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Fitzpatrick’s Dermatology in General Medicine

Dr Charles Dupont, Consultant Dermatologist, assesses the seventh edition of the classic textbook on dermatology in general medical practice.

This classic American textbook is here again with over 300 contributors and many changes from the sixth edition. Most notably, only a minority of literature references are available in the book – the remainder being obtainable from the internet. This is probably advantageous, as a very large number can be intimidating, marginally relevant and rarely consulted.

Different diagnoses

Each disease has a large list of differential diagnoses. Greater details of a few would be preferable, e.g. how to distinguish scabies from atopic eczema.
The id hypothesis for some forms of pompholyx is exhumed. Most dermatologists do not believe in this and I am one of them.

Diet probably plays little part in atopic eczema, and cellulitis and lymphoedema in this condition are surprisingly rare, considering the degree of scratching and inoculation of bacteria. Patch testing in atopic eczema is not mentioned, but is probably worthwhile, particularly to eliminate topical medicament allergy.

The quoted incidence of arthropathy in psoriasis of up to 50 per cent seems very high and is only likely in very widespread plaque disease or the erythrodermic variety.
Also a 21 per cent incidence of onychomycosis in nail psoriasis seems excessive. Continuous antihistamine therapy for chronic urticaria may mask natural remission.

Basal cell carcinoma

Roles (if any) of H. pylori and demodex in rosacea are not discussed and the immunology of basal cell carcinoma, particularly in relation to the use of imiquimod, does not get an airing.

The above minor criticisms do not detract from the value of this excellent work, however. Although the vast majority of contributors are USA-based, there is no trans-Atlantic bias. The treatment sections are admirably comprehensive and to incorporate such excellent colour illustrations in such a reasonably-priced book is quite a feat. The summary statements are a splendid innovation.

Every dermatologist, whether fledgling or fully fledged, must have their personal copy and no medical library should be without it.

• Fitzpatrick’s Dermatology in General Medicine. Edited by Klaus Wolff, Lowell A. Goldsmith, Stephen I. Katz, Batbarbara A. Gilchrest, Amy Paller and David J. Leffell. Seventh edition, two volumes, 2,402 pages.
  Published by McGraw-Hill Professional, 2007, $495.

Posted in Features, General Practice on 15 June 2008
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