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Advances in Dermatologic Diagnosis, Part II
Clinics in Dermatology (2011) 29, 481–482
Commentary
Advances in Dermatologic Diagnosis, Part II What is hardest of all? That which seems most simple: to see with your eyes what lies in front of your eyes Johann Wolfgang von Goethe The skin calls for faculty of close observation and attention to detail Louis A. Duhring [1845-1913], Valedictory address, University of Pennsylvania Medical School, June 7, 1894.
describes round or discoid lesions. Ilan Goldberg and Eli Sprecher review patterned disorders in dermatology by concentrating mainly on the famous lines of Blaschko and Jasna Lipozencic joins one of us (RW) to cover the fascinating topic of targetoid lesions by focusing on the differentiation of erythema multiforme from Stevens-Johnson syndrome and other diseases. The last chapter of the shape and configuration section on grouped/herpetiform arrangement is dealt with expertly by Alfredo Rebora.
To look is not necessarily to see, not to touch to feel. Anonymous The most important instrument in dermatology is and has always been the naked eye. The very essence of dermatology, its raison d'être, resides in the realm of morphology. Without knowledge of the manifold cutaneous presentations of disease, the clinician would be at loss to guess what the diagnosis might be and what to request from the dermatopathologist should a microscopic examination be required. Without knowing the picture of possible diagnoses, the additional selection of diagnostic studies might be as rewarding as attempting to pin the tail on the donkey at a children's birthday party. Accurate interpretation of the visual manifestation of a given pathology ensures the wise selection of other diagnostic studies ultimately to give it a name and to decide upon its appropriate management.
Names in dermatology The next chapter describes cutaneous signs (Auspitz, Gottron, Hutchinson, butterfly, etc.). Clark Lambert with Laju Patel, Phelps Lambert, Claude Gagna, and Amin Maghari provide extensive information about the signs which dermatologists love to use. What would a discussion of psoriasis be without the mention of Auspitz and Koebner? We all love mnemonics, which amuse and help us in everyday practice and add a light touch in lecturing and preparing students for exams. A simple list of the most important mnemonics was not enough, however, for Svetlana Rubakovic and Charles Steffen who add a synopsis of the original description of the condition and a sketch of the original authors.
Configurations Cutaneous medicine The first contribution, which is coauthored by the distinguished Italian dermatologists Vincenzo Ruocco, Eleonora Ruocco, Giampiero Brunetti, and Sonia Sanguiliano, joined by one of us (RW), describes a new concept of localization, namely, opportunistic localization of skin lesions on vulnerable regions. We believe that this novel concept will soon become accepted as an important principle of localization. The issue continues with four chapters devoted to the shape and configuration of skin lesions. Donald Rudikoff 0738-081X/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.clindermatol.2011.05.001
One of the most significant contributions of dermatology to general medicine is the knowledge and awareness of signs of systemic diseases that appear on the skin. Dimitris Rigopoulos, George Larios, and Andreas Katsambas, all famous Greek dermatologists, provide a brilliant summary of this topic. Paraneoplasias are the signs of a subjacent malignant tumor. Although relatively rare, they need to be recognized by dermatologists for early diagnosis and for improvement of
482 prognosis of neoplasias. Marcia Ramos-e-Silva, a distinguished clinician and scientist, together with Joana Castro Carvalho and Sueli Coelho Carneiro superbly summarize the essential elements of this important subject.
Newer concepts In an era in which sophisticated methods of molecular biologic and genetic methods dominate the scene, many dermatologists, particularly the young among us, are not sufficiently familiar with simple diagnostic procedures. Eleonora Ruocco, Adone Baroni, Giovnna Donnarumma and Vincenzo Ruocco, present an interesting and concise review, which expands on and refreshes our previous knowledge on the fundamental tools of the trade. The hottest and most recent topic in dermatologic diagnosis is the use of dermatoscopy. Jason Lee and Dawn Hirokawa take us for an extensive tour of how this instrument holds increasing importance for the clinician.
Reflections We believe that this second part of Clinics in Dermatology, which is devoted to “Advances in Dermatologic Diagnosis”, together with the first one will satisfactorily cover the important but neglected topic of clinical morphological descriptive dermatologic diagnosis. Our first and foremost aim is to serve our patients for whom the clinical diagnosis of skin diseases is the most important part of medical care. Our
Commentary second aim is to help the physicians and medical personnel who treat skin diseases in recognizing what they see on a real, live patient and not be dependent upon printouts from the lab. Clinical descriptive dermatology is an endangered species, struggling for survival. As such, “reading and understanding” the skin and knowing how to document the findings are indispensable.
Conclusions This issue is the final product of the efforts and cooperation of an extraordinary team, all first-rate and extremely busy scientists and dermatologists who have been more than generous in giving of their valuable time to ensure the success of this project. Their talent, experience, and knowledge enable us to offer our colleagues a comprehensive, intelligent, and interesting collection of contributions that will impact many thousands of patients. Ronni Wolf, MD Kaplan Medical Center Dermatology Unit Rechovet 76100, Israel E-mail address: [email protected] Lawrence Charles Parish, MD, MD (Hon) Department of Dermatology and Cutaneous Biology Jefferson Center for International Dermatology Jefferson Medical College of Thomas Jefferson University Philadelphia, PA, USA E-mail address: [email protected]
Commentary
Advances in Dermatologic Diagnosis, Part II What is hardest of all? That which seems most simple: to see with your eyes what lies in front of your eyes Johann Wolfgang von Goethe The skin calls for faculty of close observation and attention to detail Louis A. Duhring [1845-1913], Valedictory address, University of Pennsylvania Medical School, June 7, 1894.
describes round or discoid lesions. Ilan Goldberg and Eli Sprecher review patterned disorders in dermatology by concentrating mainly on the famous lines of Blaschko and Jasna Lipozencic joins one of us (RW) to cover the fascinating topic of targetoid lesions by focusing on the differentiation of erythema multiforme from Stevens-Johnson syndrome and other diseases. The last chapter of the shape and configuration section on grouped/herpetiform arrangement is dealt with expertly by Alfredo Rebora.
To look is not necessarily to see, not to touch to feel. Anonymous The most important instrument in dermatology is and has always been the naked eye. The very essence of dermatology, its raison d'être, resides in the realm of morphology. Without knowledge of the manifold cutaneous presentations of disease, the clinician would be at loss to guess what the diagnosis might be and what to request from the dermatopathologist should a microscopic examination be required. Without knowing the picture of possible diagnoses, the additional selection of diagnostic studies might be as rewarding as attempting to pin the tail on the donkey at a children's birthday party. Accurate interpretation of the visual manifestation of a given pathology ensures the wise selection of other diagnostic studies ultimately to give it a name and to decide upon its appropriate management.
Names in dermatology The next chapter describes cutaneous signs (Auspitz, Gottron, Hutchinson, butterfly, etc.). Clark Lambert with Laju Patel, Phelps Lambert, Claude Gagna, and Amin Maghari provide extensive information about the signs which dermatologists love to use. What would a discussion of psoriasis be without the mention of Auspitz and Koebner? We all love mnemonics, which amuse and help us in everyday practice and add a light touch in lecturing and preparing students for exams. A simple list of the most important mnemonics was not enough, however, for Svetlana Rubakovic and Charles Steffen who add a synopsis of the original description of the condition and a sketch of the original authors.
Configurations Cutaneous medicine The first contribution, which is coauthored by the distinguished Italian dermatologists Vincenzo Ruocco, Eleonora Ruocco, Giampiero Brunetti, and Sonia Sanguiliano, joined by one of us (RW), describes a new concept of localization, namely, opportunistic localization of skin lesions on vulnerable regions. We believe that this novel concept will soon become accepted as an important principle of localization. The issue continues with four chapters devoted to the shape and configuration of skin lesions. Donald Rudikoff 0738-081X/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.clindermatol.2011.05.001
One of the most significant contributions of dermatology to general medicine is the knowledge and awareness of signs of systemic diseases that appear on the skin. Dimitris Rigopoulos, George Larios, and Andreas Katsambas, all famous Greek dermatologists, provide a brilliant summary of this topic. Paraneoplasias are the signs of a subjacent malignant tumor. Although relatively rare, they need to be recognized by dermatologists for early diagnosis and for improvement of
482 prognosis of neoplasias. Marcia Ramos-e-Silva, a distinguished clinician and scientist, together with Joana Castro Carvalho and Sueli Coelho Carneiro superbly summarize the essential elements of this important subject.
Newer concepts In an era in which sophisticated methods of molecular biologic and genetic methods dominate the scene, many dermatologists, particularly the young among us, are not sufficiently familiar with simple diagnostic procedures. Eleonora Ruocco, Adone Baroni, Giovnna Donnarumma and Vincenzo Ruocco, present an interesting and concise review, which expands on and refreshes our previous knowledge on the fundamental tools of the trade. The hottest and most recent topic in dermatologic diagnosis is the use of dermatoscopy. Jason Lee and Dawn Hirokawa take us for an extensive tour of how this instrument holds increasing importance for the clinician.
Reflections We believe that this second part of Clinics in Dermatology, which is devoted to “Advances in Dermatologic Diagnosis”, together with the first one will satisfactorily cover the important but neglected topic of clinical morphological descriptive dermatologic diagnosis. Our first and foremost aim is to serve our patients for whom the clinical diagnosis of skin diseases is the most important part of medical care. Our
Commentary second aim is to help the physicians and medical personnel who treat skin diseases in recognizing what they see on a real, live patient and not be dependent upon printouts from the lab. Clinical descriptive dermatology is an endangered species, struggling for survival. As such, “reading and understanding” the skin and knowing how to document the findings are indispensable.
Conclusions This issue is the final product of the efforts and cooperation of an extraordinary team, all first-rate and extremely busy scientists and dermatologists who have been more than generous in giving of their valuable time to ensure the success of this project. Their talent, experience, and knowledge enable us to offer our colleagues a comprehensive, intelligent, and interesting collection of contributions that will impact many thousands of patients. Ronni Wolf, MD Kaplan Medical Center Dermatology Unit Rechovet 76100, Israel E-mail address: [email protected] Lawrence Charles Parish, MD, MD (Hon) Department of Dermatology and Cutaneous Biology Jefferson Center for International Dermatology Jefferson Medical College of Thomas Jefferson University Philadelphia, PA, USA E-mail address: [email protected]