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This book is the first comprehensive treatise on pigmentation that combines its physiology in animals with its pathophysiology and clinical aspects in humans. The five editors have provided an opportunity for the leading investigators in pigmentation to show their stuff. The editors and authors have succeeded in presenting a thorough work. The book begins with an informative history of the science of pigmentation, from which one learns that the correct explanation for the differences in color among races has been determined more recently than might be imagined. A discussion of the cell biology of pigmentation follows. This section includes advances that allowed for the culturing of pigment cells from several species, providing tools for pigmentation researchers and others. One of the best chapters in the book tells why the molecular biology of genes involved in and controlling pigmentation is currently in the scientific limelight. This chapter leads to an extensive discussion of the current status of genes and pigment cells, including the chemistry of pigment molecules and the enzymology of pigment pathways.
The discussion of the pathophysiology of pigmentation and descriptions of clinical disorders take up 27 chapters, including almost 150 subchapters. Are there really that many disorders of pigmentation? A little reflection reveals why the answer is yes. All the conditions involve the melanocyte in some fashion. This cell had to migrate from the neural crest to its appropriate place in the skin and is affected by autocrine signals, signals from neighboring nonmelanocytes, drugs, sunlight, and other factors. The road that melanocytes take to perform their normal function thus has many checkpoints, which can be interrupted, with resulting alterations in melanocyte function. In some conditions, such as piebaldism, the genetic defect is known but how this alteration leads to the clinical entity is less clear. In most of the other conditions, excellent clinical descriptions are provided, but the mechanisms causing the disorders are less clear. As the function of individual genes and how they work in aggregate is determined, the pathophysiology of pigmentary disorders will be clarified.
The writing style varies from one chapter to another, and in a few chapters, the grammar is unacceptable. Duplication of information occurs often. This may be useful if one is using the book as a reference work but is irritating when the book is viewed more broadly. The color photographs are valuable and nicely reproduced. The same cannot be said of the photographs in black and white. One picture is reproduced in color in one section and in black and white in another. The difference in quality is readily apparent.
This book contains a large amount of information on pigmentation. Who will want it? Its usefulness in everyday practice will be limited, but it will be a handsome addition to a library. From a clinical standpoint, the book will perhaps be most valuable to pediatric dermatologists. It will appeal to investigators in pigmentation and serve as an important reference work for those in the cosmetic and pharmaceutical industries.
Fewer than 30 of the approximately 1000 pages in this book deal with the treatment of conditions that affect the pigmentary system. This is unfortunate, but it reflects the dearth of information about controlling the melanocyte. Perhaps the dramatic increase in the knowledge gained in the field of pigmentation over the past few decades, which is presented so well in this book, will prompt the research community to think more about novel approaches to the treatment of disorders ranging from benign processes such as "liver spots" and vitiligo to potentially deadly processes such as melanoma.
Reviewed by Ethan A. Lerner, M.D., Ph.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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