Stress has multiple and wide-ranging physiologic and clinical impacts on skin disease. This has led to an interest in mind body therapies as potential adjunct treatments for skin disease. The stress response results in the activation of the endocrine, neurologic, and immune systems, with a resulting cascade of impacts, that are both systemic and cutaneous. The 2 main arms of the stress response are the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. The resultant release of cortisol, catecholamines, and neuropeptides has multiple effects. Clinically, these have been shown to increase skin inflammation, increase itching, impair skin barrier function, impair wound healing, and suppress immunity.Mind body therapies are those that focus on the interaction between the mind and the body, with the goal to influence physical function and impact health. These have been shown to ameliorate some of the harmful physiologic changes attributed to stress or to reduce harmful behaviors. In some cases, such as with biofeedback, they may also result in beneficial physiologic changes. Treatments such as meditation, biofeedback, hypnosis, guided imagery, and others have been evaluated in the treatment of skin disease and have shown some benefits. Although randomized controlled trials are limited, these interventions have shown beneficial effects on itching, psychosocial outcomes, and even skin severity. These interventions have been evaluated in diseases such as atopic dermatitis, psoriasis, trichotillomania, and others. Given the potential benefits, improvements in psychosocial outcomes, and a low risk profile, referral to qualified practitioners or multidisciplinary clinics should be considered for some patients.

Eccrine poromas are benign tumors that arise from the eccrine sweat ducts, commonly presenting as solitary lesions. Eccrine poromatosis, the sudden eruption of multiple eccrine poromas, is a rare phenomenon that generally occurs in immunosuppressed patients at any time after receiving treatment for malignancy.  We report a case of eccrine poromatosis in a 79-year-old male patient with a previous history of recurrent T-cell lymphoma. Over the course of his disease, he was treated with polychemotherapy, radiation, and a definitive bone marrow transplant. The patient presented to the dermatology clinic 18 years after his initial diagnosis with a new onset of pruritic papules on the neck and chest. Histologic evaluation revealed all lesions to be eccrine poromas. This is the longest reported time interval between initial diagnosis of a primary malignancy and development of eccrine poromatosis. There is no evidence at this time to suggest that appearance of such lesions is indicative of cancer recurrence; therefore, there is no indication for further oncologic evaluation.

In patients with favorable wound healing profiles and surgical defects in well-perfused locations, second intention wound healing often leads to excellent cosmetic results after Mohs micrographic surgery. Second intention healing can be modified and accelerated with the use of acellular wound matrices, serving as a foundation to facilitate re-epithelialization and formation of granulation tissue. We present two patient cases demonstrating successful wound resolution of large, craniofacial surgical defects using second intention healing aided by acellular wound matrices.