The cutaneous neurosensory system appears to be involved in a number of skin diseases. Ongoing studies continue to uncover potential new roles for the components of the neurosensory system in skin homeostasis and disease states. There is new evidence that neuropeptides may play a role in melanogenesis with effects on vitiligo. An increase of intraepidermal nerve fibers with a possible pathophysiologic role in photodamaged facial skin has been proposed. As our understanding of the interactions between the cutaneous neurosensory system and the various components of the skin and the immune system in times of health and disease increases, specific treatments modulating the neurocutaneous system will find their way into the armamentarium of daily dermatologic therapy.