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A review of Hurwitz

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A review of Hurwitz Clinical Pediatric Dermatology E-dition (Third Edition) - Text with Continually Updated Online Reference
Noah Scheinfeld
Dermatology Online Journal 14 (8): 17

Assistant Clinical Professor of Dermatology, Department of Dermatology, Columbia University, New York, NY.

Hurwitz Clinical Pediatric Dermatology e-dition (Third Edition) - Text with Continually Updated Online Reference by Amy S Paller, MD and Anthony J Mancini, MD

Figure 1

Hardcover: 752 pages, 800 ills
Publisher: Saunders; 3rd edition (November 23, 2005)
Language: English
ISBN-10: 0721604986
ISBN-13: 978-0721604985
Price: $235.00, Book with Online E-dition Reference
$185.00 Book only


How truly personal and intimate a single author medical text can be. At its best a single-author text can conduct a heroic journey from callow ignorance to insightful maturity, a bildungsroman that captures and unifies a world of knowledge. From Yale several decades ago came two great single-author dermatology texts, Hurwitz's Clinical Pediatric Dermatology and Braverman's Skin Signs of Systemic Disease. Their lucid insights, concise prose, and clarity remain astounding. Braverman completed a third edition; Sidney Hurwitz died not long after the second edition of his book was published and the task of a third edition fell into the able hands of Amy Paller and Anthony Mancini.

The third edition has much to recommend. It remains a book that can be read rather than referenced and simultaneously contains almost all the answers needed to answer the 200 questions of the Pediatric Dermatology Boards.

The use and utility of a readable text can not be underplayed. I recall a conversation with a former chief resident from the University of Michigan on a bus after the first day of the Dermatology Board examination; we were trying to get from the O'Hare Holiday Inn to Lincoln Park without going downtown. He noted that he had wanted to use Andrews' Diseases of the Skin: Clinical Dermatology for the resident book club because he wanted to use a book that could be read and remembered, but the Chairman was adamant that Fitzpatrick's Dermatology in General Medicine be the choice. The task of reading the Fifth Edition of Fitzpatrick's text, cover to cover to me seemed trickier than reading Mason Dixon or Finnegan's Wake and could only be accomplished by skimming. There is no need to skim Hurwitz's Clinical Pediatric Dermatology; it can be read and savored like The Red And The Black (started on a July Sunday morning and completed with the setting sun).

Still perhaps, I possess a misplaced nostalgia for the second edition, which I bought in my fourth year in medical school and took as gospel throughout residency. I miss the glosses in the bibliography that summarized important articles; in the third edition they are merely highlighted gray. For me, diseases such as keratosis lichenoides chronica (Nekum disease) were defined by what I read in the second edition.

My criticism is mainly that the discussion of a number of rare entities in the third edition is pro-forma and incomplete. Four prominent examples include:

  • The discussion of Degos disease stresses its malignancy (although most cases are likely benign and not detected) and describes the utility (unproven) of anti-coagulants.
  • The theory that confluent and reticulated papillomatosis is linked to insulin resistance is mentioned first among theories without much substantiation, whereas its one real defining feature, almost universal response to minocycline, is underplayed. The utility of azithromycin, which is safe in children, is not mentioned at all.
  • The discussion of hypereosinophilic syndrome leaves out the crucial fact that imatinib mesylate is an effective treatment and that its genetic basis involves del(4)(q12)-FIP1L1/PDGFRA.
  • The neglect of the PHACE syndrome that had been defined by 2005, a year before the third edition was published.

The age of Hurwitz and Braverman (who is still alive) has passed. However, we are still fortunate to live in the age of Saddick and Schlesinger, of Goldberg and Goldberg and, for those students of pediatric dermatology, of Paller and Mancini. We still have scholars who do not shuck off the challenge of putting an entire field of study in a book. Physician scholars willingly and effectively take up the burden of medical history and create something new and wonderful.

© 2008 Dermatology Online Journal