Rook's Textbook of Dermatology, 7th edition

Edited by Tony Burns, Stephen Breathnach, Neil Cox and Christopher Griffiths. Blackwell Publishing. ISBN: 0‐632‐06429‐3. £450. To be asked to review the new edition of Rook was an immediate delight, but also a daunting prospect at the enormity of the task. The seventh edition, like the sixth, is presented in four volumes, of much the same size and weight as previously. The fact that dermatologists worldwide have always referred to this textbook eponymously as ‘Rook’ has now been formally recognized by the change of name to Rook's Textbook of Dermatology. It is ironic that the editors have chosen to do this at a time when Arthur Rook's son, Graham, has become a contributor, and Darrell Wilkinson's glossary of terms and eponyms chapter has not been retained from the sixth edition. Two other chapters have disappeared from the new edition. Perhaps not surprisingly, the formulary of topical applications has been axed, but there is a case for some of the formulary such as coal‐tar preparations used in psoriasis and the constituents of the commoner emollients to be included in the chapter on topical therapy, as is done for Kligman's cream. The other chapter that seems to have disappeared, this time for no obvious reason, is the short one on Reiter's disease. Logically, the topic could have been included in the psoriasis chapter, but this does not seem to have happened. Granuloma annulare and necrobiosis lipoidica have been downgraded from chapter status and included into that of cutaneous manifestations of diabetes. Perhaps putting it in with sarcoidosis would have been more appropriate. Erythema multiforme, Stevens–Johnson syndrome and toxic epidermal necrolysis have disappeared from disorders of blood vessels, been rewritten, and given their own chapter immediately after drug reactions. AIDS and the skin has a new chapter on its own. Apart from these major chapter changes, minor transfers have occurred. For example, skin complications of stomas has gone into gastrointestinal disease, whereas I thought it would have fitted better into irritant dermatitis. Otherwise, the overall chapter content and layout stays much the same as in the four volumes of the previous edition. Of immediate impact is the new indexing and pagination. In 1998, the sixth edition won the prestigious Wheatley medal awarded by librarians and indexers for a book published that year in the UK for the best index. The seventh edition might well win it again. Instead of being paginated over a cumulative 4500 pages, each chapter is given its own set of pages. This ease of reference is reinforced by having chapter headings at the top of every page in green, and the contents of each chapter listed in its own window at the beginning of each chapter with the appropriate page number. The text is slightly darker, and better use has been made of bold type for paragraph headings. In the sixth edition, the majority of the diagrams came with a pale yellow or pale green background. In the new edition, most diagrams have a background of white. While the pale yellow/green was not my favourite colour, by and large it made the diagrams easier to read and interpret. The clinical photographs are of a slightly different colour. Sometimes they are improved, sometimes not, but the best ones are undiminished. There are three strengths to this textbook. It has been available for almost 40 years, and with each new edition it has accumulated tremendous expertise from its talented contributing authors. Its second strength is the regular introduction of new contributors, 56 on my count for this edition. Whilst most of these new individuals confer a few pages of important advancement, a few provide a third strength, which is either to completely rewrite some of the old chapters or to compose new ones. In the new edition there is roughly a 10% increase in text, primarily through an increase in the number of pages, but also with judicious cutting or condensing of inappropriate text. This has allowed small but definitive improvements to be made to most chapters. Examples include molecular connections between cells, wound dressings, the neonate and immunodeficiency, the aetiology of atopic eczema, molecular biology of nonmelanoma skin cancer and the use of lasers. The new additions to dermatitis artefacta and the importance of quality‐of‐life measures are extraordinarily helpful. These multiple small benefits and updates occur throughout the text. Many chapters or segments though have been substantially rewritten. These include diagnosis of the skin, inflammation, irritant and contact allergic dermatitis, purpura, alopecia areata and androgenetic alopecia, and rosacea. The chapters on soft‐tissue and vascular tumours have been much enlarged, as has that of cutaneous lymphoma. Most of the layout has stayed the same, although it is disconcerting to find that in some, but not all, of the rewrites that the Pathology section comes after the ‘Clinical features’ section, rather than before. The format has been changed in a major way in two subjects, porphyria, and the skin and eye chapter. Sarkany has made porphyria not only very easy to understand but has given a manual of advice in what tests to do in what situation. Leonard approaches eye problems in a very practical way reflecting his interest of autoimmune blistering disease, although the chapter as a whole is not quite as comprehensive as the previous edition. The chapters on vasculitis and neutrophilic vascular reactions, AIDS, and genital, perianal and umbilical skin disease have all been completely rewritten. They are up to date and reflect the authors' practical experience, and this edition is worth buying for these alone. It goes without saying that every dermatology department worldwide should have one. The more interesting question, perhaps, is where do the editors go from here? Their aim is to provide a comprehensive guide to all recognized dermatological diseases and to encourage understanding and development of the scientific aspects of dermatology. It isn't comprehensive. I could find no reference to multinucleate angiohistiocytoma, and idiopathic CD4 lymphopenia seemed to be mentioned only in a table. There will be other entities that are missing but this is quibbling; it is simply the best and most comprehensive dermatological textbook available. To encourage the understanding and development of the scientific aspects is more elusive. There are large blocks of text explaining the minutiae of previous and present dermatological science. Much of it does not inform clinical understanding and decision‐making, and seems to reflect that golden era where so many talented individuals could bridge the gap between clinic and laboratory. Explanations of the scientific basis and understanding of disease must continue, but perhaps not in quite as much detail. If this is an age where the clinician uses PubMed, Medline, eMedicine, Litt and Lebwohl in front of the patient, and the trainee seems to prefer Bolognia or McKee, does that leave Rook only in the departmental library? Rook is already a comprehensive reference but once you have set the standard it is relatively easy for others to catch up. There is therefore a need to develop some appeal in other areas. It is not a clinical‐image atlas, but a few more clinical photographs would be good and some of the poorer ones discarded or replaced. This is particularly true for the pathology photomicrographs. Otherwise, I believe that there is a need for more diagrams to help grasp the science, more algorithms to aid diagnosis and management, and more hierarchies of best treatments to minimize patient risk. The formulary could have been replaced with a worldwide list of patient self‐help groups. Only Williams at the end of his epidemiology chapter lists online resources. That leaves Rook's possible role as a learning and educational resource. It is a marketing disaster these days not to provide a CD‐ROM at the same time as a new edition. I still prefer to browse and leaf through the hard copy rather than be blinkered by a screen, but a CD‐ROM is marvellous for finding all references to a word quickly, and online access provides downloadable images for use in learning and training. As yet, most of the downloadable images provided with other dermatological texts are of average to poor quality. If in the future Rook can set the same standard in some appropriate areas other than as a comprehensive reference with a scientific basis, every dermatologist would buy each edition.