Skin signs of systemic disease. 3rd ed

BOOK REVIEWS Skin signs of systemic disease. 3rd ed. Irwin M. Braverman, MD, Philadelphia, 1998, W. B. Saunders. 682 pages. $145.00. It was with great anticipation that I looked forward to the latest revision of Skin Signs of Systemic Disease. When I was a resident, the first edition, published in 1970, was the anchor of my personal dermatology library, a solid, tangible link between my emerging career in dermatology and my training in internal medicine. The book was revised in 1981, and I had all but given up the prospect of seeing another update until it finally came to be after a much-too-10ng wait of 17 years. As Dr Braverman indicates in the preface, approximately 75% of the material in the latest edition has been significantly revised or totally rewritten. This is to be expected, given the tremendous advances in medical knowledge since publication of the previous volume. Nearly 150 illustrations have been added, along with 2 tables that summarize the most important links between skin lesions and internal disease. (These tables, unfortunately, are lost in the preface, a section I would venture few of us actually read.) Although packed with information, the book still has its shortcomings. Like any book, most of it was probably written at least 2 years before its publication date, and hence, even now, much of the information is dated. Although there are a few references as late as 1995, much of the updated material is no more current than the early 1990s. Hence, for example, in the chapter on AIDS, there is no mention of the connection between human herpesvirus-8 and Kaposi's sarcoma. Obviously, this is not the fault of the author, but one of the inherent limitations of book publication. Perhaps easily updatable CD-ROM technology is, in fact, the wave of the future. In other areas, the merging of the old with the new simply doesn't work. Many of the old black-and-white illustrations seem out of place next to the new, often beautifully conceived color plates. In some instances, photographs using old terminology have been maintained. For example, in the chapter on lymphomas, several figures purport to show reticulum cell sarcoma, although that designation is no longer in use. The author explains that this was done because sufficient data are not available to permit classification of these illustrations using current terminology. Nevertheless, this attempt to meld the old and the new occasionally results in an effect similar to that of your grandmother wearing a Versace dress.

Journal of the American Academy of Dermatology

Despite its shortcomings, Skin Signs of Systemic Disease remains the most important comprehensive resource to document the complex relationship between the skin and the organism it envelops. It belongs in every dermatologist's library. I hope one day there will be a completely revised, all color, fourth edition. Bruce H. Thiers, MD Charleston, South Carolina

Facial skin resurfacing Thomas J. Baker, James M. Stuzin, and Tracy M. Baker, St Louis, 1998, Quality Medical Publishing, Inc. 250 pages. $275.00. Facial Skin Resurfacing has been described by the publisher as a full-color, semi-atlas with step-by-step details on chemical peeling, dermabrasion, and laser therapy, and it fulfills that description. It is not a comprehensive reference book. One of the authors, Dr Thomas Baker, elucidates his excellent experience and vantage point as a pioneer in phenol peeling to show the advances in the recent field of skin resurfacing. The chapters that discuss different skin types illustrate this comparative style of learning in an excellent fashion. The discussions of superficial peeling agents are pointed and brief, clinically oriented and without scientific discussion. The section on laser surgery illustrates a straightforward approach to the 2 leading systems according to facial units and skin types and provides good illustrations and practical points. The section on deep phenol peeling, as expected, is unsurpassed. The section on dermabrasion discusses only a technique that can be performed under sedation without using any cryoanesthesia or tumescent anesthesia to immobilize the skin. Although, to the authors' credit, recognizable end points are discussed, this form of dermabrasion does not represent the method most commonly in use in dermatologic surgery or the methods that have been scientifically and histologically evaluated. The discussion on trichloroacetic acid (TCA) peeling reflects only the authors' point of view and eliminates both the scientific basis behind discussion of ancillary topical agents and a thorough discussion of combination medium-depth chemical peeling, commonly used by dermatologists and plastic surgeons alike. The emphasis on a modified, additive-based deep TCA peel is without histologic basis and is controversial, but the authors are clear in pointing out the increased risks of scarring complications.

October, Part 1, 1998

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