Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) use in children is rapidly expanding, though in contrast to adults, morphologic data on dermatologic adverse events (AEs) in pediatric patients remain sparse, underscoring the need for further focused investigation. We review and synthesize the existing literature on dermatologic AEs of GLP-1 RAs in children in comparison to adults, to summarize current evidence, identify knowledge gaps, and highlight areas for future research. Available reports suggest that rash, urticaria, and alopecia may occur with greater frequency in children on injectable GLP-1 RAs compared with adults, while facial lipodystrophy has been more often described in adults. However, pediatric dermatologic AE data are not as robust as adult data, reducing the ability for direct comparisons. Based on this initial investigation, dermatologic AEs of GLP-1 RAs are seemingly under-described in children and may have important differences compared with adult dermatologic AEs.

BACKGROUND:As the incidence of frontal fibrosing alopecia (FFA) continues to rise, there is a need for an optimal treatment algorithm for FFA. OBJECTIVES:To produce an international consensus statement on the treatment modalities and prognostic indicators of FFA. METHODS:Sixty-nine hair experts from six continents were invited to participate in a three-round Delphi process. The final stage was held as a virtual meeting facilitated via Zoom. The consensus threshold was set at ≥66%. RESULTS:Of 365 questions, expert consensus was achieved in 204 (56%) questions following completion of the three rounds. Three additional questions were included at the final meeting. The category with the strongest consensus agreement was disease monitoring (9; 100%). Questions pertaining to physical therapies achieved the least category consensus (15; 40%), followed by systemic therapy (45; 43%). LIMITATIONS:The study lacked sufficient representation from Africa and South America. CONCLUSIONS:SOFFIA highlights areas of agreement and disagreement among experts. Robust research is warranted to provide evidence-based treatment recommendations.

Chemotherapy-induced alopecia and radiation-induced alopecia, the thinning or loss of hair due to cytotoxic chemotherapy and radiation therapy, respectively, are distressing adverse effects of cancer treatment. Chemotherapy, targeted therapies, and radiation therapy used in pediatric oncology often lead to alopecia by damaging hair follicles, with varying degrees of severity depending on the specific treatment type, mechanism of action, and damage-response pathway involved. Pediatric chemotherapy-induced alopecia, radiation-induced alopecia, and permanent alopecia, defined as hair regrowth that remains incomplete 6 months or more after treatment, have significant negative impacts on mental health, self-esteem, and social interactions, highlighting the need for further research into supportive care strategies. There are currently no standard interventions for chemotherapy-induced alopecia or radiation-induced alopecia in children, with most recommendations limited to gentle hair care and camouflaging techniques during treatment. Scalp cooling has demonstrated safety and efficacy in reducing chemotherapy-induced alopecia in adults and is currently under investigation in children and adolescents. Topical and low-dose oral minoxidil have been studied in children for other hair loss disorders and may improve hair regrowth after chemotherapy or radiation. Increased awareness and continued research into management strategies for pediatric chemotherapy-induced alopecia and radiation-induced alopecia are necessary to help mitigate its significant negative impact on quality of life.

Venture capital in dermatology has emerged as a key driver of innovation, significantly influencing the development of treatments, diagnostic tools, and patient care practices. This form of investment bridges the gap between groundbreaking research and its clinical application, fostering the creation of companies and scaling of cutting-edge technologies. The advent of artificial intelligence (AI) has led to a proliferation of startups leveraging this technology in various sectors, including medicine and dermatology, drawing substantial interest from the venture capital community. Potential applications of AI in dermatology and examples of currently funded companies range from image-based diagnostic support (VisualDx, Piction Health) and devices with real-time imaging capabilities (3Derm, Dermasensor, Anapix Medical), image-based direct to patient triaging tools for underserved populations with poor healthcare access (Triage, Eskindoctor), clinical workflow tools and decision support (Aiklu, Magnosco), clinical analytics (BoomerangFX, Qubole), direct-to-patient AI-enabled skincare recommendations (Daisies, Exely, IQONIC.AI), and telehealth augmented by AI (SolDoc, Yuko AI). Future potential applications may include AI-enabled drug discovery, predictive therapeutic analytics (how will a particular patient phenotype respond to a particular biologic medication?), and clinical co-pilots, especially as large language models become more widespread. Here, we analyze venture capital investment in AI-dermatology companies over the past decade (2013–2023) and compare to investments in: dermatology, healthcare AI, and AI at-large. We used the Pitchbook comprehensive database (https://pitchbook.com) to examine all venture capital deals with recorded deal monetary size taking place in the sectors of dermatology and dermatology-AI spanning the 10-year period from 11 July 2013 to 11 June 2023 regardless of geography. Pitchbook is the leading database used in the investment sphere for comprehensive data spanning the global capital markets. All searches include the following criteria: completed transactions, all ownership models, no minimum or maximum deal criteria, no location criteria. The search parameters were:•Dermatology: dermatology OR dermatology services OR cosmetic dermatology OR dermatology care OR dermatology treatment OR dermatology practice OR acne OR basal cell carcinoma OR bullous OR dermatitis OR eczema OR mycosis fungoides OR nail fungus OR alopecia OR psoriasis OR squamous cell carcinoma OR tinea OR urticaria OR vitiligo OR melanoma detection•AI-Dermatology: (dermatology OR dermatology services OR cosmetic dermatology OR dermatology care OR dermatology treatment OR dermatology practice OR acne OR basal cell carcinoma OR bullous OR dermatitis OR eczema OR mycosis fungoides OR nail fungus OR alopecia OR psoriasis OR squamous cell carcinoma OR tinea OR urticaria OR vitiligo OR melanoma detection) AND Artificial Intelligence & Machine Learning To conduct our analyses of investments in healthcare AI and AI at-large, we used the following Boolean search parameters:•Healthcare: (Healthcare: Industry == "Healthcare") OR (Healthcare: Emerging Spaces == "Healthcare") OR (Healthcare: Verticals == "HealthTech")•AI: (Vertical == "Artificial Intelligence and Machine Learning")•Medical AI: ((Industry == "Healthcare") OR (Emerging Spaces == "Healthcare") OR (Verticals == "HealthTech")) AND (Vertical == "Artificial Intelligence and Machine Learning") After searches were completed, databases of results were reviewed by two authors, V.R. and N.K.J, to ensure accuracy of the search terms. Analysis was performed using Microsoft Excel (Microsoft Corporation, Redmond, WA). Descriptive statistics were extracted for this analysis. Overall, there were a total of 542 dermatology companies participating in 1359 deals between 11 July 2013 and 11 June 2023, with a total of $10.45 billion in capital invested. During this period, the median deal size was $3.02 million with median post-deal valuation of $19.51 million. The largest deal was $1.14 billion. The year of 2021 saw the greatest deal flow with a total of 148 deals with $2.69 billion in capital invested (median deal size of $5.13 million; median post-deal valuation $26.67 million; Figure 1a). Shifting our focus to AI-dermatology deal flow during the study's timeframe, there were a total of 35 companies participating in 115 deals with a total of $327.97 million in capital invested. During this period, the median deal size was $1.71 million with a median post-deal valuation of $56.26 million. The largest deal was $75.00 million. The year of 2022 saw the greatest deal flow with a total of 15 deals with $110.86 million in capital invested (median deal size of $2.12 million; median post-deal valuation $29.85 million; Figure 1a). For medical AI, there are a total of 4070 companies participating in 12,144 deals with a total of $70.75 billion in capital invested. The median deal size was $2.34 billion with a median post-deal valuation of $11.54 million. The largest deal was $1.60 billion. The year of 2021 saw the greatest deal flow with a total of 1487 deals with $18.29 billion in capital invested (median deal size of $3.03 million; median post-deal valuation $19.37 million). For AI at-large, there were a total of 25,250 companies participating in 68,085 deals with a total of $484.73 billion in capital invested. The median deal size was $2.32 billion with a median post-deal valuation of $9.41 million. The largest deal was $10.00 billion. The year of 2021 saw the greatest deal flow with a total of 8155 deals with $116.47 billion in capital invested (median deal size of $3.20 million; median post-deal valuation $20.61 million). Our analysis of AI-dermatology deals as a fraction of total AI at-large and medical AI showed a decrease in AI-dermatology deals relative to the other two sectors during the period of capital influx during the COVID-19 pandemic (2020–2021). This fraction of AI-dermatology deals relative to AI at-large and medical AI rebounded in 2022 and 2023 (Figure 1b). Analysis of year-over-year (YoY) deal flow growth for all three sections show a steady downtrend since 2014 (Figure 1c). Assessment of the capital flow into AI-dermatology as a fraction of total AI at-large and medical AI showed a decrease between 2017 and 2021, with a rebound in 2023 before another subsequent decrease in these ratios (Figure 2a). YoY capital flow changes were relatively flat apart from an outlier in 2016 for AI-dermatology (Figure 2b). Probing the trend in median post-funding valuations, all three sectors showed what appears to be a gradual increase in valuations, with the AI-dermatology showing variability in the dataset given the relatively low number of deals closed, lending to outliers (Figure 2c). This study represents an approach to assess the impact of venture capital in private markets at the intersection of AI, medicine, and dermatology, building upon a prior study performed in evaluating venture investment (Agarwal and Orlow, 2023Agarwal A. Orlow S.J. Skin in the game: an analysis of venture capital investment in dermatology from 2002 to 2021.J Invest Dermatol. 2023; 143: 533-537.e1Google Scholar).1 Our descriptive analyses show that although AI-dermatology deals were on average smaller in size than dermatology deals, the median post-deal valuations of the former were larger. Although median deal size itself may be influenced by different stages of venture investment, the larger median post-deal valuation of AI-dermatology companies may reflect the perception among venture capitalists that AI technology in dermatology is a high-potential, high-value sector. The peak in AI-dermatology deal flow occurring one year after dermatology deal flow may reflect a combination of factors, including but not limited to a shift in market focus to new growth opportunities after saturation of existing verticals and evolving technology and awareness of such technology to impact prior areas of investment. Interestingly, when AI-dermatology deals are assessed as a percentage of overall deals in dermatology, there is a notable increase in the percentage of deal flow in the AI-dermatology space beginning in 2017, coinciding with the publication of Google's Transformer paper (Figure 1d; Vaswani et al., 2017Vaswani A. Shazeer N. Parmar N. Uszkreit J. Jones L. Gomez A.N. et al.Attention is all you need.2017https://proceedings.neurips.cc/paper_files/paper/2017/file/3f5ee243547dee91fbd053c1c4a845aa-Paper.pdfDate accessed: November 23, 2023Google Scholar). This may possibly be related to technological advancements and subsequent interest in AI's potential in medicine. We must be cautious in this assessment given the generally low number of AI-dermatology deals and because temporal association may not always equate with causality. Meanwhile, in the immediate years during and after the COVID-19 pandemic (2020 and 2021), there was a decrease in AI-dermatology deals, highlighting a deviation from the trend wherein the increase in global liquidity fueled a flurry of deals in AI and Medical AI. Specifically, the YoY change for Derm AI for the years 2020 and 2021 were 0%, whereas deal flow increased by 8% and 35.6% for AI, and 22.2% and 36.7% for Medical AI. There was a subsequent increase in AI-dermatology deals as a percentage of overall dermatology deals in 2022 and 2023, despite the decrease in global liquidity; however, this data are limited and without additional years of assessment, we are unable to draw conclusions. Compared to other medical and surgical specialties, image-based subspecialties such as dermatology have demonstrated lower deal volume and lower overall funding (Supplementary Table S1). Limitations of our study include an inability to distinguish between dermatology-driven and AI-driven applications. It is likely that dermatologists themselves are not heavily involved in the funding of these companies, thus highlighting the importance of this study in making these data accessible to our dermatology community to be better positioned to help shape innovation in our specialty. Furthermore, there is variability in when these funded companies will result in clinical impact. For instance, some companies are already available for use (eg, VisualDx), whereas others are in the development phase. On the other hand, some companies are consumer-facing and available for use. Meanwhile, other funded companies are somewhere in-between, marketed to customers, but designed to triage patients for providers while others. Generally speaking, the range of need for funding can vary from conception stage to development to marketing, depending on the stage the company is at because we considered all funding rounds in our study to capture the spectrum of deal flow. The fluctuation in AI-dermatology space (median funding, valuations, and growth rates) reflect the susceptibility of metrics in Derm AI to outliers, as the number of deals was extremely small (annual average deals 6.8) compared to Medical AI (annual average: 775.9) and AI (annual average: 4746.5). Our data highlight a relatively small number of deals in the AI-dermatology space. We postulate that this is because, in the early stages of a technological paradigm shift, investments often favor foundational tools with wide market applications, such as hardware and computing power. Examples include companies like NVIDIA, which provide the essential backbone (colloquially referred to as the "golden shovels," referencing the manufacturers selling shovels used in the California gold rush) for further technological advancements (Knight, 2016Knight W. The man selling shovels in the machine-learning gold rush.https://www.technologyreview.com/2016/04/07/161131/the-man-selling-shovels-in-the-machine-learning-gold-rush/Date: 2016Date accessed: November 23, 2023Google Scholar). As these core technologies mature and become more accessible, industry-specific applications may begin to emerge, leveraging the refined tools and reduced costs of computing power as highlighted in research documents published by ARK Invest, 2023ARK InvestBig ideas 2023.https://research.ark-invest.com/hubfs/1_Download_Files_ARK-Invest/Big_Ideas/ARK%20Invest_Presentation_Big%20Ideas%202023_FINAL_V2.pdfDate: 2023Date accessed: November 23, 2023Google Scholar and OpenAI, 2023OpenAIChatGPT can now see, hear and speak.https://openai.com/blog/chatgpt-can-now-see-hear-and-speakDate: 2023Date accessed: November 23, 2023Google Scholar. This evolution is evident in the rise of more sophisticated AI applications, such as OpenAI's enhanced chatbot tools and data integration capabilities. We anticipate that the coming years will see a shift. As technology evolves and becomes more integrated with specific clinical needs, we anticipate a rise in venture capital funding for specialty-specific projects in dermatology. This has been described by some as "vertical AI" (Kim, 2023Kim C. Vertical AI.https://greylock.com/greymatter/vertical-ai/?utm_source=tldrfoundersDate: 2023Date accessed: December 8, 2023Google Scholar). This shift will likely be driven by a collaborative synergy among developers, clinicians, and venture capitalists, who are increasingly recognizing the potential in targeting smaller, more specialized total addressable markets within dermatology (Davis et al., 2023Davis M.J. Levy J. Chacko R. Davis M.J. Srinivasan G. Goel T. et al.Poster 43: a deep learning algorithm for integration of artificial intelligence in the Mohs Micrographic surgery workflow for treatment of basal cell carcinoma. Presented at: 55th Annual Meeting of American College of Mohs Surgeons, Hyatt Regency, Seattle2023Google Scholar). Perhaps this shift is hinted at in our 2022 and 2023 data, which show AI-dermatology deals encompassing a larger percentage of overall dermatology deals. This prospective trend underscores the dynamic and evolving landscape of dermatology, where innovation is continually reshaping the horizons of patient care and clinical practice. Finally, if we as dermatologists are not more involved with the conception and development of new technologies, we may never be confident that the solutions being built will most effectively address the needs of our patients and ourselves. Vignesh Ramachandran: https://orcid.org/0000-0002-4958-2182 Neil K. Jairath: https://orcid.org/0000-0003-2317-169X Seth J. Orlow: https://orcid.org/0000-0003-2548-7380 The authors state no conflict of interest. Conceptualization: SJO, VR, NKJ; Data Curation: VR, NKJ; Methodology: SJO; Formal Analysis: SJO, VR, NKJ; Supervision: SJO; Writing - Original Draft Preparation: VR, NKJ; Writing - Review and Editing: SJO, VR, NKJ Supplementary Table S1Venture Capital Deal Metrics for Dermatology Compared to Cardiology, Orthopedic Surgery, Oncology, Radiology, and OphthalmologySpecialtyNumber of CompaniesNumber of DealsTotal Raised ($ Million)Median Valuation Range ($ Million)Deal Flow Peak YearsDermatology36125378.242.26–93.52022Cardiology27,00572,167498,1009.8–21.672021, 2022Orthopedic Surgery26,91471,923495,9409.8–21.672021, 2022Oncology138460645016.35–58.992021, 2022Radiology8730412603.5–54.52020, 2021Ophthalmology2068247.94.1–84.42020, 2022 Open table in a new tab

Introduction Chemical hair relaxers straighten hair by breaking disulfide bonds. These products are predominantly used by women of African descent. There are increasing concerns regarding the safety of hair relaxers, which may contribute to racial health inequities. Methods We performed a broad literature review of the safety and toxicity of chemical hair relaxers. Results Chemical hair relaxers are associated with increased fragility of the hair shaft, allergic contact dermatitis, and irritant contact dermatitis. Gas chromatography/mass spectrometry analysis has also revealed numerous asthma-associated chemicals in these products. Relaxers may result in acute kidney injury via glycolic acid derivatives that are absorbed through the skin and metabolized into oxalate, leading to calcium oxalate nephropathy. Hair relaxers also contain endocrine-disrupting chemicals that can be hormonally active and carcinogenic. Several large studies have supported associations between hair relaxer use and breast, uterine, and ovarian cancers. These chemicals also impact puberty and fertility, as supported by studies showing increased risk for earlier menarche and reduced fecundability. Conclusions Chemical hair relaxers are associated with wide-ranging adverse effects. The Food and Drug Administration has limited regulatory control over personal care products, underscoring the importance of further research into the safety of chemical hair relaxers.

Acquisition and consolidation of medical practices has been a subject of substantial attention in the health care landscape, with considerable activity in dermatology driven by private equity (PE) investors. PE acquisitions of dermatology practices rose at a rate of 65% annually from 2012 to 2017,1 and locations owned by private equity–backed dermatology groups (PEGs) increased by 77 (10.1%) from July 2018 to July 2019.2 While related articles reflect data from 2018 to 19, data on more recent PE activity in dermatology are limited in the medical literature.

Abstract Alopecia is traditionally classified into scarring and nonscarring subtypes, with etiopathologies ranging from androgen‐mediated to immuno‐inflammatory. Over 50% of men and almost 50% of women will experience some form of hair loss in their lifetime. Given this prevalence and the psychosocial significance of hair, understanding the pathophysiology and comorbidities of different types of hair loss is imperative. Other proinflammatory dermatologic disorders, such as psoriasis, are recognised to have systemic manifestations including an increased risk of cardiovascular (CV) disease, and are now considered CV risk‐enhancing conditions. With increased recognition of the importance of systemic inflammation in promoting atherosclerosis, high prevalence, and improved treatment strategies, there is increased interest in establishing whether a similar association between alopecia and cardiovascular disease (CVD) exists. In this manuscript, we aim to review the current literature regarding CV risk in androgenic alopecia (AGA) and alopecia areata (AA). Additionally, we review the literature for cicatricial alopecias and highlight the need for more research into their potential associations with CV risk. Evidence from the identified AGA publications suggests an association of AGA with CV risk factors including hypertension, dyslipidemia, and insulin resistance, as well as with coronary artery disease. For AA, most of the identified studies found an association between AA and CV risk, though the relationships were not always statistically significant. Research on cicatricial alopecias and CV risk is limited and often contradictory. There is great need for more studies regarding the association between various types of alopecia and the development of CVD, and potential mechanisms. Particularly needed are more studies of cicatricial alopecias and potential associated CV risk. While some literature suggests that patients with alopecia have an increased risk of CVD, the lack of concrete evidence represents a notable gap in our current understanding.

Importance Current measures of alopecia areata (AA) severity, such as the Severity of Alopecia Tool score, do not adequately capture overall disease impact. Objective To explore factors associated with AA severity beyond scalp hair loss, and to support the development of the Alopecia Areata Severity and Morbidity Index (ASAMI). Evidence ReviewA total of 74 hair and scalp disorder specialists from multiple continents were invited to participate in an eDelphi project consisting of 3 survey rounds. The first 2 sessions took place via a text-based web application following the Delphi study design. The final round took place virtually among participants via video conferencing software on April 30, 2022. Findings Of all invited experts, 64 completed the first survey round (global representation: Africa [4.7%], Asia [9.4%], Australia [14.1%], Europe [43.8%], North America [23.4%], and South America [4.7%]; health care setting: public [20.3%], private [28.1%], and both [51.6%]). A total of 58 specialists completed the second round, and 42 participated in the final video conference meeting. Overall, consensus was achieved in 96 of 107 questions. Several factors, independent of the Severity of Alopecia Tool score, were identified as potentially worsening AA severity outcomes. These factors included a disease duration of 12 months or more, 3 or more relapses, inadequate response to topical or systemic treatments, rapid disease progression, difficulty in cosmetically concealing hair loss, facial hair involvement (eyebrows, eyelashes, and/or beard), nail involvement, impaired quality of life, and a history of anxiety, depression, or suicidal ideation due to or exacerbated by AA. Consensus was reached that the Alopecia Areata Investigator Global Assessment scale adequately classified the severity of scalp hair loss. Conclusions and Relevance This eDelphi survey study, with consensus among global experts, identified various determinants of AA severity, encompassing not only scalp hair loss but also other outcomes. These findings are expected to facilitate the development of a multicomponent severity tool that endeavors to competently measure various disease impact. The findings are also anticipated to aid in identifying candidates for current and emerging systemic treatments. Future research must incorporate the perspectives of patients and the public to assign weight to the domains recognized in this project as associated with AA severity.

ImportanceCurrent measures of alopecia areata (AA) severity, such as the Severity of Alopecia Tool score, do not adequately capture overall disease impact.ObjectiveTo explore factors associated with AA severity beyond scalp hair loss, and to support the development of the Alopecia Areata Severity and Morbidity Index (ASAMI).Evidence ReviewA total of 74 hair and scalp disorder specialists from multiple continents were invited to participate in an eDelphi project consisting of 3 survey rounds. The first 2 sessions took place via a text-based web application following the Delphi study design. The final round took place virtually among participants via video conferencing software on April 30, 2022.FindingsOf all invited experts, 64 completed the first survey round (global representation: Africa [4.7%], Asia [9.4%], Australia [14.1%], Europe [43.8%], North America [23.4%], and South America [4.7%]; health care setting: public [20.3%], private [28.1%], and both [51.6%]). A total of 58 specialists completed the second round, and 42 participated in the final video conference meeting. Overall, consensus was achieved in 96 of 107 questions. Several factors, independent of the Severity of Alopecia Tool score, were identified as potentially worsening AA severity outcomes. These factors included a disease duration of 12 months or more, 3 or more relapses, inadequate response to topical or systemic treatments, rapid disease progression, difficulty in cosmetically concealing hair loss, facial hair involvement (eyebrows, eyelashes, and/or beard), nail involvement, impaired quality of life, and a history of anxiety, depression, or suicidal ideation due to or exacerbated by AA. Consensus was reached that the Alopecia Areata Investigator Global Assessment scale adequately classified the severity of scalp hair loss.Conclusions and RelevanceThis eDelphi survey study, with consensus among global experts, identified various determinants of AA severity, encompassing not only scalp hair loss but also other outcomes. These findings are expected to facilitate the development of a multicomponent severity tool that endeavors to competently measure disease impact. The findings are also anticipated to aid in identifying candidates for current and emerging systemic treatments. Future research must incorporate the perspectives of patients and the public to assign weight to the domains recognized in this project as associated with AA severity.

To the Editor: Though the primary source of grant funding for dermatology in the United States and many other countries remains government bodies, funding by nonprofit organizations can have a major role in advancing science and broader health advocacy.1Abkowitz J.L. Hromas R. Approaching the crisis in medical research funding: an important role for nonprofit organizations and medical societies.Blood Adv. 2018; 2: 846-847Crossref PubMed Scopus (4) Google Scholar However, there is limited reporting on nonprofit activities in dermatology and their impacts on the field. We conducted a cross-sectional analysis of dermatology grant funding provided in the United States by major nonprofit organizations from 2015 to 2019. To identify organizations, we queried the Candid nonprofit database using dermatologic and other field-related keywords for those focusing on dermatology or skin disorders reporting annual revenues ≥$1 million. US grant funding was obtained from the US Internal Revenue Service Form 990 Schedule I filings (or ProPublica for absent data). Twelve organizations reporting grants during all years were identified (Table I). Four category codes—research, education, public health/advocacy, and other (without descriptive detail on Schedule I line-item or organization webpage)—were developed to classify funding activities.Table ITotal grants given by dermatology nonprofits∗Organizations include Dermatology Foundation, American Academy of Dermatology, American Skin Association, AIM at Melanoma, American Society for Dermatologic Surgery, Melanoma Research Foundation, Melanoma Research Alliance, American Society of Dermatopathology, Women's Dermatologic Society, National Psoriasis Foundation, National Eczema Association, and National Alopecia Areata Foundation. (US dollars)20152016201720182019MeanResearch12,897,93639,826,36522,564,42631,937,56222,291,50626,335,844Education1,205,9291,311,8111,300,7521,224,0571,326,4211,403,419Public health/advocacy209,543200,364245,824492,317298,122292,034Other130,95097,21997,516127,825138,552133,134Total14,444,35841,435,75924,208,51833,781,76124,054,60127,584,999∗ Organizations include Dermatology Foundation, American Academy of Dermatology, American Skin Association, AIM at Melanoma, American Society for Dermatologic Surgery, Melanoma Research Foundation, Melanoma Research Alliance, American Society of Dermatopathology, Women's Dermatologic Society, National Psoriasis Foundation, National Eczema Association, and National Alopecia Areata Foundation. Open table in a new tab From 2015 to 2019, average annual overall funding was nearly $27.6 million, and total funding increased by 66.5% over this period (Table I). Research received 93.9% of overall funding, whereas education, public health/advocacy, and other received 4.6%, 1.0%, and 0.4%, respectively. Funding increases were seen broadly; over the entire period, the largest percent increase was seen in research ($9.4 million, 72.8% increase), followed by public health/advocacy ($88.6K, 42.3%), education ($120.5K, 10.0%), and other ($7.6K, 5.8%). Although many disease-focused organizations contributed exclusively to research, professional societies such as the American Academy of Dermatology (AAD) tended to donate across categories (Fig 1). Research funds were provided primarily to individuals, institutions, or, less frequently, industry. Education funds largely comprised fellowships, resident grants, and support for meetings, courses, and mentorship. Public health/advocacy grants were mainly directed to sun protection initiatives. In context, from 2015 to 2019, the US National Institutes of Health awarded $554.2 million in dermatology-related funding,2Price K.N. Collier E.K. Atluri S. Hsiao J.L. Shi V.Y. National Institutes of Health dermatology funding trends 2015-2019.J Invest Dermatol. 2021; 141: 232-235Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar and the identified nonprofits awarded $137.9 million. A central question is the impact of this funding, which is not always straightforward to measure. A Dermatology Foundation study analyzing impact of Career Development Awards they provided to researchers found that each Career Development Award dollar through 2015 was linked to over $10 of subsequently garnered federal grant support ($12 through 2017).3Boris C. Cotsarelis G. Fairley J.A. Wintroub B.U. Yancey K.B. A cross-sectional survey and analysis of Dermatology Foundation Career Development Award recipients.J Am Acad Dermatol. 2019; 81: 1093-1098Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar These data suggest that nonprofit-funded research efforts can have outsized multiplicative impacts. Demonstrating the impact of public health/advocacy funding, the AAD reports 505 sun-shaded structures constructed and 4 million people shaded across public schools and nonprofits since program inception.4Support AAD: American Academy of Dermatology Association.https://www.aad.org/support-aadDate accessed: April 17, 2023Google Scholar From 2015 to 2019, the AAD provided an average of 781 resident grants annually (mainly supporting AAD meeting attendance), exceeding the 527 residency positions in 2020,5Thatiparthi A. Martin A. Liu J. Wu J.J. Preliminary outcomes of 2020-2021 dermatology residency application cycle and adverse effects of COVID-19.J Am Acad Dermatol. 2021; 84: e263-e264Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar suggesting broad support for the advancement/future of the specialty. Similar quantitative studies, impact tracking, and needs assessments may be important to promote further giving in areas of maximal impact/demand on the part of donors in a virtuous cycle positively impacting research, education, and the public. Due to 990 form processing delays (COVID-19–related and otherwise), data herein did not extend beyond 2019. Therefore, COVID-19 impacts and subsequent financial system challenges on donations/grant funding by these entities remain to be seen. Although the data presented address the scope and distribution of nonprofit funding for dermatology in the United States (and of course scientific discoveries advance the field globally), they illustrate the role that such organizations can play in augmenting traditional government funding, and we hope that our work stimulates colleagues in other countries to perform and publish similar analyses. Data related to this article can be found at https://www.guidestar.org hosted by Candid, https://www.irs.gov/charities-non-profits/tax-exempt-organization-search hosted by the United States government, and https://projects.propublica.org/nonprofits/ hosted by ProPublica, Inc. Author Agarwal has no conflicts of interest to declare. Dr Orlow serves on the boards of Almirall Srl and R2 Technologies, Inc, as a senior adviser to Pharus Advisors, and has served on the Board of Trustees of the Dermatology Foundation from 2009 to 2020.

View Large Image Figure ViewerDownload Hi-res image Download (PPT) Across >$9 billion invested in dermatology companies from 2002-2021, annual deal counts, total investment value, and the range of deal sizes have increased, while average investment size and post-investment company valuations decreased; funding was largely directed to pharmaceuticals/biotechnology, though historical maximum funding amounts for clinics/outpatient services, health information technology, and medical devices were achieved in 2021. Across >$9 billion invested in dermatology companies from 2002-2021, annual deal counts, total investment value, and the range of deal sizes have increased, while average investment size and post-investment company valuations decreased; funding was largely directed to pharmaceuticals/biotechnology, though historical maximum funding amounts for clinics/outpatient services, health information technology, and medical devices were achieved in 2021. Venture capital (VC) financing plays a central role in bringing novel technologies, therapeutics, and processes into clinical practice (Cwalina et al., 2022Cwalina T.B. Jella T.K. Acuña A.J. Samuel L.T. Kamath A.F. Venture capital investment in orthopaedics: has the landscape changed over the past two decades (2000–2019)?.Surg Innov. 2022; 29: 103-110Crossref PubMed Scopus (2) Google Scholar; Rathi et al., 2019Rathi V.K. Murr A.H. Feng A.L. Tauscher J.L. Naunheim M.R. Kozin E.D. et al.Analysis of venture capital investment in therapeutic otolaryngologic devices, 2008–2017.JAMA Otolaryngol Head Neck Surg. 2019; 145: 387-389Crossref PubMed Scopus (2) Google Scholar). The role of VC in medicine has been expanding; a notable example is the digital health segment, where the growth rate of the total invested amount was over five times higher than that of all other fields from 2010 to 2017 and over 25 times higher than the growth rate of overall healthcare spending during the same period (Gondi and Song, 2019Gondi S. Song Z. The burgeoning role of venture capital in health care. Health Affairs.https://www.healthaffairs.org/do/10.1377/forefront.20181218.956406/Date: January 2, 2019Date accessed: July 30, 2022Google Scholar). In the field of dermatology, traditional private equity buyouts of physician practice groups have increasingly received attention (Tan et al., 2019Tan S. Seiger K. Renehan P. Mostaghimi A. Trends in private equity acquisition of dermatology practices in the United States.JAMA Dermatol. 2019; 155: 1013-1021Crossref PubMed Scopus (60) Google Scholar). VC investing, by contrast, is conventionally associated with acquiring a stake in a private business at an earlier stage often long before a company has any commercial products or revenues, with the intent of selecting and helping to grow businesses with the highest expected promise for an outsized return on invested capital (Lehoux et al., 2016Lehoux P. Miller F.A. Daudelin G. How does venture capital operate in medical innovation?.BMJ Innov. 2016; 2: 111-117Crossref PubMed Scopus (15) Google Scholar). Innovation in dermatology is broad, ranging from precision biopharmaceuticals to mobile and even behavioral health (Bezalel and Otley, 2019Bezalel S.A. Otley C.C. Invention in dermatology: a review.J Drugs Dermatol. 2019; 18: 904-908PubMed Google Scholar). Effective development and clinical translation from early-stage ventures would be expected to require significant capital (Cwalina et al., 2022Cwalina T.B. Jella T.K. Acuña A.J. Samuel L.T. Kamath A.F. Venture capital investment in orthopaedics: has the landscape changed over the past two decades (2000–2019)?.Surg Innov. 2022; 29: 103-110Crossref PubMed Scopus (2) Google Scholar). A recent analysis indicated that both VC deals and total funding have grown since 2011 in the broader skin-related sphere, which in one published analysis included skin-related consumer products that make up an outsized percentage of such funding (Venkatesh and Nambudiri, 2022Venkatesh K. Nambudiri V. Characterization of venture capital investments in dermatology: a cross-sectional analysis, 2011 to 2021.J Am Acad Dermatol. 2022; ([e-pub ahead of print])https://doi.org/10.1016/j.jaad.2022.06.1177Date accessed: July 10, 2022Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar). However, given the implications of VC-driven commercialization for patient care and healthcare markets (Cwalina et al., 2022Cwalina T.B. Jella T.K. Acuña A.J. Samuel L.T. Kamath A.F. Venture capital investment in orthopaedics: has the landscape changed over the past two decades (2000–2019)?.Surg Innov. 2022; 29: 103-110Crossref PubMed Scopus (2) Google Scholar), it is important for stakeholders, including researchers, providers, and payers, to understand the evolving impacts of VC in areas of dermatology that involve the diagnosis and management of diseases. In this study, using a private capital markets information database, we characterize significant trends in dermatology VC financing activity worldwide over a 20-year period from 2002 to 2021. In total, there were 873 VC deals involving dermatology-focused companies from 2002 to 2021, totaling $9.1 billion of investment (Figure 1a). Inflation over this same period totaled 50.6%. Of these deals, 641 (73.4%) were in pharma/biotech, 49 (5.6%) were in clinic/outpatient services, 65 (7.5%) were in health information technology (IT), and 118 (13.5%) were in medical devices. Annual deal count (mean = 43.7, range = 12‒72) increased at an average rate of 11.5% or 2.89 deals per year, with the greatest annual increases of 46.7% (seven deals) and 46.2% (12 deals) seen in 2006 and 2010, respectively (Figure 1a). Deal count has remained on a primarily upward trajectory, although 2014, 2017, and 2020 exhibited the largest drops in the most recent decade of 11 (17.7%), 11 (15.7%), and 4 deals (5.7%), respectively (Figure 1a). The change in deal count in 2021 represented the smallest recorded positive growth at one deal (1.5%) and a total of 67 deals, not recovering to the levels seen in 2018‒2019, before the COVID-19 pandemic (average of 71 deals) (Figure 1a). Total annual invested capital (mean = $452.8 million, range = $124.3–$995.6 million) has been on an upward trend of $23.4 million (14.5%) annual growth, although this displays cyclicality, with the 2002‒2011 annual average being $296.4 million and that of 2012‒2021 being $609.2 million (Figure 1a). Although there was less volatility in the 2000s, in the most recent decade, 2018 and 2019 were marked by increases in total annual investment of $306.1 million (69.5%) and $248.8 million (33.3%), respectively, whereas 2020―the year in which the global COVID-19 pandemic began in earnest―showed the greatest decrease, $413.4 million (41.5%); recovery in the following year was only $102.3 million (17.6%) (Figure 1a). The average overall deal size (mean = $10.4 million, range = $10,000–$299.2 million) was highly cyclical for each segment. The average annual change in deal size decreased by $1.2 million in the first decade and increased by $140,000 in the second decade, resulting in an average annual decline of $520,000 over the entire period (Figure 2a). The average deal size was $12.1 million for pharma/biotech, $4.7 million for clinic/outpatient services, $5.5 million for health IT, and $6.0 million for medical devices. Pharma/biotech and medical devices had associated VC activity since 2002, whereas health IT contributions began in 2010, and clinic/outpatient investments emerged in 2011 (Figure 2a). The total investment amount in all segments also showed cyclicality. From 2002 to 2011, the average total annual investment in dermatology-related pharma/biotech was $267.3 million and was $508.5 million from 2012 to 2021, although a decrease of $360.2 million (41.8%) in total pharma/biotech funding was seen in 2020 (Figure 2b). Funding in this category was at its lowest in 2003 ($124.0 million) but peaked in 2019 ($861.8 million) (Figure 2b). Average annual total funding for clinic/outpatient services, health IT, and medical devices was $5.6 million, $6.9 million, and $27.1 million, respectively, in the first decade and $22.3 million, $34.2 million, and $44.1 million, respectively, in the subsequent period (Figure 2b). All sectors experienced drops of at least 22% in 2020 but rebounded to historical maxima in 2021 at $48.0 million, $103.3 million, and $110.5 million, respectively, and since their corresponding VC activity inception years, they have grown by $42.4 million (758%), $96.01 million (132%), and $79.0 million (251%), respectively (Figure 2b). Overall minimum deal size decreased from $750,000 to $30,000 during 2002‒2011 and further to $10,000 in 2021, whereas the maximum deal size was relatively stable during the first decade at an average of $49.4 million, although it reached its height at $299.2 million in 2019 (Figure 1b). Of the 873 total deals, 360 had disclosed premoney and postmoney valuations. During the first decade, premoney and postmoney valuations averaged $48.6 million and $65.9 million, respectively, and $43.0 million and $54.50 million in the second period, respectively (Figure 1c). The difference between average premoney and postmoney valuations during 2012‒2021 was $5.3 million less than that during 2002‒2011 (Figure 1c). Of all dermatology companies in which a VC investment was made, 188 (57%) were headquartered in the Americas, 93 (28.2%) were headquartered in Europe, 43 (13%) were headquartered in Asia, and 6 (1.8%) were headquartered in Oceania. VC investment can be a useful representation of the direction of innovation within a specific field (Ackerly et al., 2009Ackerly D.C. Valverde A.M. Diener L.W. Dossary K.L. Schulman K.A. Fueling innovation in medical devices (and beyond): venture capital in health care.Health Aff (Millwood). 2009; 28: w68-w75PubMed Google Scholar), and monitoring trends can help stakeholders to better understand the broader environment of VC-driven impacts. Venture funding has been characterized as three times more effective than traditional research and development spending in developing intellectual property (Ackerly et al., 2009Ackerly D.C. Valverde A.M. Diener L.W. Dossary K.L. Schulman K.A. Fueling innovation in medical devices (and beyond): venture capital in health care.Health Aff (Millwood). 2009; 28: w68-w75PubMed Google Scholar). Although inherently a form of private equity, VC differs from traditional private equity by its focus on early stages companies, often development stage and before commercial, where there is a high risk from a large startup failure rate (53%) and extended illiquidity (Ackerly et al., 2009Ackerly D.C. Valverde A.M. Diener L.W. Dossary K.L. Schulman K.A. Fueling innovation in medical devices (and beyond): venture capital in health care.Health Aff (Millwood). 2009; 28: w68-w75PubMed Google Scholar), making significant commercialization and business growth necessary for investors to receive a favorable return on investment. As a result of the broad-scale appeal and dissemination required for the business growth needed to qualify a successful investment, VC has been previously described as a positive force for advancement in medical fields (Shah and Berry, 2020Shah R.N. Berry O.O. The rise of venture capital investing in mental health.JAMA Psychiatry. 2020; 78: 351-352Crossref Scopus (15) Google Scholar). Recent analyses have shown VC activity to be increasing across many different medical specialties. From 2000 to 2019, orthopedics VC deal numbers have grown at a rate of 9.53%, and total investment value has grown by nearly 5% (Cwalina et al., 2022Cwalina T.B. Jella T.K. Acuña A.J. Samuel L.T. Kamath A.F. Venture capital investment in orthopaedics: has the landscape changed over the past two decades (2000–2019)?.Surg Innov. 2022; 29: 103-110Crossref PubMed Scopus (2) Google Scholar). In plastic surgery, from 2011 to 2018, total annual VC funding rose by over 600% to over $350 million at the end of the period (Khetpal et al., 2022Khetpal S. Pourtaheri N. Lopez J. Alperovich M. Venture capital investments in plastic surgery: an 8-year analysis.Plast Reconstr Surg. 2022; 149: 179e-180eCrossref PubMed Scopus (1) Google Scholar). Ophthalmologic VC funding increased by over 90% overall from 2011 to 2020, reaching $680 million in 2020 (Gupta et al., 2022Gupta S. Uppal N. Chang E.K. Fetter T. Hunter D.G. Trends in venture capital investments in ophthalmology companies (2011–2021).Ophthalmology. 2022; 129: 353-354Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar). Our analysis reveals that investment growth in many other specialties is outpaced by that in dermatology, where the overall deal count has increased by over 11% annually, funding amount has increased by nearly 15% annually, and the respective annual invested capital has attained larger total amounts than those of the ending years of all specialty-specific analyses mentioned earlier. Within dermatology, the vast majority of VC deals since 2002 were in pharma/biotech and medical devices, although clinic/outpatient services and health IT began receiving attention around the end of the first decade, indicating that although the primary emphasis is on therapeutic development, more implementations of technology and novel care delivery/evolved patient experiences may characterize the future of dermatologic practice. The largest deals with implications in care delivery involve vertically integrated dermatology telehealth services with direct prescription delivery, on-demand digitized pathology services, and technologically driven customized treatment planning coupled with rapid-service dermatology office locations, among others in related domains. Our analysis shows that deal count almost consistently increased during every year in the evaluated period, although to a larger degree from 2002 to 2011, before recently stabilizing around the high-60s annually during 2017‒2021. The increased number of investments in clinically relevant ventures by VC firms suggests both the expansion of dermatologic innovation in areas of relevance to patient care and increasing confidence in the specialty at large. This may also underscore an expected greater demand for dermatologic services in the near future, consistent with skin disease's role as a top five leading cause of nonfatal disease and the associated threat to QOL and mental health (Seth et al., 2017Seth D. Cheldize K. Brown D. Freeman E.F. Global burden of skin disease: inequities and innovations.Curr Dermatol Rep. 2017; 6: 204-210Crossref PubMed Scopus (154) Google Scholar). Although there were notable decreases in deal making in 2014 and 2017, subsequent years consistently marked complete recovery, showing the general resilience of dermatology VC investment over the longer term. Importantly, deal count decreased in 2020 as well; although lower in magnitude and proportion, it did not recover in 2021 to previous levels, likely attributable in part to continued public health and economic impacts of the COVID-19 pandemic and shifts in investment priorities. In parallel with the increase in deal count, overall total annual investment has increased as well since 2002, with slumps in the mid-2010s and 2020, consistent with the shift in VC's focus to invest over 40% more in pandemic-related areas (Bellucci et al., 2022Bellucci A. Borisov A. Gucciardi G. Zazzaro A. The reallocation effects of COVID-19: evidence from venture capital investments around the world.J Bank Financ. 2022; : 106443Crossref PubMed Scopus (5) Google Scholar). In the context of growing annual funding and deal counts, it is important to note that minimum deal size has decreased by over 98% since 2002 and that average deal size has increased in all segments except pharma/biotech. The observed increase in average deal size for three of four segments is in agreement with broader VC trends, where there is a growing preference for larger later-stage investments (Colecchi and Tancredi, 2016Colecchi C. Tancredi D. Broadview ventures: investing in the future of cardiovascular technology.JACC Basic Transl Sci. 2016; 1: 87-93Crossref PubMed Scopus (3) Google Scholar). Conversely, in pharma/biotech, the trend of smaller average deal size is more suggestive of an increasing focus on early-stage investments and greater portfolio diversification for investors (more deals at fewer dollars per deal). Although in contrast to other segments, this finding may reflect an increase in open innovation, where multinational pharmaceutical corporations are engaging in more investments into and acquisitions of smaller pharmaceutical ventures to mitigate the risks of failure and to more efficiently fill their own pipelines (Schuhmacher et al., 2016Schuhmacher A. Gassmann O. Hinder M. Changing R&D models in research-based pharmaceutical companies.J Transl Med. 2016; 14: 105Crossref PubMed Scopus (210) Google Scholar). An openness to acquiring external innovation by big pharma and big biotech can render smaller, broader investments in boutique pharma/biotech a potentially appealing approach for VC firms. In addition, given pharma/biotech's overwhelming proportion of total deals and funding, the lower premoney and postmoney valuations during 2012‒2021 lend further support to increasingly smaller and earlier-stage deals in this segment in more recent years. Despite the deal size, total annual investments in pharma/biotech, although cyclical, have generally trended upward since 2002, far outpacing any other segment in magnitude of funding increase, suggesting that the dermatology market may be able to expect the continued emergence of improved novel therapeutics in future years. Consistent with generalized deal count decreases, large declines in pharma/biotech funding were seen in 2020 and 2021 (ending at over 30% lower than the 2019 historic maximum), although at a decreasing rate and still greater than the funding amount at any point in the previous decade, lending possible preliminary support to a potential rebound in the coming years. By contrast, all of the clinics/outpatient services, health IT, and medical devices segments showed all-time highs in total funding in 2021. This may be consistent with documented post‒COVID-19 trends in dermatology toward hybrid and technology-supported care delivery models (Kassamali et al., 2021Kassamali B. Tan A. Franciosi E. Rashighi M. LaChance A. Teledermatology before, during, and after Covid-19: a vital tool to improve access and equity in specialty care.J Cell Immunol. 2021; 3: 61-67Google Scholar) as well as a general digitalization within the specialty (Mehta-Ambalal and Nisarta, 2021Mehta-Ambalal S.R. Nisarta M. Dermatology 2.0- how the Internet is changing us, our patients and our practice.Indian Dermatol Online J. 2021; 12: 593-596Crossref PubMed Scopus (2) Google Scholar). Of the investee companies analyzed, most clinics/outpatient services and health IT companies were involved in the provision of hybrid and on-demand care, whereas medical device companies were largely involved in more rapid/accurate clinical diagnostics and in-practice aesthetic procedures. Finally, the overwhelming presence of VC-backed clinically relevant dermatologic companies in the western world may reflect an unmet need among lower-income demographics elsewhere and potentially highlight an area where strategic policymaking is needed to stimulate greater innovation and funding to support global health equity. VC financing of dermatologic innovation has increased since the early 2000s. Although nearly three quarters of VC activity and an even higher proportion of total funding are concentrated in the pharmaceuticals and biotechnology sector, there has been a growing interest in clinics and outpatient services, health information technology, and medical devices in recent years and particularly in 2021 after the initial period of the COVID-19 pandemic. In addition to the development of new therapeutics, the noted acceleration in other segments suggests a shift toward more patient-centric care delivery models in technologically integrated, personalized formats. The direct impacts of privately commercialized innovation in the clinical dermatology environment have not been well-characterized in the literature, so the impacts on specific stakeholders are not completely understood. Given the significant volume of capital injected into dermatology companies, future studies are needed to investigate the effects of VC activity and funding trends on areas, including patient outcomes, the value of care, and patient‒provider dynamics. Our study has a number of limitations: the funding amounts reported may be underestimated owing to the exclusion of transactions with an undisclosed investment size. This uncharacterized funding activity may impart additional variability to various aspects; although given the large sample size of 873 deals, it is likely that the observed trends are sufficiently robust. There is also the possibility of deals that are absent from the Pitchbook (Pitchbook, 2022PitchbookThe insights you need to pull ahead.http://www.pitchbook.comDate: 2022Date accessed: July 8, 2022Google Scholar) platform; however, it is broadly trusted in the private capital markets industry and has been utilized in a number of previous academic analyses, many of which have been referenced in this study. Owing to its legally protected nature, the original dataset cannot be made openly available. Further information about data terms of use and access is available at https://pitchbook.com/terms-of-use. The authors state no conflict of interest. SJO serves on the boards of Almirall Srl and R2 Technologies and as a senior advisor to Pharus Advisors. Conceptualization: AA, SJO; Data Curation: AA, SJO; Formal Analysis: AA, SJO; Writing – Original Draft Preparation: AA, SJO; Writing – Review and Editing: AA, SJO Investment and company information for venture capital (VC)-backed enterprises was sourced from Pitchbook Data (Pitchbook, Seattle, WA), a database covering private capital markets. We conducted a cross-sectional analysis of VC investments from January 1, 2002 through December 31, 2021 using keywords related to dermatologic care as well as 14 skin disease‒related terms (acne, alopecia, basal cell carcinoma, bullous, dermatitis, eczema, hives, mycosis, nail fungus, psoriasis, squamous cell carcinoma, tinea, urticaria, and vitiligo), which expanded the search to capture a broad group of relevant companies and transactions. Each of 555 captured companies in which a VC investment was made was individually screened for clinical relevance to dermatology; in particular, only companies developing a dermatologically related pipeline drug/biotechnology, creating dermatologic medical-grade devices, providing health information technology (IT) services with at least some patient and dermatologist interfacing element, and provisioning care within the clinical dermatology outpatient setting were included. Companies targeting medical care broadly, including generalized health IT, nonspecific devices, and heterogeneous clinical specialties, were excluded from this analysis. We also excluded companies exclusively involved with consumer nondurables or consumer-only technologies, largely comprising personal care products. Pharmaceuticals and biotechnology companies were included as long as there was at least one explicit dermatologic indication under development. Although it is an active area of venture investment, our search did not include companies focused on treatments for melanoma or other advanced cancers that would not generally be managed by a dermatologist. A total of 330 relevant companies were identified. Deals for these companies included those of any stage round of VC funding. Data were analyzed to determine trends in investment amount, deal flow, and segments of high interest, along with the activities and characteristics of VC-backed firms operating in the dermatology space. Four primary segments, pharma/biotech, clinics/outpatient services, health IT, and medical devices, were identified and analyzed. On the basis of company industry codes/keywords and description per the company website, if available, each company was assigned to the corresponding segment. Pharma/biotech included the following industry codes/keywords: biotechnology, drug delivery, drug discovery, pharmaceuticals, laboratory services (healthcare), other pharmaceuticals and biotechnology, and discovery tools (healthcare). Clinics/outpatient services included the eponymous industry code/keyword and other services, and health IT consisted of application software, communication software, decision/risk analysis, media and information services (business-to-business), medical records systems, other healthcare technology systems, other healthcare/commercial services, telemedicine, and practice management. Medical devices comprised diagnostic equipment, monitoring equipment, other devices and supplies, surgical devices, laser equipment, and therapeutic devices. Consistent with previous analyses in other specialties, deals with undisclosed financing amounts were excluded (Rathi et al., 2019Rathi V.K. Murr A.H. Feng A.L. Tauscher J.L. Naunheim M.R. Kozin E.D. et al.Analysis of venture capital investment in therapeutic otolaryngologic devices, 2008–2017.JAMA Otolaryngol Head Neck Surg. 2019; 145: 387-389Crossref PubMed Scopus (2) Google Scholar).

A male neonate, born at corrected gestational age of 25 weeks and 4 days by spontaneous vaginal delivery to a 25yearold gravida 2 para 1 woman with preterm labor, was admitted to the neonatal intensive care unit with respiratory distress syndrome requiring mechanical ventilation. His course was complicated by hyperglycemia, hypernatremia, spontaneous bowel perforation requiring Penrose drain placement, and hemodynamic instability requiring dopamine inotropic support. The pediatric dermatology service was consulted 7 days after birth for necrotic yellow to brown eschars which had developed over the course of 2 days on the left thigh and subsequently on the buttocks and back (Figures 1 and 2), from which initial superficial swabs had not yielded growth of any organism. Punch biopsies were performed for histology (Figure 3), including staining with periodic acid Schiff with diastase (PASD, Figure 4), and culture.