This retrospective study describes 68 alpacas with skin diseases investigated from 1997 through 2006 at Cornell University. During this time period, 40 of 715 (5.6%) alpacas presented to the university hospital had dermatological diseases. In addition, skin-biopsy specimens accounted for 86 of 353 (24.4%) of alpaca biopsy specimens submitted to the diagnostic laboratory, and of these 86 specimens, follow-up was available for 28 cases. The following diseases were most common: bacterial infections (22%); neoplasms, cysts and hamartomas (19%); presumed immunological disorders (12%); and ectoparasitisms (10%). Conditions described for the first time included intertrigo, collagen and hair follicle hamartomas, lymphoma, hybrid follicular cysts, melanocytoma, anagen defluxion, telogen defluxion, presumed insect-bite hypersensitivity, ichthyosis, and possible hereditary bilateral aural haematomas and chondritis. The results of the retrospective study are compared and contrasted with the results of a literature review.