Necrotizing infundibular crystalline folliculitis (NICF) is a rare superficial folliculitis characterized by expansive deposits of birefringent crystallized lipid. We report a case of NICF in a transplant patient presenting with folliculocentric acneiform papules across the lateral face and neck. Biopsy demonstrated intrafollicular crystalline deposits within an intact epidermis. Diagnostic crystals were identified using a non-aqueous histologic technique involving thick unstained sections. To our knowledge, this is the first report of NICF in a transplant patient. Our case suggests NICF is a follicular disorder and highlights a technique that may prevent loss of birefringent crystals and assist in facilitating accurate diagnosis.

Granulomatous pigmented purpuric dermatosis (PPD) is a rare subtype of pigmented purpuric dermatosis that is typically seen in women of Far East Asian descent on the distal lower extremities and feet. Granulomatous PPD is a benign condition that does not typically require treatment. Hyperlipidemia has been seen in over half of the eighteen cases reported in the literature. We report an unusual presentation of granulomatous PPD seen in a 71 year-old Caucasian female with hyperlipidemia.

Sclerodermoid chronic graft-versus-host disease (scGVHD) is a rare form of cGVHD with an estimated prevalence of 3% to 11% in patients receiving allogeneic bone marrow transplants. scGVHD is believed to be an immune-mediated response characterized by aberrant T-cell function and dysregulation of tyrosine kinase cascades. Published literature on scGVHD is still limited and the mechanisms are yet to be fully understood. Thus, successful treatment of scGVHD remains largely unknown and many current options are hindered by potential side effects. This case provides an example of scGVHD localizing to areas of trauma and friction as a potential mechanism behind scGVHD and provides several case reports that document similar findings.