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The author discusses methods of developing alternative therapies when standard treatments have proved ineffective or do not exist. Specific treatments for a wide range of stubborn or difficult dermatologic conditions are presented.

This article is a tribute to clinician Henry M. Lewis. The author shares practical therapeutic pearls developed and used over the years by Dr. Lewis.

After four months of use, a 13-year-old girl with acne developed allergic contact urticaria to 5 percent topical benzoyl peroxide. This was confirmed by closed patch tests. It is suggested that concomitant use of an abrasive scrub cleanser may have damaged the stratum corneum and initiated or enhanced sensitization.

A 30-year-old woman with aquagenic urticaria developed hives every time she came in contact with a water source such as tap water, snow or sweat. The patient's condition was satisfactorily controlled with cyproheptadine hydrochloride. I believe the triggering event in these attacks may have been an osmotic stimulus.

A patient with a solitary keratoacanthoma of the glans penis is presented. Since this area is devoid of hair, this keratoacanthoma could not have arisen from a hair follicle as has been suggested as the cause of keratoacanthoma. Keratoacanthoma should be included in the differential diagnosis of rapidly growing keratotic tumors of the glans penis. Correct diagnosis of this tumor may save patients from needless mutilating surgery of the penis.