Eczema craquelé with purpura: a sign of internal malignancy or malabsorption syndrome?

We describe a patient with eczema craquelé associated with adenocarcinoma of the pancreas. Following a Whipple operation, zinc malabsorption was ruled out as the cause based on the distribution of the dermatitis, alkaline phosphatase levels within reference range, and response to pancreatic enzyme replacement therapy. Because the patient's skin changes appeared following removal of the malignancy and resolved shortly after the second course of pancreatic enzyme replacement therapy, fat malabsorption probably was responsible for the skin changes rather than a direct paraneoplastic expression of the cancer. The occurrence of purpura with eczema craquele has not been previously described in the literature. These findings raise the possibility that generalized eczema craquele is a diagnostic clue to a malignancy and argue for adding it to the list of cutaneous paraneoplastic syndromes.