Fitzpatrick's Dermatology in General Medicine

It has been said that dermatology is the most inclusive specialty because it deals not only with the skin but also with everything that the skin contains and touches. There's some truth to that. For instance, where else can you find the editors of a medical textbook, as in Fitzpatrick's Dermatology in General Medicine, waxing proudly in the preface about including fresh material on anthrax, smallpox, and Botox? In other words, the field considers its domain to range from the war on terrorism to our narcissistic culture. Happily, the Botox chapter does not include tips on how to throw a "Botox party."

There is also a new chapter on "Evidence-Based Dermatology." I must admit that when I first heard of the evidence-based approach, I wasn't much impressed with its novelty, seeming to remember at least one old-timer who made a comment about experiment being treacherous and judgment difficult (Hippocrates). But the author does a good job of defending the system, and in an honest self-referential bit of criticism of textbooks, he points out that most tend to "reflect the biases and shortcomings of the experts who write them," are about 2 years out of date by publication, and are "narrative reviews that do not consider the quality of the evidence reported." Evidence itself, of course, is as indisputably wholesome as apple pieit's how you interpret the evidence that matters.

This edition remains heavily invested in basic science, which is becoming daily more of a misnomer as skin biology reveals an ever increasing complexity. The first part, almost 15%, is given over to anatomy, physiology, immunology, molecular biology, and so forth, and there's much more interspersed throughout the clinical chapters. These chapters have shown the most profound changes over time, with progressive improvement at each turn. Whereas the first edition relegated color clinical photographs to a relatively thin "atlas" section, this edition features them on seemingly every page. Color abounds, and the quality of the illustrations is excellent. Indeed, the difference between the first and latest edition is so great that you'd never guess at the lineage if you did not look at the titles.

With all the new material, I was astonished to discover that something unheard of had apparently occurred in medical publishing: the sixth edition is shorter than the fifth! And not by just a little: hundreds of pages have evaporated. I compared typefaces, considered a gross error in the pagination, had a colleague check my eyesight, and finally contacted the senior editor, who gave me the lowdown: they did it on purpose.

Having decided that the book had grown "too long, too heavy, too redundant," a 2-year effort was launched in which 10% was cut by "rigid editing, eliminating as much duplication as possible, cutting long, long lists of references." Another improvement was making both volumes roughly equal in size (the considerable inequality of which had always annoyed me) and using a thinner but ample stock paper. The overall weight has been reduced from 22 lb to a more portable 17 lb.

All in all, this sixth edition of Fitzpatrick's Dermatology in General Medicine is the premier textbook of dermatology, a bargain if there ever was one, and a blessing for those of us with derangements in our rotator cuffs.

Michael B. Brodin, MD

Monroe, NYFitzpatrick, Thomas B. is the author of 'Fitzpatrick's Dermatology in General Medicine', published 2003 under ISBN 9780071380768 and ISBN 0071380760.