VITILIGO: PROBLEMS AND SOLUTIONS (BASIC AND CLINICAL DERMATOLOGY)

Scaling new heights in the literature on vitiligo, this reference comprehensively informs medical practitioners, researchers, and students of all aspects and approaches to this common skin disorder-offering key updates on basic and clinical research as well as invaluable professional guidelines from authors affiliated with the most esteemed dermatological institutes worldwide.

The late Thomas Fitzpatrick, one of the leading dermatologists of the past 50 years, liked to quip that the three greatest problems faced by mankind were "the atom, the ovum, and the melanocyte." Many people want their skin to be either lighter or darker than its normal tone. Regardless of what one may think about changing skin color, it is generally agreed that everyone wants a uniform color. Vitiligo interrupts the uniformity of skin color and can have devastating effects on a person's self-image. Societies ancient and modern have perceived blotchy pigmentation in a negative way, associating hypopigmentation or depigmentation with leprosy, or at least with something not to be shared. (Figure) Vitiligo may be difficult to treat, but the doctor-patient relationship is important, and a positive approach by the physician makes patients optimistic. Most patients with the condition find that the treatment of vitiligo is worthwhile, but most dermatologists do not encourage treatment. Perhaps this difference in attitude results from a lack of knowledge, interest, or time on the part of the physician or from the modest reimbursement to him or her. A successful interaction between patient and physician need not take a lot of time, but it does require a mutual appreciation of the problem. This thorough book covers all aspects of vitiligo, from a historical perspective to thoughts on pathophysiology to the numerous treatments. It has 48 brief chapters, written by an international group -- mostly physicians from Italy, reflecting the Florentine base of the lead authors. Groups based in the United States wrote only two of the chapters. This underrepresentation is consistent with my impression that of the 10,000 dermatologists in the United States, probably fewer than a dozen have a thorough understanding of and an interest in vitiligo, a disorder that probably affects more than 1 percent of the population. A strength of the format is that the chapter titles constitute an excellent outline for the approach to the treatment of vitiligo. The brevity of the chapters not only helps to keep the reader's attention but also forces the authors to focus on their topics. An extensive range of therapeutic options is discussed: topical steroids, ultraviolet light (including the positive results associated with the use of narrow-band ultraviolet B irradiation), vitamins, pigment-cell grafts, tissue-engineered skin, alternative treatments, and cosmetic cover-ups. Complete depigmentation, discussed clearly in one of the later chapters, is a useful therapeutic option and dramatically improves the quality of life for patients with extensive vitiligo. This chapter would be better if it addressed the mechanism of obtaining the depigmenting agent monobenzylether of hydroquinone. Chapter 6, which covers basic research, is unbalanced, because it gives the reader a narrow view of the potential enzymatic and genetic defects involved in the disease. Because subsequent chapters implicate numerous cell types, cytokines, free radicals, and nitric oxide, it becomes clear that the cause of vitiligo is elusive. Chapter 19, "Vitiligo: Emotional Aspects and Personality," by Giuseppe Hautmann, Torello Lotti, and Jana Hercogova, provides wonderful insight into the psychological aspects of the condition. Vitiligo is not life-threatening, but treatment of the disease affects the quality of life. This book serves as a useful resource for readers interested in vitiligo and for those who might want to develop an interest in this important condition. Ethan A. Lerner, M.D., Ph.D.
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