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Evidence-Based Dermatology

Evidence-Based Dermatology If an academic topic is said to have arrived when a book is written about it, then evidence-based dermatology is clearly in the spotlight. Two entirely different books with the same title have become available within the past year. This is good news for those who care about evidence-based medicine. But it is another unwelcome reminder for the many excellent clinicians who are annoyed by the increasing insistence that their time-tested, best-loved therapies be objectively shown to be effective. For many, the term evidence-based dermatology conjures images of dense statistical analyses or never-ending structured reviews that culminate in self-evident conclusions. Why is evidence-based dermatology worth reading about when it is more about technique than clinically relevant substance? The authors of both these books are sensitive to such charges of boredom and irrelevance, and have focused on providing readable, valuable content. In both books, most of the space is devoted to evidence-based examinations of clinical dermatology topics or questions. The Williams et al book is more tilted in this direction, with only about a tenth devoted to the abstract concepts of evidence-based dermatology and the evidence-based "toolbox"; perhaps because the Maibach et al volume is less than half the size of the other, a relatively greater proportion of Maibach et al comprises articles on the process of critical thinking in dermatology. The hearts of both books are fascinating and informative, and can be read in bits and pieces, as time permits. Williams and coauthors undertake a disease-based approach, with sections on inflammatory skin disorders, skin cancer, infections and infestations, disorders of pigmentation, hair problems, and less common skin disorders. Individual chapters have titles such as "Acne Vulgaris" or "Erythema Multiforme," and follow an internal format similar to that of the Clinical Evidence series published several times a year also by BMJ. For each disorder, background, epidemiology, etiology, prognosis, diagnosis, and aims of treatment are quickly reviewed under appropriate headings. Then specific treatments are discussed in greater detail, with an emphasis on "harm," "benefits," and implications for clinical practice. At the conclusion of the chapters, which are about 10 pages long, key points are reviewed in a colored box. Throughout, case scenarios and clinically important questions (eg, "What is the best treatment for oropharyngeal candidosis?") guide the discussion and keep it rooted in practicality. The book by Maibach and colleagues prefers to address a few specific issues, both general disease states and extremely specific clinical challenges. For instance, there are chapters on atopic dermatitis and toxicodendron dermatitis, but there are also chapters entitled "Laser Resurfacing of the Skin for the Improvement of Facial Acne Scarring" and "Dressings for Chronic Wounds." The goal appears to whet the reader's appetite with a few succulent morsels rather than attempting a comprehensive review of dermatologic diagnoses or questions. Chapter authors have more latitude to choose their own format rather than adhering to a preset one. Both books are interesting and worthwhile. Both offer specific data as well as condensed tutorials on such basics as the "hierarchy of evidence." Both are written by important figures in the field: the Maibach volume is held up by the hard work of Ann McKibbon, who is with McMaster University, the well-spring of evidence-based thought; and Williams shares the editorial mantel with other luminaries of evidence-based medicine, including Luigi Naldi of Bergamo, Italy, and Michael Bigby, who is on the editorial board of this journal. The Williams volume is about twice as big and costs about twice as much. If a dermatologist were to purchase only one of these, and wanted a reference text, then the text by Williams et al would be the best choice. On the other hand, the Maibach volume is much briefer and would also be instructive for the newcomer to evidence-based dermatology. The Williams' systematic internal approach, including nicely spaced, navigable section headings and illustrations, make it easily usable for answering specific questions. The Maibach, like all BC Decker books, comes with a free CD-ROM affixed to the inside cover. In evidence-based medicine, questions are easier to pose than to answer. And it is easier to criticize methodological flaws in extant studies than to perform the perfect study oneself. So readers of either of these volumes will not find everything they want to know. But at least they will have a better sense of what is known and what is not. This should help in selecting between therapies and counseling patients. Hopefully, future editions of these books will keep pace with advances in dermatology and have more answers. Maibach et al Utility Index: Useful Production Quality: Good Primary Readership: Clinical dermatologists, dermatologists-in-training, subspecialists in dermatology, dermatologic surgeons Value for Money: Bargain Williams et al Utility Index: Indispensable Production Quality: Excellent Primary Readership: Clinical dermatologists, dermatologists-in-training, subspecialists in dermatology, dermatologic surgeons Value for Money: Good buy http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Evidence-Based Dermatology

Archives of Dermatology , Volume 140 (3) – Mar 1, 2004

Evidence-Based Dermatology

Abstract

If an academic topic is said to have arrived when a book is written about it, then evidence-based dermatology is clearly in the spotlight. Two entirely different books with the same title have become available within the past year. This is good news for those who care about evidence-based medicine. But it is another unwelcome reminder for the many excellent clinicians who are annoyed by the increasing insistence that their time-tested, best-loved therapies be objectively shown to be...
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Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.140.3.371
Publisher site
See Article on Publisher Site

Abstract

If an academic topic is said to have arrived when a book is written about it, then evidence-based dermatology is clearly in the spotlight. Two entirely different books with the same title have become available within the past year. This is good news for those who care about evidence-based medicine. But it is another unwelcome reminder for the many excellent clinicians who are annoyed by the increasing insistence that their time-tested, best-loved therapies be objectively shown to be effective. For many, the term evidence-based dermatology conjures images of dense statistical analyses or never-ending structured reviews that culminate in self-evident conclusions. Why is evidence-based dermatology worth reading about when it is more about technique than clinically relevant substance? The authors of both these books are sensitive to such charges of boredom and irrelevance, and have focused on providing readable, valuable content. In both books, most of the space is devoted to evidence-based examinations of clinical dermatology topics or questions. The Williams et al book is more tilted in this direction, with only about a tenth devoted to the abstract concepts of evidence-based dermatology and the evidence-based "toolbox"; perhaps because the Maibach et al volume is less than half the size of the other, a relatively greater proportion of Maibach et al comprises articles on the process of critical thinking in dermatology. The hearts of both books are fascinating and informative, and can be read in bits and pieces, as time permits. Williams and coauthors undertake a disease-based approach, with sections on inflammatory skin disorders, skin cancer, infections and infestations, disorders of pigmentation, hair problems, and less common skin disorders. Individual chapters have titles such as "Acne Vulgaris" or "Erythema Multiforme," and follow an internal format similar to that of the Clinical Evidence series published several times a year also by BMJ. For each disorder, background, epidemiology, etiology, prognosis, diagnosis, and aims of treatment are quickly reviewed under appropriate headings. Then specific treatments are discussed in greater detail, with an emphasis on "harm," "benefits," and implications for clinical practice. At the conclusion of the chapters, which are about 10 pages long, key points are reviewed in a colored box. Throughout, case scenarios and clinically important questions (eg, "What is the best treatment for oropharyngeal candidosis?") guide the discussion and keep it rooted in practicality. The book by Maibach and colleagues prefers to address a few specific issues, both general disease states and extremely specific clinical challenges. For instance, there are chapters on atopic dermatitis and toxicodendron dermatitis, but there are also chapters entitled "Laser Resurfacing of the Skin for the Improvement of Facial Acne Scarring" and "Dressings for Chronic Wounds." The goal appears to whet the reader's appetite with a few succulent morsels rather than attempting a comprehensive review of dermatologic diagnoses or questions. Chapter authors have more latitude to choose their own format rather than adhering to a preset one. Both books are interesting and worthwhile. Both offer specific data as well as condensed tutorials on such basics as the "hierarchy of evidence." Both are written by important figures in the field: the Maibach volume is held up by the hard work of Ann McKibbon, who is with McMaster University, the well-spring of evidence-based thought; and Williams shares the editorial mantel with other luminaries of evidence-based medicine, including Luigi Naldi of Bergamo, Italy, and Michael Bigby, who is on the editorial board of this journal. The Williams volume is about twice as big and costs about twice as much. If a dermatologist were to purchase only one of these, and wanted a reference text, then the text by Williams et al would be the best choice. On the other hand, the Maibach volume is much briefer and would also be instructive for the newcomer to evidence-based dermatology. The Williams' systematic internal approach, including nicely spaced, navigable section headings and illustrations, make it easily usable for answering specific questions. The Maibach, like all BC Decker books, comes with a free CD-ROM affixed to the inside cover. In evidence-based medicine, questions are easier to pose than to answer. And it is easier to criticize methodological flaws in extant studies than to perform the perfect study oneself. So readers of either of these volumes will not find everything they want to know. But at least they will have a better sense of what is known and what is not. This should help in selecting between therapies and counseling patients. Hopefully, future editions of these books will keep pace with advances in dermatology and have more answers. Maibach et al Utility Index: Useful Production Quality: Good Primary Readership: Clinical dermatologists, dermatologists-in-training, subspecialists in dermatology, dermatologic surgeons Value for Money: Bargain Williams et al Utility Index: Indispensable Production Quality: Excellent Primary Readership: Clinical dermatologists, dermatologists-in-training, subspecialists in dermatology, dermatologic surgeons Value for Money: Good buy

Journal

Archives of DermatologyAmerican Medical Association

Published: Mar 1, 2004

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