Book Review

Handbook of Contact Dermatitis

Immunology and Drug Therapy of Allergic Skin Diseases

N Engl J Med 2001; 344:388-389February 1, 2001

Article

Handbook of Contact Dermatitis
Edited by Matthias Gebhardt, Peter Elsner, and James G. Marks, Jr. 263 pp., illustrated. London, Martin Dunitz, 2000. $69.95. ISBN: 1-85317-801-2

Immunology and Drug Therapy of Allergic Skin Diseases
(Progress in Inflammation Research.) Edited by C.A.F.M. Bruijnzeel-Koomen and E.F. Knol. 204 pp. Boston, Birkhauser, 2000. $129. ISBN: 3-7643-5970-6

Immunology and Drug Therapy of Allergic Skin Diseases and Handbook of Contact Dermatitis are concise, up-to-date reviews of the basic and clinical science of inflammatory skin diseases. Whereas Immunology and Drug Therapy of Allergic Skin Diseases focuses on basic science, the focus of the Handbook of Contact Dermatitis is clinical. Well-established European authors edited both books, and there are the minor problems of syntax and usage found in literature written by non-native English speakers. Both books contain helpful tables and figures and up-to-date references. In Immunology and Drug Therapy of Allergic Skin Diseases, the diagrams depicting immune pathways are exceptionally clear. The editors of the two books have admirably accomplished their goals. The decision about which book to add to one's library will depend on one's interests and orientation.

The clinically oriented, 263-page Handbook of Contact Dermatitis has 22 chapters and appendixes. The emphasis is on allergic and irritant contact dermatitis, and the book begins with a brief epidemiologic overview, the rudiments of pathophysiology, and information about patch testing. Contact urticaria, systemic contact dermatitis, and atopic dermatitis are discussed in separate chapters. The chapter on contact allergy associated with topical treatments is helpful but omits some classic contactants such as mustard, carmustine, and other antimetabolites. The chapter on allergic drug reactions, although well written, does not fit into the organizational scheme of the book. The material is succinctly presented, with brief headings, and is appropriately indexed. I disagree with the classification of the cutaneous reaction to a Portuguese man-of-war sting as an irritant dermatitis rather than an envenomation, but I agree with the author's other classifications.

The target audience for this handbook is primary care providers, although dermatologists and those who specialize in occupational medicine will also find it a helpful resource. A strong point is the excellent précis of contact dermatitis associated with specific industries and occupations. Sections in this chapter provide interesting information about the types of chemicals that workers in health care, construction, the food-processing industry, and other areas are likely to encounter. The appendixes include sources and lists of patch-test materials that will be of greater interest to practicing dermatologists or clinicians involved in occupational medicine than to those in general practice. The introduction to this section should be rewritten in future editions to clarify the information contained in the tables.

Overall, the Handbook of Contact Dermatitis is a basic, introductory book that admirably meets its stated goals. Clinicians seeking a book with greater depth and breadth would be better served by the classic Fisher's Contact Dermatitis, currently in its fifth edition (R.L. Rietschel and J.F. Fowler, eds. Philadelphia: Lippincott Williams & Wilkins, 2000).

Immunology and Drug Therapy of Allergic Skin Diseases focuses on the basic science of the skin immune system and specific disease states. The book summarizes the tremendous advances in our understanding of the role of cytokines, chemokines, and inflammatory cells in the pathogenesis of allergic skin diseases. It is a timely, well-written review that bridges the basic-science and clinical aspects of allergic skin diseases. Although the editors state that the book is intended for clinicians, including dermatologists, allergists, and pediatricians, I believe it will have greater appeal for clinical or basic-science researchers in this area.

An important topic in this book is the immunology of atopic dermatitis. Specific chapters highlight the roles of mast cells, eosinophils, cell-to-cell interactions, and IgE regulation in the pathogenesis of atopic dermatitis. The penultimate chapter discusses advances in the treatment of atopic dermatitis. Other chapters cover contact dermatitis associated with cosmetics, occupational dermatoses, urticaria, and drug allergy.

Therapy is a minor part of the book, accounting for less than 20 percent of the text. The discussions of therapy are often theoretical, including the discussion of future developments in atopic dermatitis. The strongest section on therapy is in the chapter on urticaria. This chapter includes a 12-step pyramidal management strategy for treating patients with urticaria. As with all good 12-step programs, the first step is to acknowledge the problem and, in the case of urticaria, to remove the cause.

This book has no current competitors. It covers material contained in some recent monographs on atopic dermatitis, strengthened by a review of the basic immunology and a superb discussion of the implications of these advances for our understanding of the pathogenesis of allergic skin diseases and for future therapies.

Joyce Rico, M.D.
New York University School of Medicine, New York, NY 10803