About

Dr. Anna Lien-Lun Chien is Associate Professor and Vice-Chair of Quality, Safety, and Service for the Department of Dermatology at the Johns Hopkins School of Medicine. She is the medical director of the Howard County Dermatology Practice and directed the department’s Cutaneous Translational Research Program for over ten years. Her clinical interests include skin aging, photoprotection, rosacea, and general dermatology. Dr. Chien earned her medical degree from the University of Chicago Pritzker School of Medicine, completed a transitional-year program at St. Joseph Mercy Hospital, and completed her dermatology residency with the University of Michigan Health System. She is board-certified in dermatology by the American Board of Dermatology. Her professional focus encompasses clinical care, translational research, and quality improvement in dermatology, with a particular emphasis on skin aging, photoprotection, and rosacea.

Research topics

• Medicine
• Dermatology
• Immunology
• Gerontology

Selected publications

• The cutaneous microbiome as a dynamic photoprotective interface against solar radiation

  Photochemical & Photobiological Sciences · 2026-03-23

  articleSenior author
  PublisherDOI

• P02 Topical retinoids for the treatment of photodamage in Latino skin

  British Journal of Dermatology · 2026-01-01

  article

  Abstract Introduction and aims Chronic sun exposure is a major contributor to photodamage, leading to significant changes in the skin’s appearance and alterations in the dermal extracellular matrix, particularly degradation of fibrillin-rich microfibrils (FRM) at the dermopidermal junction. All-trans retinoic acid (ATRA) is the gold standard for treating photodamage, with proven efficacy in both White and Black skin. However, efficacy of topical retinoids in skin of Latino individuals, whose skin tones range from light to dark, remain unexplored. The aim of this study was to assess the impact of ATRA and cosmetic retinol (ROL) on epidermal and dermal parameters of photodamage in sun-exposed Latino skin. Methods Using the Manchester Patch Test Assay, 0.025% ATRA (n = 4) and 0.3% ROL (n = 4) were applied under occlusion to dorsal forearm skin of healthy, photodamaged Latino volunteers (19–36 years) for 12 days. Skin biopsies were obtained from treated and untreated sites and processed for histological analysis. Results ATRA and ROL induced significant epidermal thickening, increasing by 72.9% (P < 0.05) and 108.7% (P < 0.01), respectively. Similarly, both treatments led to greater numbers of Ki67 positive keratinocytes, compared with untreated skin (ATRA: 5.5 vs. 2.7 cells per field; P < 0.05; ROL: 6.2 vs. 2.1 cells per field; P < 0.01). Dermal remodelling was evident following both treatments, with significant restoration of the FRM network at the dermoepidermal junction (ATRA: P < 0.01; ROL: P < 0.01). Conclusions ATRA and cosmetic ROL are effective in improving histological parameters of photoaged Latino skin, inducing similar epidermal changes and dermal remodelling. These findings suggest that both treatments may be viable options for the repair of photodamage across a broad spectrum of skin tones. Further investigation is needed to assess their long-term effectiveness in daily use.

  PublisherDOI

• Eruptive Cutaneous Metastatic Leiomyosarcoma

  SKIN The Journal of Cutaneous Medicine · 2026-03-10

  articleOpen accessSenior author

  Introduction: Leiomyosarcomas are malignant tumors of smooth muscle origin that infrequently involve the skin. Cutaneous metastases are rare and typically arise from retroperitoneal, uterine, or vascular primaries. We report a case of eruptive cutaneous leiomyosarcoma metastases occurring over two decades after excision of a primary subcutaneous leiomyosarcoma, representing an unusually long latency period and atypical metastatic pattern. Case Presentation: An 85-year-old Black man presented with several months of pruritic, painful, firm nodules on the scalp, right palm, and left shoulder. His history included a subcutaneous high-grade leiomyosarcoma of the right forearm excised with negative margins 26 years earlier and an incidentally discovered hepatic mass five years prior to presentation. Biopsies of the cutaneous nodules revealed atypical spindle cell proliferations positive for smooth muscle actin and desmin, consistent with leiomyosarcoma. PET imaging demonstrated an infiltrative hepatic mass invading the right kidney and numerous pulmonary and adrenal metastases. Histopathologic correlation confirmed metastatic leiomyosarcoma involving the liver and skin. The patient elected palliative gemcitabine monotherapy. Discussion: Cutaneous metastases from leiomyosarcoma are uncommon and typically signify advanced disease. The clinical and pathologic findings in this case suggest metastatic spread from the original subcutaneous tumor to the liver, which subsequently re-metastasized to the skin. Conclusion: This case underscores the potential for very late visceral and cutaneous metastases in leiomyosarcoma and highlights the need for ongoing clinical vigilance, even decades after initial treatment.

  PublisherOA PDFDOI

• Sun‐Exposed but Under‐Treated: Mapping the Geospatial Imbalance of Dermatologists and Outdoor Laborers

  Photodermatology Photoimmunology & Photomedicine · 2025-04-02

  articleOpen accessSenior author

  The data that support the findings of this study are available from the corresponding author upon reasonable request.

  PublisherOA PDFDOI

• Oral Glucoraphanin and Curcumin Supplements Modulate Key Cytoprotective Enzymes in the Skin of Healthy Human Subjects: A Randomized Trial

  Metabolites · 2025-05-29 · 3 citations

  articleOpen access1st authorCorresponding

  Background/Objectives: Oxidative stress plays a pivotal role in skin aging and carcinogenesis. Phytochemicals such as sulforaphane (SF, from broccoli sprouts or seeds) or curcumin (CUR, from turmeric) can be highly protective against this stress. They each induce a suite of cytoprotective and antioxidant enzymes that are coordinately transcribed via the Keap1-Nrf2-ARE pathway in mammals, such as the prototypical cytoprotective enzyme NAD(P)H dehydrogenase 1 (NQO1). Methods: Eighteen healthy human volunteers (9 males, 9 females, aged 18–69. were randomized to receive daily glucoraphanin (GR), which is converted to SF upon ingestion (450 mg; 1 mmol), CUR (1000 mg; 2.7 mmol), or both (450 mg GR + 1000 mg CUR), as oral supplements. After 8 days of a diet low in both compounds, blood and urine were collected for compliance and biomarker measurements. Randomized spots on the buttock’s skin were exposed to 2 x M.E.D. of UVB, and punch biopsies were obtained 1 and 3 days later for biomarker and histological measurement. Erythema was measured with a chromameter daily for 3 consecutive days following UVB. The process was repeated after receiving oral supplements, both with and without UVB exposure. Results: Compared to baseline, each treatment (n = 6 for each) induced NQO1 mRNA levels in skin biopsies: 3.1-fold with GR, 3.3-fold with CUR, and 3.6-fold with the combination of GR and CUR. Across all treatments (n = 18), expression of the pro-inflammatory cytokines IL-1β and TNF-α were reduced, as were IL-6, IL-17, STING, and CYR61, though less robustly. Modulation of these biomarkers persisted, but was less pronounced, in biopsies taken following UV exposure. The presence of SF and its metabolites in the skin post-treatment was confirmed by examining 6 of 12 subjects who ingested GR. Supplement effects on erythema following UV exposure were not significant, and no significant changes were measured in the same biomarkers in blood cells (PBMC), or by counting dyskeratotic keratinocytes. Supplements were well tolerated and compliance was excellent. Conclusions: Oral GR and CUR are well tolerated and have for the first time been shown to result in increased expression of cytoprotective genes and reduced expression of inflammatory cytokine genes in human skin in vivo. This mechanism-based clinical study suggests that an antioxidant, anti-inflammatory, and cytoprotective benefit from these oral supplements is delivered to the skin in humans.

  PublisherOA PDFDOI

• Have We Moved the Needle on Photoprotection Messaging? Insight From Sunburn Trends Using the 2019 Behavioral Risk Factor Surveillance System

  Photodermatology Photoimmunology & Photomedicine · 2025-05-01 · 1 citations

  articleSenior authorCorresponding

  BACKGROUND: Despite decades of public health messaging promoting sun safety and universal sunscreen utilization, sunburn remains prevalent among U.S. adults, posing a significant public health concern due to its links to skin cancer and photoaging. OBJECTIVES: This study aims to evaluate self-reported sunburn prevalence and associated risk factors using a nationally representative cross-sectional survey. METHODS: We analyzed data from the Centers for Disease Control and Prevention's (CDC's) 2019 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative cross-sectional survey of the US civilian noninstitutionalized population. Our sample included 15,545 adults aged 18 years and older who had complete data on sunburn and relevant variables. Multivariable logistic regression with adjustment for sampling probabilities was used to examine factors associated with self-reported sunburn in the last 12 months preceding the interview. All statistical analyses were performed using Stata 17. RESULTS: We found that 31.02% of American adults reported sunburn in the past year, with higher rates observed among younger adults, those with higher income and education, and rural residents. Binge drinking was strongly associated with increased sunburn risk. Despite increased sun-protective behaviors such as sunscreen use, seeking shade, and wearing protective clothing, these practices have not significantly reduced sunburn prevalence, particularly among high-risk groups. CONCLUSIONS: Our findings suggest that public health campaigns may not sufficiently address the unique needs of certain populations, including young adults, rural residents, and binge drinkers. We recommend tailored interventions, multimodal sun protection strategies, and enhanced use of digital platforms for outreach. Further research is essential to refine these strategies and reduce the public health burden of sunburn and its associated risks.

  PublisherDOI

• Social Disparities in Photoprotection Behaviors and Sunburn Risk Among Individuals on Photosensitizing Drugs: A Decade‐Long National Health and Nutrition Examination Survey Analysis (2009–2018)

  Photodermatology Photoimmunology & Photomedicine · 2025-09-01

  articleSenior author

  The data that support the findings of this study are openly available in National Health and Nutrition Examination Survey at https://wwwn.cdc.gov/nchs/nhanes/Default.aspx.

  PublisherDOI

• Who Still Indoor Tans in the United States? An Updated Analysis of the 2019 Behavioral Risk Factor Surveillance System

  Photodermatology Photoimmunology & Photomedicine · 2025-08-10

  articleOpen accessSenior authorCorresponding

  All data used in this study were obtained from the publicly available Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) (www.cdc.gov/brfss). Access to the BRFSS's deidentified survey data is available for the purpose of public health research and analysis under the conditions specified by the CDC.

  PublisherOA PDFDOI

• Photoaging: Current Concepts on Molecular Mechanisms, Prevention, and Treatment

  American Journal of Clinical Dermatology · 2025-03-12 · 23 citations

  reviewSenior author
  PublisherDOI

• Protocol for a multisite, observational clinical study of the association between skin colour and pulse oximeter accuracy in children undergoing cardiac catheterisation (PACH study)

  BMJ Open · 2025-04-01 · 1 citations

  articleOpen access

  Introduction Prospective, real-world clinical studies of the association between skin color and pulse oximeter (SpO2) accuracy in children are needed to address the limitations of previous research. Such studies are essential for generating evidence for clinicians, regulators and industry. This is the protocol for a multisite study funded by the National Heart, Lung, and Blood Institute (R01HL171313; 1 January 2024–31 December 2028). Methods and analysis In this pragmatic, observational study conducted in three large paediatric cardiac catheterisation centres in the USA, children undergoing cardiac catheterisation with directly measured arterial oxygen saturation will be prospectively enrolled. The outcome variable (SpO 2 bias) is the difference between contemporaneous paired measurements of pulse oximetry (SpO 2 ) and the standard reference comparator, arterial blood sample oxygen saturation (SaO 2 ), obtained during the catheterisation procedure. The independent variable is an objective measure of skin colour obtained via spectrophotometry. Our primary analysis is a multivariable regression model testing the relationship between skin colour and SpO 2 bias, after adjusting for covariates. We will also conduct a moderator analysis to identify factors that may affect the magnitude of the association. The target sample size is 584 participants. Ethics and dissemination This study was approved by the University of Pennsylvania Institutional Review Board (#854895) under expedited review. Study risks are minimal. Parental permission, and child assent when applicable, are obtained prior to enrolment. In accordance with the NIH Public Access Policy, publications associated with the study will be made publicly available through PubMed Central. The analytic dataset will be contributed to a repository for future use. In collaboration with a children’s hospital-based research family advisory council, interpretation and dissemination of the results for lay, clinical and scientific audiences will be considered. Trial registration number Although not a clinical trial, this observational study is registered on ClinicalTrials.gov (identifier: NCT06529575 ) for public awareness.

  PublisherDOI

Frequent coauthors

• Sewon Kang

  Johns Hopkins Medicine

  172 shared

• Barbara M. Rainer

  Medical University of Graz

  52 shared

• Sherry Leung

  42 shared

• Alexander H. Fischer

  36 shared

• Luis A. Garza

  33 shared

• Rachel Watson

  31 shared

• A.K. Langton

  Salford Royal NHS Foundation Trust

  29 shared

• Sooyoung Kim

  Seoul National University

  28 shared

Education

• M.D.

  University of Chicago Pritzker School of Medicine

• Other, Transitional-year program

  St. Joseph Mercy Hospital

• Other, Dermatology residency

  University of Michigan Health System