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. Perhaps the most satisfying clinical scenario is the patient whose unusual internal medical problems can be explained through his or her skin. A good example of this was a woman who came to me who appeared to have had a stroke. The right side of her face was somewhat expressionless with subtle asymmetry to it. Multiple visits to her internist and neurologist failed to reveal any evidence of stroke. A skin biopsy revealed the diagnosis of lupus erythematosus. Of note, all her blood work for lupus was negative. In this fascinating case, had the biopsy not been done, the diagnosis would have remained elusive.