The goal of our research in pharmaceutical safety and monitoring is simple. Whenever we are prescribing a medication or a test for a patient, we should be able to answer 3 questions: 1) why this intervention (test or drug); 2) why this patient; and 3) why right now? This data is lacking in dermatology, where the combination of a lack of research and a risk-adverse culture has led to rigid testing standards based on anecdote and dogma.  We seek to perform studies that challenge conventional wisdom and provide dermatologists with evidence to improve clinical decision making.

One area of emphasis has been acne, where we have identified the low utility of potassium monitoring in healthy women taking spironolactone and evaluated the risk of isotretinoin-related side effects, including pregnancy-related and mental health-related adverse events. Our models have proposed alternative contraception requirements for patients taking isotretinoin. In addition we have explored the safety of isotretinoin in patients with abnormal baseline laboratory testing. These efforts have led to changes in American Academy of Dermatology Guidelines for monitoring during spironolactone and to increased scrutiny of the risks and benefits of the iPLEDGE program.

A second area of focus has been in evaluating testing and monitoring practices for patients with onychomycosis.  We have demonstrated limited value for confirmatory testing prior to treatment of onychomycosis, and called into question the utility of baseline transaminase monitoring.   

Selected Publications:

Tkachenko E, Sharma P, Mostaghimi A. Abnormal Baseline Lab Results Rarely Lead to Treatment Modification for Patients on Isotretinoin. Dermatology (Basel, Switzerland). 2020:1-4.

Tkachenko E, Singer S, Mostaghimi A. Contradictory iPledge Requirements Hinder Physician Practice and Patient Care-Reply. JAMA dermatology. 2020.

Tkachenko E, Singer SB, Sharma P, Barbieri J, Mostaghimi A. FDA Reports of Alopecia as an Adverse Event to Isotretinoin. Journal of cutaneous medicine and surgery. 2019;23(4):451-452.

Tkachenko E, Singer S, Sharma P, Barbieri J, Mostaghimi A. US Food and Drug Administration Reports of Pregnancy and Pregnancy-Related Adverse Events Associated With Isotretinoin. JAMA dermatology. 2019.

Singer S, Tkachenko E, Sharma P, Barbieri JS, Mostaghimi A. Psychiatric Adverse Events in Patients Taking Isotretinoin as Reported in a Food and Drug Administration Database From 1997 to 2017. JAMA dermatology. 2019.

Li DG, Din RS, Mostaghimi A. Cost-effectiveness of Confirmatory Testing and Empirical Therapy for Onychomycosis in Canada. Journal of cutaneous medicine and surgery. 2018;22(2):242-243.

Li DG, Mostaghimi A. Utility of Baseline Transaminase Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis. JAMA dermatology. 2018;154(5):626-627.

Cao S, Karmouta R, Li DG, Din RS, Mostaghimi A. Opioid Prescribing Patterns and Complications in the Dermatology Medicare Population. JAMA dermatology. 2018;154(3):317-322.

Xia FD, Song P, Joyce C, Mostaghimi A. The Utility of Microbiological Studies in Diagnosis and Management of Suspected Dermatological Infection. JAMA dermatology. 2017;153(11):1190-1192.

Xia FD, Khosravi H, Waul MA, Butler D, Joyce C, Mostaghimi A. Low risk of hemorrhagic complications after obtaining diagnostic skin biopsy specimens in a cohort of thrombocytopenic inpatients. Journal of the American Academy of Dermatology. 2017;76(5):1004-1005.

Plovanich M, Weng QY, Mostaghimi A. Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne. JAMA dermatology. 2015;151(9):941-944.