Cutaneous findings can be useful in establishing the diagnosis and treatment of hospitalized patients. Observation and identification of cutaneous abnormalities can improve the accuracy of diagnosis and result in improved patient care. We set out to determine the prevalence of cutaneous abnormalities in hospitalized pediatric patients in a hospital and how often these findings were noted and properly diagnosed by the admitting team of physicians. Children with medical problems admitted to Kosair Children's Hospital during the month of January 1995 were randomly selected for a skin examination, which was performed within 24 to 28 hours of admission. Parental consent was required prior to admission into the study. Of 117 patients offered participation, 110 accepted. Physical findings were noted and in addition the completeness of charting by the admitting physician and the relationship of any cutaneous findings to admitting diagnosis were noted. One hundred five of the 110 patients (95%) had cutaneous findings consisting of either a "rash" or a "congenital lesion." Fifty-one had more than one cutaneous finding noted on examination. Dermatitis was the most common diagnosis made, followed by pigmented lesions and congenital vascular malformations of all types. In 35 of the 105 patients with a dermatologic diagnosis, the dermatologic diagnosis related directly to the admitting diagnosis. In only 22 of these 35 (63%) was the cutaneous involvement noted by the admitting physician. In 9 of the 110 cases (8%), the findings on dermatologic examination altered the primary diagnosis and/or treatment. Cutaneous findings are very common in the hospitalized pediatric patient. The diagnosis, charting, and treatment of dermatologic conditions by the primary pediatric team were often incomplete, although an expert cutaneous examination can be critical to patient care.