In a time when more and more dermatologists are practicing cosmetic dermatology, I am fortunate to enjoy the practice of 'bread and butter' dermatology, whether it be acne, eczema, warts, moles, rashes, skin cancer or the cutaneous manifestation of internal disease.  Patients and doctors alike forget that skin disease can often be the window through which a clinician can see diseases of the kidneys, heart, or lungs. Often, skin disease can be the first manifestation of  a systemic disease that involves multiple organ systems.