In 1968, Arthur Rook and colleagues published the first edition of Textbook of Dermatology, a two-volume, 1964-page work (Oxford, England: Blackwell Scientific). The sixth edition of this book is a four-volume, 3683-page textbook that is amply illustrated with color photographs. None of its original editors are among the four who edited this new work. The authors, with only three exceptions, are from Great Britain and are predominantly English. The style of the writing is clearly British, but the style of the references has been changed to the Vancouver style, which is now accepted almost universally.
The editors believe, and I agree, that they have continued to fulfill the mission of the original edition, which was a compilation of all recognized dermatologic diseases, to encourage an understanding of the scientific basis of skin disease. In the original edition, the editors emphasized the importance of the practitioner's ability to make a correct clinical diagnosis. To this end, they focused a major portion of the book on clinical description. This edition continues that rich heritage of excellent description.
Unfortunately, as is the case with almost all major textbooks, the material in the current edition was outdated by the time of publication. Of the references cited in this textbook, which has a 1998 copyright, few were published after 1996. The richness of the book is in its description of clinical and pathological features, however, rather than in the discussions of pathophysiology and therapy. Clinical entities and their corresponding histopathological features change far less rapidly than therapies or our understanding of the scientific basis of disorders of the skin.
The editors have continued the traditional organization of the material, and they note that this scheme leads to some duplication. Such duplication is necessary, in my opinion, because it allows the reader to use an individual chapter or section without constantly having to look at another volume or another part of the same volume. What would have been helpful for this edition, and perhaps will be part of the next, is a small index, constituting a fifth volume, so that the reader could go to the proper volume when attempting to locate the section that discusses the subject of interest. It seems that when dealing with multivolume textbooks, I invariably pull out the volume that does not have the information I am seeking.
Each chapter is broken into understandable discussions, and each discussion is followed by a list of references. Although I found this interesting at first glance, the result is that references are often repeated throughout a chapter. I would prefer to have the authors select references that are classic or that are recent and have resulted in changes in our understanding of the issue at hand.
I found most discussions of therapy too superficial. Often the authors presented little more than an overview, listing many therapies that have been reported to be effective in small case series or clinical anecdotes. The practitioner needs direction in the form of expanded discussions of the appropriate means of selecting a treatment for a patient and the methods of monitoring the treatment selected. The evidence that one treatment might be better than the next is frequently not discussed fully. For example, in the discussion of the treatment of pemphigus, the authors discuss various immunosuppressive agents as well as gold and dapsone. I was unable to ascertain the step-by-step approach to treatment that the authors of this chapter might recommend for the next patient that presents to their clinic. Such is the case with almost all the discussions.
The Rook/Wilkinson/Ebling Textbook of Dermatology is a handsome book, and its weight and paper make the book durable. Almost all the photographs are excellent, and their color has been maintained without variation throughout. This book should be in all libraries of dermatology departments and medical schools. It is too voluminous for primary care practitioners, whether they specialize in internal medicine, pediatrics, or another field, but dermatologists will find the book very useful. Its price is comparable to that of similar textbooks.
Reviewed by Jeffrey P. Callen, M.D.
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