Lichen spinulosus (LS) is an uncommon skin condition mostly in children and adolescents but uncommon in adults. It presents as a group of hypopigmented or skin-colored follicular papules and keratotic spines with a sandpaper-like appearance. There is a lymphohistiocytic infiltrate in the dermis centered around hair follicles. We present a rare case of LS in a 52-yearold woman with a rough, bumpy, itchy rash affecting the trunk and extremities. Her rash consisted of clusters of hyperkeratotic follicular-based spiny papules. Histologic sections demonstrated several dilated hair follicles filled with keratotic plugs surrounded by a dense perifollicular lymphohistiocytic infiltrate, particularly at the level of the infundibula, that extended into the follicular epithelium.

Paget's disease of the breast (PDB) is a rare disorder of the nipple–areola complex that may present clinically as a unilateral, eczematous, or ulcerated papule or plaque. This case highlights the importance of either punch or incisional wedge biopsy to establish a diagnosis of PDB for patients who present with chronic cutaneous changes of the nipple, areola, or skin of the breast, regardless of any previous normal mammogram or breast ultrasound. Mammography alone cannot rule out a diagnosis of PDB in a patient with cutaneous changes of the breast.

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Vitiligo is a common condition. This article provides a comprehensive overview of vitiligo including the clinical presentation, associated comorbid conditions, treatment, emerging therapies, and psychosocial and cultural considerations.

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