rameters has been overcome, the techniques were proprietary. The third paper describes a study on the esterase activity of the skin using molecules of clinical significance. The paper is well documented and presents new experimental data. The work was said to be confirmatory of similar ester degradation studies by a Japanese group. The last section contains four contributions under the general heading of "Practical Applications of Skin Pharmacokinetics." It was here that I hoped to find the basis for the symposium. However, two of the contributions were equivocal regarding their practical applications as indicated by the section heading. One dealt with the outward migration of theophylline and the other described the absorption and disposition of benzyl acetate in the rat. This uncertainty was particularly evident for the benzyl acetate studies where the recovery of radiolabeled material was said to range from 77% to 88%. Of the remaining two papers only one had clinical significance but did not entail much in the way of penetration kinetics. In summary, it may be said that for those who are well versed in the past and current literature this book will provide little that they do not already know. With regard to any advance in understanding skin processes, improving the quality of skin therapy, or practical systems for systemic drug delivery via the skin portal, I found no evidence in the discussion or concluding paragraphs of the contributions that led me to believe that this has been achieved. This book is judged to be of greater value to symposium participants rather than to nonparticipants because it is they who will have had the advantage of direct interaction with the gathering of their peer experts in this field. This is also true with regard to the poster presentation section. The editors are to be congratulated on their achievement of organizing this volume and overcoming the problems of assigning the contributions to their appropriate sections. It is a universally difficult task. It is far easier to find contributors willing to deliver subjective and data-based presentations in a symposium forum than it is to persuade them subsequently to submit timely and quality texts of their oral presentations. Peter J. Ayres, Ph.D., Cincinnati, OH
Journal of the American Academy of Dermatology Psoriasis: Proceedings of the Fourth International Symposium Eugene M. Farber, M.D., Lexie Nall, Ph.D., Vera Morhenn, M.D., and Paul H. Jacobs, M.D., editors, New York, 1987, Elsevier Science Publishing Co. Inc. 574 pages. $85.
The goal of the Fourth International Symposium on Psoriasis was to facilitate and accelerate communication among psoriasis investigators in the diverse areas of ongoing research. The purpose of this text appears to be the consolidation of this information. The first half of the book consists of plenary papers on keratin maturation pathways, immunologic aspects, therapies, and special themes such as psoriatic arthritis. This section provides background information for the second half, which is entitled "Brief Communications." This second section consists of concise reviews of topics such as systemic and local growth control, regulation of keratinocyte maturation, immunologic mechanisms, epidemiology and genetics, unusual expressions of psoriasis, and therapies. All current treatment modalities are covered with emphasis on the latest developments in standard therapies as well as experimental agents. There are also several papers on self-help and mutual aid that include the patient's perception of psoriasis and patient education programs. The strongest points of the text are the range of topics covered and emphasis on the most current research. Dividing the treatment section into specific therapies provides logical access to this information. These chapters address not only current research but also equally emphasize the clinical applicability of the information. The division of the text into plenary papers and brief communications is confusing as the same topics are discussed repeatedly in each section. Background material contained in the plenary papers is separated from the same topics covered in the brief summaries by several hundred pages. It is not clear why this format was chosen. Overall, this text covers the "cutting edge" of psoriatic research concerning theories, cellular biology, and experimental therapies in a concise reference. The treatment section will be of the most interest for a dermatologist who treats a large population of psoriatics and wishes to have a brief
Volume 18 Number 6 June 1988
reference on the latest developments in psoriatic research. However, since the majority of this text is aimed at a research-oriented audience, it may have limited practical use for the general dermatologist.
Beth Goldstein, M.D., Augusta, GA
Advances in surgery. Vol. 5 in series Clinics in dermatology
Larry E. Millikan, M.D., guest editor, Philadelphia, 1987, J. B. Lippincott Company. 144 pages. $60 annual subscription.
Advances in Surgery is the 1987 fourth quarter offering of the Clinics in Dermatology series. The yearly subscription rate is $60, or this single volume m a y be purchased for $25. The fourteen chapters in this small book are directed primarily toward more advanced or specialized aspects of dermatologic surgery. It starts with an original approach to the history of dermatologic surgery, followed by a survey of contemporary office equipment and instrumentation. In Chapter 3 a practical look at wound healing and the effects of various dressings on the healing process is presented by Larry Millikan, M.D., guest editor of this volume. Chapter 4 is a basic science contribution examining ongoing cellular activity during wound healing from a unique electron microscopic point of view. The chapter on chemical peels by Dr. Paul Collins is very well written and is perhaps the most useful, practical treatise on the subject I have seen. He reviews his techniques and the formulas he uses and then discusses sequelae and possible complications.
Chapter 6 is a brief summary of current practice and recent advances in the use of dermabrasion. Dr. John Yarborough provides a good overview of the procedure, indications and contraindications, and management of complications, as well as how to avoid them. Hair transplant surgery is reviewed in the next chapter, including patient selection, planning, graft preparation, and the procedure itself. A few illustrations would have added to the chapter's value. In Chapter 8 there is a discussion of scalp reduction for treatment of alopecia. Again, diagrams or illustrations would have been helpful. Next there is a nice summary of flap and graft repairs of surgical defects at a variety of anatomic sites such as eyebrows, nose, and ears. Chapter 10 is a review of liposuction, including fat metabolism, patient selection, side effects, and technique. Then a chapter on cryosurgery briefly examines techniques and clinical applications. There follows a brief but fairly comprehensive review of soft tissue augmentation. Then Dr. Richard Scher discusses nails, including anatomy, function, and a minireview of recent advances in nail surgery. Finally, Dr. Collins presents a brief but lucid review of where we have been, where we are now, and where we are going in dermatologic surgery. Overall this is an excellent concise review of recent dermatosurgical advances. Although the single volume price is a little steep, this is a real bargain for Clinics in Dermatology subscribers.
Jack L. Lesher, Jr., M.D., Augusta, GA