At first glance, it does not seem difficult to find unusual and even bizarre dermatologic treatments. Any treatment that is effective, however, becomes generally accepted and then can no longer be perceived as unusual or bizarre. For example, crude coal tar was once commonly available as a result of the coking process (by which gas for street lamps was extracted from coal, with the coal tar as a discarded residual). It must have been an unusual or bizarre thought to have smeared this compound on the skin of a patient with psoriasis. Once its effectiveness was noted, the treatment could not be considered unusual. Another example of unusual treatment derived from Guinter Kahn's (Miami, FL) idea that because a new antihypertensive, minoxidil, was reported to cause hirsutism, perhaps smearing it on the skin could grow hair. Because it was successful, no one would consider it as unusual or bizarre therapy today. Likewise, prior to FDA approval of Propecia (finasteride 1 mg), Shelley and Shelley suggested that in male pattern baldness, finasteride 5 mg down to 0.2 mg/d might be helpful as prevention and possible treatment. The information presented in this article is in a somewhat telegraphic style, organized as surgical pearls, followed by acne, rosacea, and other disorders of the pilosebaceous unit; other medical and dermatologic pearls; and useful medications, tools, and appliances.