Early in each physician’s training, it is emphasized that every patient encounter offers an opportunity to be a detective. Using deductive reasoning based on the "clues" presented, the physician strives to solve the mystery of the patient’s illness. Dermatological issues most commonly present in the primary care setting and from there are referred to a specialist. As frontline evaluators of these complaints, each physician must, at times, play detective to discover the real cause for the patient’s symptoms.

This issue of Pediatric Annals presents three case vignettes in which the patient or patients suffer from an unusual systemic cause for their skin findings. As well, two short reviews of environmental causes for skin irritation are provided to alert the practicing healthcare professional to increasingly common but often overlooked chemical irritants in children.

After reviewing this issue of Pediatric Annals, the participant will be more keenly aware of subtle clues to systemic disease that present on a patient’s skin, as well as better able to provide counseling to families whose child has developed a sensitivity to chemical irritants.