Searching For Skin On The Net : Dermatology Resources

by Stephen M. Pribut, D.P.M., F.A.C.F.A.S.

Dermatology is a subject of great importance to Podiatric Medicine. The American Society of Podiatric Dermatology has recently concluded their annual "Cherry Blossom Seminar" in Washington, D.C. This meeting has been taking place here for nearly 20 years. Skin serves the important functions of keeping the environment out of our interior and providing us with our feeling sensations such as touch, pressure, two point discrimination, heat and cold. Skin also plays an important role in thermoregulation. Skin is the largest organ of the body. Gary Dockery, in his excellent text "Cutaneous Disorders of the Lower Extremity" states that Skin has surface area of up to 15,000 square inches which would measure out to cover nine by twelve feet. All of this skin weighs more than twice as much as the average sized human brain.

Many of the disorders we treat exhibit significant skin manifestations. Among the many clinical entities we encounter are Melanoma, Kaposi's Sarcoma, Onychomycosis, Psoriasis, Solar induced disorders, Lichen Planus, Lichen Planus, Verruca, and Eczema. The skin may also be a portal for infections of both skin and deeper structures. A thorough knowledge of the structure and appearance of both normal and diseased skin is essential to our practice. I recommend Dockery's book as an excellent desk reference and the Internet as an active supplement. The Internet has many dermatological organizations and institutions which contribute to an ever expanding and evolving web of resources.

Before visiting the serious sites, let's go the movies and visit Dermatology In The Cinema. This is a fascinating site which reveals the truth of the dermatological splotches of the Hollywood Stars in both real life and cinematic depictions. This site combines knowledge and humor in a delightful manner and gets a 3 toe rating in my book. The site's author, Vail Reese M.D., reviews a variety of categories of skin conditions and has an Academy Award Update page. Hot topics include the signs of evil in the cinema such as tatoos, alopecia, and scars. You can also see the dangers of sun exposure revealed in comparative photos of aging actors such as Robert Redford and Brigette Bardot.

Our formal tour of Dermatological sites begins with a visit to the Internet Society of Dermatology (IDS). Their goal is to promote the use of the Internet to share and enhance dermatological knowledge and patient care. They host numerous online services such as online texts, lectures, grand rounds and have excellent links to other sites. They also plan to have online credentialing and a network for consultation.

Texts and Atlases:

Looking for online reference sources we find hyper-textbooks and searchable atlas-databases. An Electronic Textbook of Dermatology is available at the IDS site at: http://www.telemedicine.org/stamfor1.htm . This multi-author work is superb. The topics include Alopecia, Diabetes and Skin Disorders, Blistering Diseases, Sun Damage, and Contact Dermatitis. The Friedrich-Alexander-University of Erlangen-Nürnberg, School of Medicine in Germany has a searchable combination atlas and database available at: http://www.rrze.uni-erlangen.de/docs/FAU/fakultaet/med/kli/derma/ . Loyola University Medical School has an excellent online atlas at: http://www.meddean.luc.edu/lumen/MedEd/medicine/dermatology/melton/atlas.htm The illustrations and slides are of high quality.

Grand Rounds:

The Internet Society of Dermatology also hosts the "Global Dermatology Grand Rounds". This allows their members to participate in a world wide grand rounds. They also have links to an online Textbook of Dermatology, online lectures on a variety of topics and an excellent set of links. The clinical entities are diverse and interesting. Slides, lab tests and photographs are well presented at their site. To actively participate you can readily become a member of the IDS. Other grand rounds are hosted at: http://dermatology.wustl.edu/Case.html.

Journals and News:

The Online Journal Of Dermatology is found at: http://matrix.ucdavis.edu/DOJdesk/desk.html . Their publication has been intermittent but has newly revived with the March 1997 issue. The articles are interesting, well presented and of high quality. Recent articles include the online web educational program at Washington University in St. Louis, Missouri, Ulcerating necrobiosis lipoidica, Malignant Melanoma, and reviews of books and software. With their latest issue comes the announcement that this journal is now indexed on Medline achieving the distinction of being the first exclusively online journal to do so.

MedWebLit (http://www.webmedlit.com/topics/DermLit.html ) extensively covers the recent dermatological literature. Both abstracts from print journals and full text from online information sources are found here. A link to a newswire search of relevant articles from electronic newswires, newspapers, and trade periodicals is also just a click away from this site.

Skin Cancer:

Arthur C. Huntley, M.D. of the University of California, Davis has an online tutorial to assist you in becoming an "expert at diagnosing Melanoma. His site is found at: http://matrix.ucdavis.edu/tumors/new/tutorial-intro.html . The well known online cancer site called Oncolink has extensive information for both the physician and the patient on Skin Cancer available at http://oncolink.upenn.edu/disease/skin1/ . Links to Cancer Net literature search and databases of therapy are also found here.

The future of computers in medical and specifically dermatological diagnosis may be glimpsed at http://www.cs.umr.edu/~hlee/thesis/thesis.html . This Master's thesis of Hsi-Chieh Lee tells it all in the title "Skin Cancer Diagnosis Using Hierarchical Neural Networks And Fuzzy Logic". The system described here had a diagnostic accuracy of 93% while general dermatologists had an average diagnostic accuracy of 82%. Neural networks and fuzzy logic may be our future diagnostic consultants.

Rounding out our computer based Dermatological resources is the Textbook of Dermatology on CD-ROM, by Thomas B. Habif, M.D. This CD-ROM textbook is based on the third edition of his highly praised text. It was published in 1996 by Mosby-Year Book, Inc., St. Louis. The CD-ROM edition has approximately 3,000 images which triples the number of illustrations in the print edition.

Our travels through the web of Dermatological resources again shows how the web can be used as an instrument for medical education and the sharing of knowledge. I hope I've inspired some of the membership of the American Society of Podiatric Dermatology to add Podiatric Dermatology to the list of web based resources.

Stephen M. Pribut, D.P.M. hosts a popular Sports Medicine site at: http://www.drpribut.com/sports/spsport.html