Dermatology may not strike us as a specialty that is particularly plagued by ethical dilemmas, but much of the dermatologist’s work is carried out in the context of patient concerns over appearance and enhancement, and this is ethically uncertain territory. The clinical cases examine the dispensing of cosmeceuticals from physicians’ offices and use of the controversial drug isotretinoin (Accutane) for treatment of severe acne. Isotretinoin is highly effective but can cause birth defects if taken by pregnant women. The health law and policy forum sections also discuss this drug and the evolution of the burdensome iPLEDGE program developed to prevent pregnancies in women who take it. Other articles examine the reputation of dermatology as a lifestyle-friendly specialty and the debate over whether it is ethical for residency programs to accept financial support from pharmaceutical companies.