A patient in whom eczema craquele was associated with adenocarcinoma of the pancreas is described. Malabsorption following a Whipple operation was ruled out as the cause based on the distribution of the dermatitis and normal alkaline phosphatase. Because the patient's skin changes appeared following removal of the malignancy and disappeared shortly after a second attempt at pancreatic enzyme replacement therapy, the malabsorption of fats was probably responsible for the skin changes rather than a direct paraneoplastic manifestation of the cancer. The occurrence of purpura with eczema craquele in the patient has not been described previously. The findings raise the possibility of eczema craquele being a diagnostic clue to a malignancy and argue for adding it to the list of cutaneous paraneoplastic signs.
Kraigher O., Brenner S. Eczema Craquele with Purpura as a Sign of Internal Malignancy or Malabsorption Syndrome? Cutis. 2009 Feb;83(2):75-76