Book Review

Eczema

N Engl J Med 1993; 328:1048April 8, 1993

Article

Eczema
Edited by Ronald Marks. 293 pp., illustrated. London, Martin Dunitz, 1992. £65. ISBN: 1-85317-023-2

The term “eczema” is often misused and misunderstood, but Professor Marks and his coauthors tackle the subject directly and thoroughly. The contributors are for the most part leading researchers on their specific topics. Although the chapters have been written by authorities from around the world, very few problems in translation are evident. Each chapter has a similar format and clear presentation. The photographs, almost exclusively in color, are superb, including the high-magnification histopathological and immunohistochemical stains.

The book covers the expected topics such as atopic dermatitis, allergic contact dermatitis, and seborrheic dermatitis, yet it also contains more unusual subdivisions on such subjects as “ethnic differences in the experience of eczema” and “epidemiology, social aspects, and economic significance.” We are reminded that skin disorders made up about 50 percent of all occupational diseases in the United States in 1979 and that eczema was responsible for 40 to 60 percent of all cases of temporary or permanent working disability due to skin disease. In the chapter on occupational skin disease, Iain Foulds comments that “the actual suffering of individuals with dermatitis is impossible to quantify.” There is little doubt of the enormous amount of morbidity associated with these skin disorders. As is mentioned, data on the economic effects on society are scarce.

There are a number of excellent contributions. Subtle histologic distinctions between subtypes of dermatitis are highlighted in chapter 3. The section on atopic dermatitis by Jon Hanifin contains a very interesting discussion of the interaction of interleukin-4 with immune cells. His coverage of the major clinical problems in atopic dermatitis is succinct and masterly. A practical table is provided on the location of allergic contact dermatitis as a clue to specific allergens. A how-to section on photo-patch testing is also very useful. The chapter on drug-induced eczema is particularly well researched, with an astonishing 400 references.

My criticisms of the book are minor. Not every chapter conformed in content to its title, and as can be a problem with multiauthored books, there is repetition. Another issue that arises with authors from around the world is regional variation in treatment. A few treatments are presented that would not pass the test of consensus. One section deals with psychological problems in atopic dermatitis, with characterization of the mother. Our bias is toward support of the parents, with education about the influence of their own behavior on that of their child, especially when they are confronted by a disease that is not well understood and whose symptoms are often severe.

Perhaps the authors did save the best for last. The final chapter on the future treatment of eczema discusses the newest findings and the rationale for specific interventions, such as the use of recombinant soluble interleukin-4 receptor to induce tolerance, and other sophisticated and appealing selective approaches.

In summary, this book admirably covers a difficult topic and is highly recommended to every dermatologist. It is also definitely worthwhile for pediatricians, internists, general practitioners, and occupational health specialists.

S. Honor Fullerton, M.D.
Alvin H. Jacobs, M.D.
Stanford University Medical Center, Stanford, CA 94305