n today's complex economic and health care environment, the interactions between physicians, hospitals, and health care manufacturing companies are under increased scrutiny. Under the Patient Protection and Affordable Care Act, the Physician Payments Sunshine Act requires manufacturers and group-purchasing organizations that make products reimbursed by a government-run health program to report on all payments and other transfers of value to physicians in categories, such as consulting, speaking fees, food, travel, and research. 1 Specifically, amounts greater than $10 or aggregates of payment greater than $100 during a calendar year are mandatory reports. 1 Industry-physician interaction is common in all medical specialties, and dermatology is no exception. [2][3][4] While the types of interaction between dermatologists and industry have been described, 2,4 there is very little literature on the amount and geographic distribution of financial distributions by industry to dermatologists. To better understand the qualitative and quantitative characteristics of physician payments from industry sources, we probed the Centers for Medicare and Medicaid Services (CMS) Sunshine Act Open Payments database, the largest public nationwide database detailing financial relationships of industry and physicians and the first of its kind.The purpose of this study was to characterize the extent and nature of industry payments to dermatologists for 2014, the first year that a full 12 months of financial data have been released. Specifically, we examined the number, amount, and IMPORTANCE Significant ties exist between clinicians and industry. Little is known about the characteristics of industry payments to dermatologists.OBJECTIVE To analyze the nature and extent of industry payments to dermatologists. DESIGN, SETTING, AND PARTICIPANTSThis was a retrospective review using the publicly available Centers for Medicare and Medicaid Services (CMS) Sunshine Act Open Payment database. Data were downloaded from the publically available CMS website under General Payment and Research Payment data sets. All payments to dermatologists from companies making products reimbursed by a government-run health program were reviewed.MAIN OUTCOMES AND MEASURES Mean, median, and range of payments made, including quantity and total sum of payments, per clinician. Total payments and number of transactions per category of payment, geographic region, and payment source were also assessed.

We use the results of this study to recommend best practices for photography in dermatology.

Dermatologists value medical photography. While patterns of image acquisition, storage and consent are noted, a variety of methods and preferences exist. Clearer photography guidelines and increased educational resources are likely to improve image quality, exchangeability and confidentiality.

IMPORTANCE Alopecia universalis is an uncommon form of alopecia areata (AA) involving hair loss over the entire scalp and body and is often difficult to treat. Tumor necrosis factor (TNF)inhibitors have been largely unsuccessful in treating AA and have been reported to induce or worsen AA in patients.We report herein a case of alopecia universalis successfully treated with adalimumab and discuss the possible mechanism.OBSERVATIONS A woman in her 30s with alopecia universalis, refractory to multiple treatment modalities, was successfully treated with adalimumab.CONCLUSIONS AND RELEVANCE Tumor necrosis factor has multiple important roles in the pathogenesis of AA, and its interplay with other cytokines, specifically interferons, may be responsible for the development of AA in patients treated with TNF inhibitors.Pharmacogenetics and the inherent physiologic levels of TNF may explain why TNF inhibitors cause AA in some individuals, while treating AA in others. These conclusions warrant further investigation on this subject.