Factitious disorders and factitious disorders imposed on another are a prevalent encounter during dermatology visits. Here, we present a case of a pediatric patient who presented with ulcer-like lesions that, based on initial biopsy, suggested an immunobullous etiology. Further exploration revealed her underlying psychiatric disorder. Dermatologists play an integral role in recognizing and initiating "nervous system" management to establish a level of trust with the patient that will ultimately allow bridging to psychiatric care. The case discussed here serves as an example of the successful diagnosis and treatment of a pediatric psychiatric patient by raising clinical suspicion, using investigative techniques, employing separate interviews and the Patient Health Questionnaire-9, and sensitively addressing the relationship between the patient, guardian, and provider within the dermatology clinic.

Background

While alopecia areata (AA) has been associated with atopy, the immunological relationship is unclear, with the association of specific atopic and systemic respiratory diseases not established. The relationship between T-helper (Th)1-mediated AA and Th2-mediated atopy challenges the conventional Th1/Th2 paradigm of autoimmune disease categorization.

Objectives

To determine the association between AA and atopic respiratory diseases in adults and children, and respiratory diseases in general.

Method

All primary literature, excluding case reports, were identified within PubMed/MEDLINE, CINAHL, and Web of Science in May 2018 using the following search terms: "(alopecia OR hair loss) AND (respiratory OR pulmonary OR lungs OR asthma OR rhinitis OR bronchitis OR COPD OR atopy OR atopic)." Information from 32 articles meeting the inclusion and exclusion criteria was reviewed.

Results

Among the 32 articles identified for inclusion, the prevalence of AA was more strongly associated with allergic rhinitis compared to asthma among pediatric and adult populations. While a significant association was identified between AA, allergic rhinitis, and a late age of onset, the association of AA and asthma remains controversial despite asthma's prevalence among AA patients. No significant difference was identified with regard to the association of AA and non-atopic respiratory diseases between adult and pediatric patients.

Conclusions

Adult and pediatric patients with AA warrant further workup for atopic respiratory diseases such as allergic rhinitis. AA may have an underlying Th2-mediated immunological component, which supports its association with atopic respiratory diseases and provides a new avenue for targeted therapies in select cases.

The primary objective of this abstract is to define the growing trend of private equity (PE) backed consolidation of dermatology practices and explore its impact on patient care. The secondary objective is to better inform dermatologists of the acquisition process as well as how practices are valued in the event of a leveraged buyout. A systematic review was conducted using PRISMA guidelines using PubMed/MEDLINE and Web of Science in July 2021. Studies included were graded using the Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence.1 A total of 18 articles met the inclusion/exclusion criteria. With the current environment of low interest rates combined with increasing cost of medical operations and non-clinical administrative burdens, PE is positioned to expand exponentially in total value through leveraged buyouts of solo and small dermatology groups.2 Selling dermatologists receive payment in form of upfront cash, and equity in escrow incentivizes them to continue the growth of their clinic so that it can be consolidated into a larger portfolio of practices to be sold to another buyer in 3-7 years at a far higher valuation. Within the fragmented $8.4 billion-dollar dermatology space, PE-backed practices represent approximately 10-15% of all private practices.3-5 Dermatologists should be aware of both the risks and the rewards of acquisition by PE given the fiduciary responsibility to shareholders and their patients. J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.6892 Citation: Sung CT, Salem S, Oulee A, et al. A systematic review: Landscape of private equity in dermatology from past to present. J Drugs Dermatol. 2023;22(4):404-408. doi:10.36849/JDD.6892.

The terms composite and collision tumors have been used interchangeably throughout radiological literature. Both composite and collision tumors involve two morphologically and immunohistochemically distinct neoplasms coexisting within a single organ. However, collision tumors lack the histological cellular intermingling seen in composite tumors. Composite tumors often arise from a common driver mutation that induces a divergent histology from a common neoplastic source while collision tumors may arise from coincidental neoplastic change. The purpose of this review is to provide an overview of abdominal composite and collision tumors by discussing hallmark radiographic and pathological presentations of rare hepatic, renal, and adrenal case studies. A better understanding of the presentation of each lesion is imperative for proper recognition, diagnosis, and management of these unique tumor presentations.