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Fitzpatrick's dermatology in general medicine. 6th edition

Irwin M. Freedberg, MD, Arthur Z. Eisen, MD, Klauss Wolff, MD, K. Frank Austen, MD, Lowell A. Goldsmith, MD, and Stephen I. Katz, MD, PhD, editors, New York, 2003, McGraw-Hill. 2 volumes, 3328 pages. $495.00. ISBN: 0-07-138076-0
      What could be more foolhardy than to try and review “Fitz?” There are few tasks in academic dermatology less rewarding than reviewing major textbooks. I have many conflicts of interests, including being a contributor to the book since the 2nd edition and longstanding friendships with several of the editors. I also learned my first dermatology from the first edition of “Fitz” with the psychedelic cover, and have many fond memories.
      First, let me clearly establish that “Fitz,” formally known as Dermatology in General Medicine (DIGM), has come a long way in the last 30 years. It has grown in size, added color, and reacted to or even anticipated many of the trends in our specialty, including expansion of material on basic science and dermatologic surgery, as well as attention to subspecialty interests such as pediatric dermatology. Fortunately, there is no section on current billing procedures, but otherwise the contents of DIGM accurately reflect the current interests of most dermatologists.
      When one compares DIGM to previous editions, one can only admire the editors for all they have accomplished. Most of the obvious defects in the previous editions, such as extreme variations in chapter length and emphasis, have been smoothed out. The first 15% of the book is devoted to basic science. Surgery, including cosmetic surgery, receives 100 pages with almost all-encompassing coverage including botulinum toxin, tissue augmentation, and all types of resurfacing. The balance of the book covers all aspects of so-called “medical” dermatology in a predictable fashion.
      When approaching such a massive textbook, an editor is always tempted to continue with the existing organization because this is easier than making drastic changes. Here is my only serious criticism of DIGM. I fear a bit too much of the old framework has been retained. My intention in mentioning specific topics is only to paint examples; I did not read the entire book, have no intention of doing so, and readily admit there may be a selection bias. But, for example, all of us now consider Darier disease and Hailey-Hailey disease as closely related disorders involving mutations in genes controlling calcium metabolism leading to abnormal epidermal cell adhesion and keratinization. In DIGM, Darier disease is listed under Math Eq, while Hailey-Hailey disease is 100 pages away under Math Eq. A similar example is the presence of pustular diseases of the palms and soles, clearly closely related to psoriasis in many cases, under bullous diseases rather than as psoriasis variants. The pigmented purpuras are found under Math Eq. There are other areas in need of a bit of reshuffling, including genodermatoses, where the best overview is hidden under “Neurocutaneous Diseases” under Math Eq.
      The appearance of Fitzpatrick is traditional. There are two columns of text interspersed with pictures and with references at the end of the chapter. There are a number of new color diagrams and tables, but many old friends in black and white have been retained. A concerted effort has been made to add new clinical pictures, but some older ones are still around and starting to show their age. In general, much more attention has been paid to improving the didactic quality of the introductory basic science material than of the clinical discussions. In this day and age, when we all are confronted daily by computer images, with all sorts marginal notations, background color, complex tables, and links, I fear that books with such a conservative format are nearing the end of the road.
      I will not try to comment on individual chapters, as most are written by good personal friends. The entire book moves along about like this—highly qualified authors, adequate illustrations, some chapters that are clearly committed to springing into the new century, and others which are rather adynamic updates of material which could easily have been lifted from the 1st edition.
      No one who buys DIGM is likely to be disappointed. It is an enormous bargain for the price, contains all that anyone could reasonably expect to find in a book this size, and remains a superb contribution to the dermatologic literature. I glanced through all six editions in preparing this review and would compare the present effort to a superb finesse by a group of skilled card players. Somehow without making any drastic changes, they have managed to produce a fine text. The structural similarities between the 1st and 6th editions are extraordinary; note carefully that I do not imply that the facts have not be updated. They surely have, and in an expert fashion. The youngest of the editors is nearing eligibility for Social Security. For the 7th edition, new blood will be needed, and I encourage the lucky individuals chosen to move DIGM forward to boldly attack the structure of the book, ruthlessly add new illustrative material, and finally cut the cord with the past. This is what Thomas B. Fitzpatrick would have wanted. As proud as he would be of this edition, Dr Fitzpatrick was always willing to gamble and be innovative. He would want his book to evolve in the same way.