitude of this effect. As a result, dupilumab will likely be reserved for cases of severe AD unresponsive to traditional modalities.
    Expert Opinion on Biological Therapy 10/2015; DOI:10.1517/14712598.2015.1076388 · 3.74 Impact Factor
  • Steven R Feldman · Yang Zhao · Lizheng Shi · Mary Helen Tran
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    ABSTRACT: Background: Previous studies demonstrated substantial economic and comorbidity burden associated with psoriasis (PsO) before biologics were available. Biologics have changed PsO treatment paradigms and potentially improved patient outcomes. There is a need to reassess the economic and comorbidity burden of PsO in the biologic era. Objective: To compare the prevalence of comorbidities, health care resource utilization, and costs between moderate-to-severe PsO patients and demographically matched controls. METHODS: Adults aged 18-64 years with at least 2 PsO diagnoses (ICD-9-CM code 696.1) were identified in the OptumHealth Reporting and Insights claims database from January 2007 to March 2012. Moderate-to-severe PsO patients were identified as those receiving ≥ 1 systemic therapy or phototherapy during the 12-month study period following the index date (randomly selected date after the first PsO diagnosis). Controls were free of PsO and psoriatic arthritis (PsA) and were matched 1:1 with PsO patients on age, gender, and geographic region. All patients had at least 12 months of continuous enrollment after the index date. Selected comorbidities, medication use, all-cause health care utilization, and costs were compared between PsO patients and controls. Multivariate regression models were performed to examine the association between PsO and selected comorbidities, medication use, and health care costs and utilization, adjusting for demographics, index year, insurance type, and other comorbidities. Odds ratios (ORs) were reported for any medication use, hospitalization, emergency room visit, and outpatient visit, and incidence rate ratios (IRRs) were reported for the number of medications filled. Adjusted cost differences between PsO patient and controls were also estimated. RESULTS: A total of 5,492 matched pairs of moderate-to-severe PsO patients and controls were selected, with a mean age of 47.6 years and 55.5% of patients being male. PsO patients were significantly more likely to have most of the comorbidities examined, with the top 3 most common in both groups being hyperlipidemia (33.3% vs. 27.3%), hypertension (32.8% vs. 23.5%), and diabetes (15.8% vs. 9.7%). Compared with controls, PsO patients were more likely to have any medication filled (OR = 27.5) and had more distinct number of prescription medications (IRR = 2.1; both P less than 0.01). PsO patients were more likely to have any inpatient admission (OR = 1.3), emergency room visit (OR = 1.3), and outpatient visit (OR = 29.3; all P less than 0.01). PsO patients also incurred significantly higher total, pharmacy, and medical costs (adjusted annual costs differences: $18,960, $13,990, and $3,895 per patient, respectively; all P less than 0.01) than controls. CONCLUSIONS: Compared with PsO- and PsA-free controls, moderate-to-severe PsO patients were more likely to have selected comorbidities and higher health care utilization and costs.
    09/2015; 21(10):874-888.
  • Toral S Vaidya · Robin S Lewallen · Steven R Feldman
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    ABSTRACT: Psoriasis is closely associated with cardiovascular comorbidities.(1) Poor adherence can affect both psoriasis outcomes and the effectiveness of treatment for cardiovascular comorbidities. We discuss a case of psoriasis medication non-adherence resulting in admission to the dermatology inpatient service for erythrodermic psoriasis. Administration of the patient's prescribed home anti-hypertensive regimen on admission resulted in a severe hypotension requiring transfer to the medical intensive care unit. This case illustrates the role of poor adherence in an erythrodermic flare of psoriasis; this case also illustrates how new-onset regimented adherence, in a formerly non-adherent patient, may result in life-threatening iatrogenic disease.
    Journal of Dermatological Treatment 09/2015; DOI:10.3109/09546634.2015.1087462 · 1.67 Impact Factor
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    ABSTRACT: Background: Alopecia Areata (AA) is a non-scarring alopecia that affects millions of Americans, however the way it is treated and which patients seek treatment is not well characterized. Objective: To better understand how AA was being treated in the United States, what type of patients are seen for AA, and what physicians treated them. Methods: We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 to 2010. We tabulated patient characteristics, the physicians who treated AA and what treatments were prescribed for AA. Results: There were an estimated 2.6 million outpatient visits for AA. Patients with AA were most commonly treated by a dermatologists (84.8%). Patients were most commonly treated with topical and injected corticosteroids (61.0%) followed by minoxidil (5.9%) and topical tacrolimus (5.7%). Males made fewer visits per 1,000 capita compared to females (P=0.01). Limitations: The NAMCS and NHAMCS do not record severity of disease data. Conclusions: Topical and injected corticosteroids are the mainstay of treatment for AA, however the use of steroid sparing agents such as minoxidil is low. Despite no studies demonstrating efficacy, topical tacrolimus was used almost as frequently as minoxidil. J Drugs Dermatol. 2015;14(9):1012-1014.
    Journal of drugs in dermatology: JDD 09/2015; 14(9):1012-4. · 1.45 Impact Factor
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    ABSTRACT: Atopic dermatitis affects a substantial number of children, many of whom seek initial treatment from their pediatrician or other primary care provider. Approximately two-thirds of these patients have mild disease and can be adequately managed at the primary care level. However, recent treatment guidelines are written primarily for use by specialists and lack certain elements that would make them more useful to primary care providers. This article evaluates these recent treatment guidelines in terms of evaluation criteria, treatment recommendations, usability, accessibility, and applicability to nonspecialists and integrates them with clinical evidence to present a streamlined severity-based treatment model for the management of a majority of atopic dermatitis cases. Because each patient's situation is unique, individualization of treatment plans is critical as is efficient communication and implementation of the plan with patients and caregivers. Specifically, practical suggestions for individualizing, optimizing, implementing, and communicating treatment plans such as choosing a moisturizer formulation, avoiding common triggers, educating patients/caregivers, providing written treatment plans, and scheduling physician follow-up are provided along with a discussion of available resources for patients/caregivers and providers. Copyright © 2015 by the American Academy of Pediatrics.
    PEDIATRICS 08/2015; DOI:10.1542/peds.2014-3678 · 5.47 Impact Factor
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    ABSTRACT: Background/PurposeOne reason phototherapy use is lacking in the United States may be inadequate phototherapy education during dermatology training. The purpose of this study was to estimate the level of dermatology resident training with prescribing phototherapy and to see if inadequate education may be contributing to the underuse of phototherapy in the US.MethodsA questionnaire was developed to assess resident education and comfort with prescribing phototherapy from the resident perspective. Botulinum toxin and radiation therapy training were used as positive and negative controls, respectively. Responses were tabulated and comparisons made using Fisher's exact test and Cochran-Armitage Trend Test.Results88 residents responded. 42% and 81% of respondents reported not receiving didactic education on prescribing in-office and home phototherapy, respectively, compared to 13% for botulinum toxin and 91% for radiation therapy. 29% and 76% reported not being comfortable prescribing in-office and home phototherapy, respectively, compared to 36% for botulinum toxin and 91% for radiation therapy. Phototherapy education satisfaction was positively correlated with comfort of prescribing, and comfort prescribing was positively correlated with actual prescribing of phototherapy.Conclusions Training for prescribing phototherapy is lacking. Augmenting phototherapy training may help make home phototherapy more accessible for patients.This article is protected by copyright. All rights reserved.
    Photodermatology Photoimmunology and Photomedicine 08/2015; DOI:10.1111/phpp.12195 · 1.26 Impact Factor
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    ABSTRACT: Cryosurgery is a common treatment modality for many dermatological conditions; however, the extent to which it is used and by which medical specialties is not well characterized. To determine the rates of cryosurgery use over time, the top dermatoses treated by cryosurgery, patient demographics and the rate at which practitioners used cryosurgery. We used the National Ambulatory Medical Care Survey (NAMCS) from 1993 to 2010 in order to quantify the use of cryosurgery in outpatient offices. For visits where cryosurgery was utilized, the leading diagnoses, treating physician specialties, and patient ages were tabulated. Cryosurgery was most commonly used for treating actinic keratoses (48% of visits), seborrheic keratoses (25% of visits) and verrucae (21% of visits). Dermatologists performed 82% of all cryosurgeries, followed by family/internal medicine physicians (13.6%) and pediatricians (2.8%). The use of cryosurgery for these dermatoses has increased over time (p < 0.0001), especially in patients over the age of 65 years. Physicians in offices with health maintenance organization-based practices were more likely to utilize cryosurgery. Since NAMCS data are cross-sectional, we are unable to determine whether patients tried and failed other treatments. As the baby boomer generation ages, the demand for cryosurgery will likely further increase.
    Journal of Dermatological Treatment 07/2015; DOI:10.3109/09546634.2015.1054780 · 1.67 Impact Factor
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    ABSTRACT: Safety profiles of systemic biologic agents for the treatment of psoriasis and psoriatic arthritis (PsA) encompass a wide spectrum of adverse events. To date, no uniform evidence-based guidelines exist regarding screening and monitoring patients who are undergoing biologic therapy. We sought to identify studies evaluating screening and monitoring tests in the treatment of psoriasis and PsA with systemic biologic agents, and to propose evidence-based practical guidelines. The MEDLINE database was searched to identify data on risks associated with adalimumab, etanercept, infliximab, and ustekinumab. Articles were reviewed and graded according to methods developed by the US Preventative Services Task Force. Evidence was strongest (grade B) for tuberculosis screening. Interferon-gamma release assay was preferable to tuberculin skin testing. Among known hepatitis B virus carriers, the evidence grade was C for monitoring liver function tests and viral load. This study was limited by the lack of high-quality controlled trials evaluating screening and monitoring tests in patients treated with biologic agents. Baseline tuberculosis testing remains the only screening test with strong evidence to support its practice. Other screening and monitoring tests commonly performed in patients who are taking biologic agents are supported only in certain clinical settings or lack evidence to support or recommend against their practice. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
    Journal of the American Academy of Dermatology 07/2015; 73(3). DOI:10.1016/j.jaad.2015.06.004 · 4.45 Impact Factor
  • Source
  • Steven R Feldman · Susannah George
    British Journal of Dermatology 07/2015; 173(1):313-4. DOI:10.1111/bjd.13963 · 4.28 Impact Factor
  • Alyson Snyder · Sara E West · Christopher M Miles · Steven R Feldman
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    ABSTRACT: Melanoma is a common, potentially deadly disease but is curable if caught early. A specimen of a pigmented lesion must capture the entire width and depth of the lesion to evaluate the lesion's size, symmetry, and circumscription. Saucerization shaving, punching, and excision biopsy are 3 techniques that can be used to achieve a satisfactory specimen. Physicians should have a low threshold to biopsy a suspicious atypical pigmented lesion, but acceptable specimens are key in following through with an accurate diagnosis. © Copyright 2015 by the American Board of Family Medicine.
    The Journal of the American Board of Family Medicine 07/2015; 28(4):523-5. DOI:10.3122/jabfm.2015.04.150043 · 1.98 Impact Factor
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    ABSTRACT: Clinical models are invaluable in studying wound healing. Challenges in studying human wounds include heterogeneity of patients and wounds, as well as prolonged study time, resulting in high costs. Animal models are an efficient method to study wound healing, but often lack correlation with human acute wound healing. Human wound models can be created using sharp instruments, suction, acids, heat and cold. In this observational study, we propose a practical human acute wound model where partial thickness wounds are induced by cryosurgery to create wounds that could facilitate wound healing research and development. METHODS: On forearms of 8 healthy adult volunteers, freeze injuries were induced using liquid nitrogen spray delivered onto a target area of a 1 cm circular opening at a distance from the cryo-device to the skin of 0.5-1 cm. Several freeze-thaw time cycles were implemented by administering pulses ranging from 3 to 12 seconds. Clinical evaluation was performed at a 24-hour follow-up period. Blister roofs were histologically analyzed by a blinded dermatophathologist. Clinical assessment of time to heal was determined. RESULTS: Freeze-times greater than 5 seconds caused a majority of subjects to develop blisters, and freeze-times greater than 8 seconds resulted in uniform blister formation. Consistent histology of full thickness necrotic epidermis with intact detached basement membrane with minimal acute neutrophilic inflammatory infiltrate was observed in all blister specimens examined. The 8-second freeze-time group had a time to heal of 13-14 days, while the 12-second freeze-time group required 3 weeks to heal. After healing, an area of hypopigmented skin and slightly hypertrophic scarring remained. DISCUSSION: This novel cryo-induced wound model is a potential simple, efficient and reliable model for studying the dynamic processes involved in acute wound healing and to aid in the development of new wound healing therapies. identifier: NCT01253135. J Drugs Dermatol . 2015;14(7):734-738.
    Journal of drugs in dermatology: JDD 07/2015; 14(7):734-738. · 1.45 Impact Factor
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    ABSTRACT: Background Novel rosacea treatments are needed. Assessment methodologies for clinical trials of rosacea treatments are not standardized and are relatively inadequate. To determine the efficacy of new treatments, a valid and reliable assessment methodology is needed. Objective We sought to determine the assessment methodologies used in clinical trials for rosacea treatments, to demonstrate the need for a valid and reliable assessment tool, and to describe the relevant properties of such a tool. Methods PubMed and MEDLINE were searched for clinical trials of rosacea treatments since January 1, 1985. Results In all, 32 clinical trials met inclusion criteria. Assessment methodologies were highly variable, and standardized assessment methodologies were used in only 3 studies. The various manifestations of rosacea were assessed inconsistently. Limitations Eighteen articles could not be included as a result of lack of access to the full text. Conclusions The diverse methodologies make the assessment of novel treatments and comparison of treatments difficult. A valid and reliable assessment tool is needed to properly assess novel treatments to improve the management of rosacea.
    Journal of the American Academy of Dermatology 07/2015; 73(1):138-143.e4. · 4.45 Impact Factor
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    Michael E Farhangian · Steven R Feldman · Bass Alexandria
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    ABSTRACT: Treatment adherence is a ubiquitous challenge in medicine, particularly in the adolescent population with chronic disorders. Web-based adherence interventions may be particularly useful in adolescents, due to their familiarity with and frequent use of the Internet. To review web-based interventions used to improve adherence to medication in adolescent patients with chronic disorders. A PubMed search was performed for full-text, English, clinical trials in adolescents using keywords "adherence" or "compliance", "Internet" or "web", and "treatment" from inception until November 2014. Articles were selected if they involved using the Internet to provide support to adolescents to help improve their adherence to treatment, excluding those focused on solely providing medical services through the Internet and articles focusing on preventative care, rather than treatment of an illness. Fourteen studies were found concentrating on chronic adolescent disorders. Interventions included online surveys, physician chat lines, monitoring programs, and interactive programs. All interventions experienced either greater improvement in adherence or another disease control measure or no statistically significant difference compared with the control group (in-clinic visits). Few clinical trials studying web-based interventions to improve adherence in adolescents were found. Due to not having one standard outcome measured in all of the studies, it was also difficult comparing the effectiveness of the interventions. Web-based interventions play a role in improving adherence in adolescents with chronic disorders by being more time saving and cost effective compared with in-clinic visits. Further research focusing on adherence interventions using the Internet is necessary to determine the ideal ways of utilizing the Internet to improve adherence in adolescents with chronic disorders.
    Adolescent Health, Medicine and Therapeutics 06/2015; 6. DOI:10.2147/AHMT.S56065
  • Palak K Patel · Caleb R King · Steven R Feldman
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    ABSTRACT: Biological drugs are large, complex glycoprotein molecules produced in living organisms. Revolutionary treatments for many conditions, biologics used in dermatology will face patent expiration, opening opportunities for competitive versions. Biologic drugs are so complex such that it is impossible to reproduce them exactly. Biosimilars are designed to be highly similar, though not identical, to the innovator product. Because biosimilars are not exact replicates of innovator biologics, guidelines have suggested that biosimilars should be considered as unique therapeutic interventions, requiring unique names and physician notification prior to substitution. However, because biologics can never be replicated exactly, even innovator biologics have inherent batch-to-batch variability; when the second batch of innovator products were released, physicians began prescribing non-identical variants of biologics to their patients, accepting the possibility of variation in clinical effects. Unlike the variants in innovator products, biosimilars will provide clinical trial data demonstrating similar clinical effects, though there will always be some degree of uncertainty in how much clinical impact will be result from the variation in both innovator and biosimilar products. How biosimilars are approved and how we use biosimilars will need to balance considerations of cost and development time with the possibility of variation in biological response.
    Journal of Dermatological Treatment 06/2015; 26(4):1-4. DOI:10.3109/09546634.2015.1054782 · 1.67 Impact Factor
  • Sara moradi tuchayi · Steven R. Feldman
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    ABSTRACT: One characteristic of many skin disease clinical trials is that they involve topical treatments. The direct application of potent topical medications can have excellent efficacy, while minimizing the potential for systemic side effects. A limitation of trials in dermatology is that topical treatment tends to be more difficult for patients to use than oral medications. An advantage of dermatologic trials is that the outcomes are readily visible on the skin. Investigator- and patient-assessed outcomes can be used. A trial of a topical clobetasol illustrates the rapid effects of the drug and the relative safety over the short term.
    Wiley StatsRef: Statistics Reference Online, Edited by N. Balakrishnan, Paolo Brandimarte, Brian Everitt, Geert Molenberghs, Walter Piegorsch and Fabrizio Ruggeri, 06/2015; , ISBN: 9781118445112
  • Leonora Culp · Sara Moradi Tuchayi · Hossein Alinia · Steven R Feldman
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    ABSTRACT: Topical retinoids are first-line treatment options for acne vulgaris. These drugs, however, produce varying degree of cutaneous irritation within the first few weeks of treatment. Our purpose was to examine differences in tolerability of topical retinoids and assess whether these differences would be clinically meaningful. A PubMed search was performed for sources on topical retinoids in acne vulgaris treatment. Thirty-four clinical studies were analyzed. Thirteen studies had statistically significant results on tolerability of retinoid based on retinoid, vehicle, concentration, or skin type. All studies classified most of skin reactions as mild-moderate. Large differences in the number of dropouts due to irritation were not identified. Irritation studies did not show a high frequency of clinically significant irritation with topical retinoids. We anticipate that the large variation in patient use of topical retinoids would likely account for more variation in response than differences between drug formulations. © The Author(s) 2015.
    Journal of Cutaneous Maedicine and Surgery 06/2015; DOI:10.1177/1203475415591117 · 0.94 Impact Factor
  • Imran Aslam · Scott A Davis · Steven R Feldman · Willis E Martin
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    ABSTRACT: Health care workers suffer from musculoskeletal disorders at a significantly higher rate than workers in other industries. Consequently, a growing demand for patient handling devices to reduce worker injury has evolved. This article reviews the literature regarding interventions designed to reduce injuries among health care workers. A PubMed search was conducted using the terms "occupational health [Mesh Terms] patient lifting." Fourteen articles were identified that assessed interventions to improve worker safety. Of the 14 articles, 7 discussed technological interventions, 4 educational approaches, and 3 policy change. All three types of interventions were generally effective at improving worker safety, with the ideal intervention consisting of elements of all three types. Although adopting a new intervention may be expensive, the reduction in workers' compensation costs associated with injured nurses can easily outweigh the costs of interventions. © 2015 The Author(s).
    Workplace health & safety 06/2015; 63(6):267-275. DOI:10.1177/2165079915580038 · 0.56 Impact Factor

Publication Stats

12k Citations
2,008.43 Total Impact Points


  • 1998–2015
    • Wake Forest School of Medicine
      • Department of Dermatology
      Winston-Salem, North Carolina, United States
  • 1989–2014
    • Wake Forest University
      • • Department of Dermatology
      • • School of Medicine
      • • Department of Psychology
      • • Department of Psychiatry and Behavioral Medicine
      Winston-Salem, North Carolina, United States
  • 2011–2013
    • University of Michigan
      • Department of Clinical, Social, and Administrative Sciences
      Ann Arbor, MI, United States
    • University of Chicago
      Chicago, Illinois, United States
    • University of Georgia
      • Department of Clinical and Administrative Pharmacy
      Athens, GA, United States
  • 2010
    • State University of New York Upstate Medical University
      Syracuse, New York, United States
    • University of Notre Dame
      • College of Science
      Indiana, PA, United States
  • 1997–2010
    • Winston-Salem State University
      Winston-Salem, North Carolina, United States
  • 2009
    • University of California, Davis
      • School of Medicine
      Davis, CA, United States
  • 2004–2009
    • University of North Carolina at Greensboro
      • • Department of Public Health Education
      • • Department of Psychology
      Greensboro, North Carolina, United States
    • Kent State University
      • Department of Geography
      Kent, Ohio, United States
    • University of North Carolina at Chapel Hill
      North Carolina, United States
    • Beth Israel Deaconess Medical Center
      • Department of Dermatology
      Boston, MA, United States
  • 2007
    • Ohio University
      Athens, Ohio, United States
  • 2006–2007
    • Northeast Ohio Medical University
      Ravenna, Ohio, United States
    • George Washington University
      Washington, Washington, D.C., United States
  • 2005–2007
    • The Ohio State University
      • Division of Pharmacy Practice and Administration
      Columbus, Ohio, United States
    • Loyola University Medical Center
      Maywood, Illinois, United States
  • 2002–2003
    • Sunnybrook Health Sciences Centre
      • • Division of Dermatology
      • • Department of Medicine
      Toronto, Ontario, Canada
    • University of California, San Francisco
      • Department of Dermatology
      San Francisco, California, United States
    • University of Toronto
      • Department of Medicine
      Toronto, Ontario, Canada
  • 2001–2002
    • Bristol-Myers Squibb
      New York, New York, United States
    • University of Nevada, Las Vegas
      Las Vegas, Nevada, United States
    • Georgetown University
      Washington, Washington, D.C., United States
  • 1993
    • Medical University of South Carolina
      • Department of Dermatology
      Charleston, SC, United States