Psoriasis, Third Edition,, Third Edition (Basic And Clinical Dermatology)

Broadening the topics that earned the Second Edition a reputation as the premier reference of its kind, Psoriasis, Third Edition, incorporates the most recent innovations and experimental therapies to create an even more comprehensive source of information on all aspects of this problematic disease.
Features new information concerning

bioengineering and psoriasis

topical retinoids

FK 506

photodynamic therapy

ascomycin derivatives

PH5T inhibitors

DAP-389 therapy

and more!
Completely updated with the latest developments in areas such as neuropeptides, acitretin, and patient involvement, this valuable monograph pools the insights of over 120 distinguished dermatologists on all aspects of psoriasis, detailing

genetics

etiology

biology

pathophysiology

clinical manifestations

pharmacology

therapeutics
Psoriasis, Third Edition, provides a wealth of information for practicing physicians treating patients in a clinical setting-including dermatologists, internists, rheumatologists, allergists, family physicians, pediatricians, immunologists, biochemists, radiologists, and graduate and medical students in these disciplines.

Psoriasis is a common chronic, inflammatory skin disease that affects approximately 6 million people in the United States, crossing the boundaries of sex, age, and race. For most patients, the diagnosis of psoriasis marks the beginning of a lifelong struggle, with cycles of remission and exacerbation. Although psoriasis is rarely life threatening, it is frequently associated with stigmatizing chronic lesions that can cause considerable physical and psychological morbidity. Because of its seemingly benign nature, the psychological and economic effects of psoriasis are often underestimated by physicians and other health care professionals.

The past decade has seen monumental advances in the fields of immunology, genetics, and molecular biology. These have changed our understanding of disease processes and revolutionized our methods of scientific inquiry. The field of dermatology, and the understanding of psoriasis in particular, has benefited from the fruits of these disciplines. There is now a substantial body of experimental and clinical evidence pointing to an immunopathological basis for psoriasis, a concept that was in its early stages only a decade ago. Recent genetic-mapping studies have identified loci on chromosomes 6p and 17q as sites that contain psoriasis-susceptibility genes. Unraveling the genetic basis of the disease and linking it to the pathogenesis is a remaining challenge.

The third edition of Psoriasis, edited by Henry Roenigk, Jr., and Howard Maibach, is the most comprehensive treatise on this subject. The two editors have enlisted as authors more than 100 international experts. The organization of the book is similar to that of its 1991 predecessor. Nine broad sections discuss clinical aspects of psoriasis, genetics, epidemiology, pathogenesis, histology, and therapeutic approaches, including evolving treatments. The book closes with a section entitled "Patient Involvement in Psoriasis." Each chapter includes subsections and an extensive bibliography that facilitates access to information.

The genetics and the pathogenesis of psoriasis are two areas that have rapidly expanded since the publication of the second edition. The chapter entitled "Genes in Psoriasis" is a concise overview of current genetic concepts of the disease and various genetic analyses, such as twin studies, large-scale epidemiologic studies, linkage analysis, and the mapping of a psoriasis-susceptibility gene.

The much-expanded section on the pathogenesis of psoriasis provides accurate and extensive reflections on the evidence that psoriasis is an immune-mediated disease. These chapters comprehensively cover the complex interplay of various immune cells (T cells), cytokines, chemokines, and epidermal factors.

The number of treatments available, both topical and systemic, has also increased in the past decade, and this book covers most of them in detail. Included are time-honored treatments such as topical corticosteroids, anthralin, ultraviolet, and psoralens and ultraviolet A, as well as newer approaches, such as topical treatment with derivatives of vitamin D (calcipotriene) and vitamin A (retinoids). The importance of combination therapies, such as retinoids plus phototherapy, and rotational therapy to minimize the cumulative side effects and tolerance is discussed. There is up-to-date information on the effects of the long-term use of psoralen and ultraviolet A, especially the increased incidence of malignant melanoma. The expanded chapters on the use of methotrexate and cyclosporine provide valuable guidelines for clinicians for the safe and efficacious use of these agents in patients with recalcitrant psoriasis. The section on new treatments and innovations attests to the flourishing and active research that capitalizes on our expanding knowledge of the pathogenesis of psoriasis. In the future, we can expect immunomodulating agents such as DAB(sub 389)-interleukin-2 (a fusion protein that combines interleukin-2 with a portion of the diphtheria toxin polypeptide) to have a greater role in the treatment of psoriasis.

Along with its many strengths, the book has some weaknesses. Several chapters, such as those on histopathology, Goeckerman therapy, the microcirculation, and most important, topical corticosteroids, have not been updated, and others, such as that on the Koebner phenomenon, have been omitted from this edition. Topical corticosteroids remain the most widely used agents for the treatment of mild-to-moderate psoriasis. Several studies have demonstrated their value for the long-term treatment of psoriasis -- for example, with pulsed therapy, a concept that is not discussed. Children with psoriasis pose distinct therapeutic challenges, and yet this topic is not discussed as a separate entity.

The discussion of the psychosocial aspects of psoriasis has been expanded, but disappointingly, this important aspect of treatment receives little attention in the book. Curiously, the section on topical retinoids (tazarotene) presents only preliminary data. This drug was approved for use in psoriasis well before this third edition was published. Chapter 24, "Anti-Infectious Therapy of Psoriasis," offers a disjointed, rambling rationale along with testimonial data to support an unproved treatment: the use of various antimicrobial agents. The review of the undefined responses to treatment and the antibiotics listed in Table 4 of the chapter is particularly troublesome. None of the antibiotic regimens tried were tested in controlled settings.

Finally, we must comment on the quality of the binding and cover of the book. After only minimal use, the cover has already broken loose from the spine -- not a good sign for a book that should enjoy frequent use.

Overall, we believe that the third edition of Psoriasis has effectively captured the expanding understanding of this challenging disease and will serve as a valuable reference book for clinicians and academicians with special interests in this field.

Reviewed by Payam Tristani-Firouzi, M.D.