From The New England Journal of Medicine
The second edition of the German textbook Dermatology is just that -- a comprehensive reference on the specialty of dermatology. Appearing nine years after the first edition, the second edition is a practical necessity. Nondermatologists may not believe it, but progress in this specialty has been rapid during the intervening years. The new genetics has been eagerly embraced, as have advances in immunology and therapeutics. The study of skin diseases and of their diagnosis and management readily lends itself to graphic images, and modern color publishing has facilitated an explosion of textbooks in this area. A good number of such books consolidate this approach by carrying the moniker ``atlas'' and as such are usually no more than expansively illustrated maps of the integument.
To go further than this and to supplement good illustrations with advice on causes, pathology, diagnosis, and therapy is another dimension altogether. Such a task can be made easier by consistency of style, facilitated by a rigorous editorial hand that keeps the number of chapter authors to a minimum. In Dermatology, the four authors accomplished this task by writing the bulk of the book themselves, on topics ranging from basic science and principles of dermatologic diagnosis to descriptions of individual dermatoses and their therapy. This is no mean feat, but one that intuitively relies on extremely broad knowledge of the specialty. Consistency benefits, but authenticity may suffer, since no four persons can write all the chapters at the level of experts in the field. One could argue, however, that the experts' ivory-tower view can at times be several standard deviations away from the norm and not pertinent to a broad readership. After all, this book is aimed at specialists and nonspecialists alike.
The world of dermatology textbooks is populated by a few well-known, multivolume heavyweights, both metaphorically and literally. Dermatology is a unique inhabitant of this world, in that it is a single, albeit bulky, volume -- a distinct advantage, since the reader knows in which volume to look for information. Although the page layout is consistent, there is room for more color figures and diagrams, but perhaps this was discounted in deference to maintaining the single-volume approach. The book itself is fairly well but not extensively referenced. At times, a somewhat endearing element of anecdote creeps into the text -- a rare phenomenon in the modern, evidence-based world. For instance, in the section on striae distensae (stretch marks), therapy is regarded as ``a bit of luck'' -- that is, the luck of not being predisposed to this scourge of pregnancy. Another example is found on the section on psoriasis. It is well known that psoriasis occurs at different frequencies in different racial groups, and it is commonly believed to be relatively rare in Native Americans. This observation is dismissed with skepticism and the statement that ``one of us ran a clinic for Navajos for a decade and saw more than enough severe psoriasis.'' Some statements are factually incorrect. Again, taking psoriasis as an example, it is stated that monozygotic twins have 90 percent concordance for psoriasis, although the widely quoted figure is closer to 70 percent. This is a minor criticism, but a reference book should be accurate. The limited authorship ensures that the book does not fall foul of another glitch of multiauthorship, in that the information presented is very current and references from 1999 are widely included.
Dermatology is increasingly a surgical specialty. Indeed, the American Academy of Dermatology has considered changing its name to incorporate a reference to dermatologic surgery, thereby emphasizing this trend. It is estimated that of patients attending a general, nonselected dermatology clinic, up to 40 percent may require some form of surgery, ranging from cryotherapy or simple elliptical biopsy to complex flap construction, previously the preserve of the plastic surgeon. The addition of a new chapter on operative technique is a welcome one; however, coverage of laser surgery in a mere 2 1/2 pages is not representative of the value and widespread use of this technique. The other new chapter is that on diagnostic issues specific to black skin, an important and difficult area. The descriptive vocabulary for dermatologic disease was primarily determined with reference to white skin. Thus, the dermatologist is faced with two problems in diagnosing and describing a rash in black skin: first, the morphologic features of common conditions such as psoriasis or atopic dermatitis may appear very different from those in white skin, and second, there are a number of dermatoses unique to black skin that are currently described within the context and confines of white-skin dermatology.
Overall, this is a valuable book that deserves a place on the shelves of most medical libraries. It is comprehensive enough in its information to benefit specialists and nonspecialists alike. After all, one can never have enough high-quality dermatology reference books.
Christopher E.M. Griffiths, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
