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Cutaneous Manifestations of Rheumatic Diseases.
  1. ALAN N BAER
  1. Division of Rheumatology
  2. State University of New York
  3. 3495 Bailey Avenue, Buffalo
  4. NY 14215 USA

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    Cutaneous Manifestations of Rheumatic Diseases. Edited by R D Sontheimer and T T Provost. (Pp 528; £116.) Baltimore: Williams and Wilkins, 1996. ISBN 0-683-07852-6.

    The idea for a monograph devoted exclusively to the cutaneous manifestations of rheumatic diseases was conceived by Professor James Gilliam, late Chairman of the Department of Dermatology at University of Texas-Southwestern MedicalSchool. This monograph has now been written by his friends and colleagues and is dedicated to the memory of a superb clinical investigator and mentor who suffered an untimely death from cancer. The aims of the editors of this monograph are dual: to provide a comprehensive review of the cutaneous manifestations of disorders that concurrently affect the skin and the musculoskeletal system and to provide a pictorial atlas of these disorders through the use of 253 photographs, 222 of which are in colour. The book was written exclusively by dermatologists (16 of the 17 authors have academic appointments in the United States) but is intended for both rheumatologists and dermatologists.

    Two thirds of the book are devoted to systemic and neonatal lupus erythematosus, dermatomyositis, scleroderma, Sjögren’s syndrome, scleroderma, and systemic vasculitides. For each of these diseases, the discussions are structured into subsections devoted to classification, epidemiology, cutaneous manifestations, pathology, aetiopathogenesis, differential diagnosis, and management. The relation between the cutaneous and systemic features of lupus, dermatomyositis, and systemic vasculitis is also discussed. These chapters are excellent, comprehensive current reviews of their topics. They summarise important recent advances in classifying and defining the cutaneous immunopathology of these disorders. The chapter on systemic lupus erythematosus, organised on the basis of Professor Gilliam’s classification of lupus erythematosus skin lesions, provides an excellent synthesis of our current understanding of the clinical, serological, and genetic features and management of the subacute and chronic cutaneous lupus subsets. The extensive chapter on vasculitis includes a useful comparison of the clinical evolution of lesions caused by vasculitis and non-inflammatory vascular occlusion in the skin. The chapter on dermatomyositis includes discussions of the relation between myositis associated autoantibodies and myositis subsets, amyopathic dermatomyositis, and the emerging role of magnetic resonance imaging in the evaluation of these patients. Comprehensive reviews focusing on the cutaneous manifestations of the connective tissue diseases are not currently available in the standard textbooks of dermatology or rheumatology. The discussions of other rheumatic disorders are not as comprehensive as those relating to the connective tissue diseases. There are no figures to illustrate the toxic erythemas associated with Still’s disease or acute rheumatic fever. The section on Reiter’s disease omits mention of the unusual severity of this disease in HIV infected patients and the dilemma that this poses in choosing appropriate therapy. Circinate balanitis and early lesions of keratoderma blenorrhagicum are not illustrated. New insights into disease pathogenesis, which have been garnered from studies of transgenic rat models and the discovery of persistent microbial antigens in synovial tissue are not mentioned. The discussion of psoriatic arthritis makes no mention of therapy, a topic of particular interest because different anti-arthritic agents may exacerbate the skin disease. For readers who are not dermatologists, it would have been helpful to emphasise differential diagnosis, including evaluation of a malar eruption or the distinction between erythema marginatum and the rash of Still’s disease.

    This monograph succeeds amply in meeting the aims of its editors. The monograph fills a definite gap in the current repertoire of rheumatology and dermatology texts and receives my strong recommendation. As this is the first edition, minor deficiencies mentioned above will probably be corrected in subsequent editions, of which I suspect there will be many.

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