In women, migraine is associated with stroke, coronary artery disease, deep venous thrombosis, as well as livedo reticularis, a dermatopathy which has been pathologically linked to cerebral vasculopathy. Whether migraineurs with livedo reticularis compose a subset at higher risk of thrombosis, including stroke, deserves further investigation.

Squamous cell carcinoma (SCC) is the second most common skin cancer worldwide, and exposure to ultraviolet (UV) light is a major cause of SCC. UV nail lamps can be used for drying and hardening acrylic or gel nail polish. We report a case of a 52-year-old Caucasian woman with an 18-year history of UV nail lamp use every 3 weeks and an 18-year history of weekly tanning bed use who presented with over 25 actinic keratoses and two SCC in situ on her dorsal hands. Of note, this patient has never had any previous biopsies, skin cancer or precancers, or skin cancer or precancer treatment at any time in the past and on skin examination had no precancers or cancers elsewhere on her body. We also review the existing research regarding nail lamp use, which overall suggests that the risk of carcinogenesis is low, and discuss ways dermatologists can educate patients regarding proper UV nail lamp use to minimize risks. This patient's extensive UV nail lamp use coupled with UVA exposure from tanning beds may have put her at particular risk and exacerbated the effects of the nail lamp alone.

Vitiligo is a common pigment disorder characterized by acquired loss of function or absence of melanocytes, leading to distinct areas of depigmentation. Physical exam reveals sharply demarcated, depigmented macules or patches on otherwise normal skin. Vitiligo can present at any age, in any skin color. There is no specific serologic marker for diagnosis, but patients often have other autoimmune problems. Treatment options are limited and are difficult given the fact that the pathogenesis of the disease is not well elucidated. We present the case of a 52-year-old woman with vitiligo for over 2 decades. The patient's medical history reveals a lack of response to many different approaches. This case highlights the ability of apremilast, an FDA-approved drug for the treatment of psoriasis and psoriatic arthritis, to achieve repigmentation in a case a vitiligo that has been extremely recalcitrant.

Acne is a chronic inflammatory disease of the pilosebaceous units. Traditional etiologic factors include increased sebum production, ductal hyperkeratosis, abnormality of the microbial flora within the pilosebaceous unit, and mediators of inflammation. Recent developments do not refute these familial elements, but rather refine particular aspects. Interleukin-1a influences hypercornification of the infundibulum as well as the inflammatory response by inducing the production of vascular endothelial growth factor in dermal papilla cells and follicular keratinocytes of the pilosebaceous unit. New retinoids have been developed based on controlling cellular proliferation and differentiation in the pilosebaceous unit by their action on nuclear receptors of cells. Dermal inflammation is not due to presence of bacteria, but from biologically active mediators produced by Propionibacterium acnes. The environment within the pilosebaceous unit is probably more important than the absolute number of P. acnes organisms. Indeed, the major role of the sebaceous gland appears to be supplying P. acnes needed nutrients. Moreover, the microbiologic principle of biofilms appears to be applicable to P. acnes in acne.

Background: Shadow cells are characteristic of pilomatricoma, a distinct neoplasm of hair matrix differentiation. Shadow cells within an otherwise classic basal cell carcinoma (BCC) has been referred to as “BCC with matrical differentiation”. We present a case of BCC with matrical differentiation in a transplant patient. To our knowledge, none have been reported arising on the background of immunosuppression. Methods: A 58‐year‐old male cardiac transplant patient had a left hand nodule, which was excised and submitted for routine histologic review. Results: The lesion revealed multiple basaloid tumor masses. In some areas, there was peripheral palisading with stromal retraction artifact, typical of basal cell carcinoma, extending into the deep reticular dermis. The tumor also contained a population of shadow cells, similar to those in pilomatricoma, with basaloid cells in the periphery. Trichohyaline granules were identified in many of the tumor cells. These granules are a hallmark of follicular matrix differentiation. Mitoses were rare. There was no evidence of an infiltrating growth pattern. Conclusion: Basal cell carcinoma with matrical differentiation is a rare subtype of basal cell carcinoma featuring shadow cells, such as those typically seen in pilomatricoma. This tumor has not yet been reported in an immunosuppressed transplant patient.