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Skin Disease in Childhood and Adolescence.
  1. SARAH WOOKEY, General practitioner and clinical assistant in dermatology

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    Skin Disease in Childhood and Adolescence. By Elisabeth Higgins and Anthony du Vivier. (Pp 277; £39.50.) Blackwell Science, 1996. ISBN 0-86542-835-2 .

    The authors of this book are to be congratulated for having produced, overall, a clear, user friendly introduction to the subject of paediatric dermatology. If what follows seems to be critical, then I hope it will be seen in this context.

    No prior knowledge of dermatology or paediatrics is assumed, and the reader is carefully taken through what the authors somewhat paradoxically call ‘physiological disorders’ such as erythema toxicum, although the major part of the book is concerned with pathological conditions. The ratio of pictures to text is about 1:1; the quality of the photographs is excellent, and the information is set out clearly and readably. The authors have decided to sacrifice detail for brevity and clarity.

    The subject matter is grouped sensibly; it took me no more than a few seconds to find whatever I was looking for.

    References are not included. This created problems whenever I came up against a statement with which I disagreed. Were they wrong, or was I out of date? For example, should children with chickenpox be off school for a week after the rash appears (p 88)? Not according to a straw poll of health visitors, practice nurses, and general practitioners who all felt that no more new spots was the correct advice.

    Similarly, I don’t know if plantar warts are spread in swimming pool changing rooms, as they assert, but if so, I’d like the chance to see the evidence. If there isn’t any then I’d hate to think of a new generation of health professionals acquiescing to swimming pools’ demands to distribute ghastly verruca socks, or, worse still, withdraw children from swimming lessons. I am also concerned to note that the maxim of active genital herpes = caesarian (sic) section, is still being promoted (p 99); they are not alone however—in fact our local genitourinary physician maintains that the single most important thing to do if you have herpes and are pregnant is not to tell the obstetrician.

    There is an underlying issue here—if statements are made ex cathedra then a student may be more inclined to accept dogmatic statements at face value in the future, rather than develop an inquiring, questioning response.

    Emphasis is rightly given to common disorders such as eczema. I was delighted to see that the amount of attention given to head lice and scabies mirrors their incidence in the community. A few rarities are included but there seems to be no obvious criterion for inclusion; in addition, incidences are not always quoted so that the uninformed reader may well infer that Netherton’s syndrome (of which I had never heard) is as common as chickenpox.

    There are one or two other minor issues—when discussing the differential diagnosis of erythema toxicum it is suggested that electron microscopy of the contents of a vesicle will exclude viral infection. I’m sure it would, but in practice I find it neither a helpful nor a practical suggestion.

    Non-accidental injury is relegated to a small section at the back; although there are competing claims for space in a book of this size, I feel that the importance of considering it and of knowing how to act upon the suspicion should be stressed.

    More than most specialties, dermatology evolved as a descriptive specialty (‘wallpaperology’ as my first consultant put it), and several terms mean nothing to a non-classicist. Perhaps a short addition of Greek and Latin terms to the glossary in this book might help students to make more sense of the terminology. ‘Pityriasis rubra pilaris’ doesn’t mean as much to the average student as ‘red scaly eruptions around hair shafts’.

    I think many groups of health workers will find this book useful and informative; not just undergraduates and general practitioners, but midwives, health visitors, and practice nurses.

    Having whetted the reader’s appetite for more, it may be worth considering a section on ‘further reading’ in future editions.

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