B o o k r e v i e w s

1983 United States Pharmacopeia Dispensing Information Volume I: Drug information for the health care provider Volume II: Advice for the patient United States Pharmacopeial Convention, Inc., Rockville, MD, 1982. Vol. I, 980 pages: vol. [I, 793 pages. $37.95 for two-volume set.

Every book must have a gimmick, but this new source of pharmacologic information surely has an attractive one. It presents information about a wide variety of systemic and topical medications in two parallel volumes. The first is meant for doctors (health cam providers) and is a well- organized con~pendium of drug information cover- ing most of the medications encountered daily. But the jewel is the second volume, which con- tains patient advice sheets covering all of the medications in volume 1. Each is concise and starts at the top of a page. Thus, one can pho- tocopy the desired sheets and provide the patient with a more usable version of' the package insert.

I assess the dermatologic sophistication of this work as minimal, despite the advice of a group of respected colleagues. Topical corticosteroids are discussed without revealing too many of our tricks, but still in enough detail to keep the non- dermatologist out of trouble. Oral retinoids are nowhere to be found, perhaps reflecting the wis- dom of publishing a 1983 drug guide in June, 1982. Neither the doctor nor patient section does much to explain oral tetracycline's role in acne therapy, although this indication is briefly men- tioned. Furthermore, the cautions still reflect a mentality that I can only categorizc as "unrealis- t ic." Does anyone in his heart feel that wearing freshly washed clothes has anything to do with the use of ketoconazole? I surely do not.

My two standard sources of drug information are the ubiquitous Physicians' Desk Reference (PDR) and The Medical Letter. This new set is far superior to the PDR, because of its impartiality and lack of emphasis on brand names. It does not have the PDR's drug identification tables. In some areas, it approaches the excellence of The Medical Letter, with good comparisons of aminoglyco-

sides, nonsteroidal anti-inflammatory agents, and other similarly important groups. My only objec- tion is the mentality that prompts the compilers to include all known warnings and thus dampen the truly important cautions.

Walter H. C. Burgdorf, M.D. Oklahoma City, OK

Skin and venereal diseases Yu. K. Skripkin, D.Sc.(Med.), Moscow, 1981, Mir Publishers. 556 pages. Clothbound; $14. (English translation by Ludmila Aksenova, M.D.)

Professor Skripkin is director of the Central Research Dermato-Venereologi'cal Institute (Mos- cow, USSR), chairman of dermatology at the Sec- ond Moscow Medical Institute, chief dermatove- nereologist of the RSFSR Ministry of Health, and chairman of" the All-Russian Scientific Society of Dermatologists and Venereologists. The first edi- tion of Skin and Venereal Diseases was published in 1979 in Russian. The textbook was intended for students of (Soviet) higher medical schools in ac- cordance with the curriculum endorsed by the USSR Ministry of Health.

The book is divided into two parts: the former, comprising three fourths of the work, is on skin diseases; the latter, comprising a quarter, is on venereal diseases. Preceding the general part on skin diseases is a brief historical outline of the development of dermatology, including the Rus- sian and Soviet Dermatological School. The "considerable successes (attained by dermatol- ogy) at the end of the 19th and particularly in the 20th centuries" is attributed to both dermatolo- gists in what are now the West and the Soviet Union. The evolution from the morphologic ap- proach to skin disease to a system based on pathophysiologic mechanisms is regarded as im- mensely significant. Several political statements, rather uncommon in most textbooks in English for medical students, are found in this section.

Next, preceding the description of specific skin diseases, is a general discourse on skin anatomy, histology, physiology, and histopathology. Signs and symptoms are categorized and described. That

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a cutaneous eruption may be monomorphic, i.e., consisting of a single type of primat3, morphologic lesion (e.g., papules in psoriasis) is often ad- dressed in the usual English language textbook of dermatology for students. The distinction between true and false polymorphism, seldom present in our textbooks for students, is succinctly articu- lated and examples are given. Also, methods for examination of a patient with skin disease and principles of therapy are presented. "Psychother- apy of dermatological patients begins as soon as they am admitted to tim clinic or when they visit the out-patient clinic." "The word is a potent therapeutic factor in many dermatoses . , , " Ad- vice on the question of the "physician's secret" is also given.

The section on therapy will appear strikingly different to most North American readers. In ad- dition to the voltage regimen to be prescribed for electric sleep, one may give tablets of camphor bromide for pruritus. Valerian tincture is one of the various sedative agents "used extensively in dermatology." Perhaps the most likely acquain- tance with valerian for American medical students would be the pleasant diversion of attending the screenplay Mttrder on the Orient Express based on the book by Agatha Christie. Fangotherapy, treatment with therapeutic (often heated) mud, and ozocerite therapy, application of a heated (45 ~ 60 ~ C) oil with a high heat capacity, will also be of interest to the reader.

Much of the section on specific skin diseases is devoted to infectious diseases that involve the skin. While some differences of opinion obtain, the reader will find this largely familiar territory. Clinical "pearls" abound. Ever heard of Gorcha- kov-Ardy sign in scabies? When an intact bulla of pemphigus vulgaris is pressed and the fluid sepa- rates the adjacent epidermal areas, enlarging the bulla on the periphery, whose sign is it? Asboe- Hansen's sign, not Nikolsky's.

The latter part of the book describes venereal diseases, especially syphilis. The classification and description of syphilis are extremely detailed. Finally, a brief supplement, which includes "rare dermatoses," gives one page to "porphyrin dis- ease ," although acknowledging that there are several forms.

In a foreign textbook for foreign medical stu- dents, one could ahnost predict issues to quibble over. Although Soviet dermatology has had a dif- ferent phylogeny from ours, the areas in which Soviet and American dermatologies are in agree- ment are many. The areas of difference represent an important resource for both Soviet and Ameri- can dermatologists. Exploration and research in these areas should provide new insights and syn- theses which will enhance and improve dermatol- ogy internationally. With this view in mind, and although 1 cannot suggest this textbook for Ameri- can medical students, i strongly recommend this work to all practicing clcmmtologists. Here are new therapies to evaluate and new ideas to oxanline.

,Iollalha/1 K. Wilkin, M.D. Richmoml, VA

Melanoma: Histoh)gical diagnosis and prognosis Vincent ,I. McGovern, M.D., New York, 1983, Raven Press. 197 pages. $49.

The quest continues for a book that will make the histologic diagnosis of malignant melanoma easier. Of the many entries into the race, l believe Dr. McGovern's tiny treatise comes closest to being a "malignant melanoma made simple" book. This is meant as absolute praise, not criti- cism. Virtually every dermatologist has ample clinical writings on malignant melanoma available in hundreds of sources. Few want to read about the tyrosinase controversy when confronted with a tough slide. What 1 want (and what 1 know my colleagues want) is twofold: good pictures and bits of wisdom from an experienced melanoma stu- dent. Dr. McGovern provides this superbly.

He has managed to skirt most of the controver- sial issues in melanoma today, including mela- noma in situ, dysplastic nevus, and the clinical subtyping of melanomas. Although he addresses all these issues, he does so in such a fair way that no matter what your opinions are, he probably has avoided offending you.

Three concepts seem especially well developed. Dr. McGovern removes the mystm2r surrounding an undisputably benign dermal nevus with overly-