Book Review: Women's Dermatology: From Infancy to Maturity
Authors: S M Cooper
Journal: Journal of the Royal Society of Medicine (2001)

The concept of a textbook devoted to dermatology in females is at first thought rather odd. Isn't skin more or less the same in males and females? Dr Parish and his co-editors argue that gender differences in dermatology have been largely neglected to date and their book is an attempt to explore the ‘differences that entitle girls and women to gender-specific health care measures’. The work offers historical aspects, multicultural views plus detailed descriptions of dermatological conditions; and, reflecting the predominantly American authorship, it gives much space to cosmetic body-beautiful issues. Some chapters achieve the woman-oriented approach better than others. The nail chapter by Baran and the chapter on pregnancy dermatoses by Vaughan Jones hit the mark exactly.

The historical section gives a fascinating insight into women's attempts to retain youthful beauty through the centuries. The taste for pallor, which continued into the twentieth century, resulted in use of toxic whitening pastes of brimstone, white lead and mercury that cracked terribly when the hapless wearer forgot not to smile. Milk, ground bones and even blood from birds were applied to the skin. Many women suffered terribly from smallpox scars. (Queen Elizabeth I survived smallpox unscathed because she did not follow the practice of the time in lancing the spots; instead she treated them by the Arabic method of applying red cloths and filling the bed chamber with red objects.)

A large cosmetics section explains the science behind the formulations of cosmetics, including the differences in the four types of facial foundation creams—oil-based, water-based, oil-free and water-free. Oil-free facial foundations contain no animal, vegetable or mineral oils but do contain other oily substances such as silicones. These non-comedogenic foundations will be of interest to acne sufferers and people with oily skins. The adverse effects of cosmetics, including contact dermatitis (both irritant and allergic), are highlighted. A particular hazard is bacterial contamination of eyeliner and mascara, which can cause devastating Pseudomonas eye infections; we probably should all check our cosmetic drawer and throw out any products more than three months old. Another large section is devoted purely to cellulite and will have the female readership leaping to the bathroom mirrors to do the pinch test. A ‘quilted’ or ‘mattress’ appearance of the skin when pinched or at rest is due to the presence of fibrous retinacula that connect skin and fascia between the fat lobes. In addition, prominent follicular openings may result in an orange peel appearance. The mainstay of treatment remains weight loss, and the authors conclude, as many doctors will have long suspected, that topical creams and systemic drugs have no effect. There do, however, seem to be some benefits from lymphatic massage, and we read of a new operation of subcision where the fibrous retinacula are sectioned.

These cosmetic items sit uncomfortably with chapters on the special problems of African, Indian, Korean and expatriate women. For many such women more pressing matters than cellulite are the hope of a normal life-span, enough food to eat and the privilege of not losing one's children in childbirth or in infancy. The contributors discuss differences in skin type between races and how these considerations may affect treatment. For instance, it could be inappropriate to suggest daily hair-washing to an African woman with scalp psoriasis since her hair might not cope. African hair is structurally different from Caucasian hair and more prone to weathering (wear and tear cuticular damage). Cultural differences and practices are covered—for instance the traction alopecia from tight plaiting or braiding that gives severe permanent hair loss around the hair margins in African women, and the alopecia resulting from the practice of hotcombing in African-American women.

Vulval dermatology should be prominent in a book of this sort and here I noted some omissions. For instance, there is no mention of vulval psoriasis or seborrhoeic dermatitis, both frequent diagnoses in the vulval clinic.

After initial scepticism I ended up won over by this text. It could be of interest to gynaecologists and general practitioners as well as dermatologists. If you want straightforward descriptions of dermatological conditions a standard text will suffice. But, if you want a bit more insight into the special problems of women, to be entertained and to learn a little more of the history of beauty you will not be disappointed.