Acne: Diagnosis and Management

Abstract

Professors Cunliffe and Gollnick have produced a useful highly illustrated handbook for clinicians who manage patients with acne and related disorders. Although much of it deals with diagnosis and management (as the title indicates), almost a quarter is taken up with an in-depth account of the pathophysiology and microbiology of acne. This section gives up-to-date information on the routine and experimental techniques that can be used to investigate acne, perhaps directed largely at those doing skin research. On this theme it describes experimental evidence on the nature of the early inflammation in acne lesions and how disruption of the pilosebaceous follicle might result in an ongoing, cellmediated, antigen-dependent immune response. Since the target readership clearly includes dermatologists as well as general practitioners and other clinicians (hospital-based treatments such as roaccutane are included) the book would have benefited from more discussion of individual complications such as acne fulminans and inflammatory sinuses or cysts, but the common features of acne are handled very thoroughly. Much of the remainder of the book offers a detailed account of modern therapies for acne, including recent evidence for the efficacy and safety of the individual topical and systemic agents. This is particularly important in the areas of antibiotic-resistant Propionibacterium acnes, autoimmune and other side-effects of systemic tetracyclines and the safety of long-term systemic retinoids. These subjects are handled very clearly. Acne subtypes and the range of differential diagnoses are also well covered. This section will be especially useful to the non-dermatologist since it includes management options for many of these conditions as well as clinical descriptions and an atlas of clinical photographs. Schering Health Care sponsored the book and some of their acne medications are mentioned by tradename rather than by generic name alone. However, perhaps for balance, one or two other treatments also include the tradename. There is certainly no bias towards the sponsoring company's treatments. In summary—a very well presented and well illustrated textbook.