Book Review

Epidemiology, Causes, and Prevention of Skin Diseases

N Engl J Med 1998; 338:479-480February 12, 1998

Article

Epidemiology, Causes, and Prevention of Skin Diseases
Edited by J.J. Grob, R.S. Stern, R.M. MacKie, and W.A. Weinstock. 370 pp. Cambridge, Mass., Blackwell Science, 1997. $195. ISBN: 0-632-04256-7

As all physicians are well aware, diseases of the skin pose serious public health problems throughout the world. The range of these conditions is wide, spanning inflammatory and infectious processes and dire neoplastic disorders such as malignant melanoma. The incidence and prevalence of these conditions are constantly changing, reflecting many variables. Thus, understanding the epidemiology of these disorders is essential if changes are to be made to prevent and cure them. To this end, in 1995 at the First International Conference on Epidemiology, Causes, and Prevention of Skin Diseases, the world's foremost experts on this subject convened and made a commitment to write a comprehensive textbook on the subject. This work is the product of that commitment and one of the few textbooks ever written about epidemiology as it relates specifically to dermatology.

The book has three sections: an introduction to basic epidemiology, a section on cutaneous neoplasia, and a section on inflammatory disorders. The editors are four dermatologists with recognized expertise in epidemiology who are from France, the United Kingdom, and the United States. There are also many contributors from many countries. Thus, there are many different styles of writing and different types of chapters; some are comprehensive treatises, but others are more akin to journal articles. The book suffers from wide variation in quality; many chapters are written clearly and objectively, but some assume decidedly personal overtones. Although a diligent attempt has been made to be comprehensive, it seems that a greater attempt has been made to include virtually all groups with an interest in dermatologic epidemiology, almost to a fault. One has the sense that this happened because the idea was spawned at a conference that was probably attended by the authors, none of whom wanted to be excluded. Unfortunately, an emphasis is placed on data from the country from which the authors hail, limiting the usefulness of such a textbook for a general audience. It seems, in fact, that the real target audience is the authors themselves.

Although there is much valuable information in this book, it is difficult to glean, because of the layout. Tables, graphs, and diagrams are used relatively sparingly, and many of those that are included are somewhat cumbersome and difficult to interpret. A glossary would have been a welcome addition, especially since some terms are defined differently by different authors. Furthermore, appendixes listing some of the most important statistical information regarding dermatologic disorders, such as the incidence of melanoma in selected countries, would have added considerably to the work.

Discussions of some topics, such as connective-tissue and sexually transmitted diseases, are rather cursory, whereas discussions of others, such as the relation between melanoma and contraceptives, are overly exhaustive. Certain topics that are important on a global scale, such as alopecia, pigmentary disorders, and photodermatitis, are not included at all.

The book is quite costly at $195, especially given its small size and lack of color photographs. Although it is a valuable reference source and should be purchased by institutions and medical libraries, it is quite unlikely that the average practitioner or dermatology resident will be willing to pay the price. The effort to address this important subject is to be lauded, but if future editions had fewer authors, perhaps just the editors themselves, and if they adopted a more concise, thematic approach, a much better work would almost certainly result.

Clay J. Cockerell, M.D.
University of Texas Southwestern Medical Center, Dallas, TX 75235