The remit for the first edition of the ABC of Dermatology in 1987 was that it should concentrate on common conditions and give down to earth advice. The ABC format proved well suited for this and there has been a steady demand for the book since then. In this edition the same approach is maintained while taking into account advances in diagnosis and treatment. Research in genetics and immunology is providing ever-increasing insights into the mechanisms that underlie clinical changes, and has led to more accurate diagnosis and more rational treatment. Specialised techniques that may not be relevant to common conditions can be of the greatest importance to an individual patient with a rare disease. In epidermolysis bullosa, for example, the ability to differentiate accurately between the different types with electronmicroscopy and immunohistochemistry is of considerable significance. Generally research increases our understanding of how diseases arise, but we have to admit to ourselves and our patients that why they occur remains as elusive as ever. In recent years the management of inflammatory skin conditions has become both more effective and less demanding for the patient. In addition there is greater recognition of the impact of skin diseases on the patient’s life. Major advances in treatment include more effective and safer phototherapy and the use of immunosuppressive drugs that enable inflammatory dermatoses to be managed without the need to attend for dressings or admission to hospital. This is just as well, since dermatology inpatient beds are no longer available in many hospitals. As a consequence, more dermatology patients are managed in the community with a greater role for the community nurse and general practitioner or family doctor.
Dermatology liaison nurses play a very important part in making sure that the patients are using their treatment effectively at home and in maintaining the link between the hospital department, the home situation, and the general practitioner. Self-help groups are a valuable resource of support for patients, and there is now much more information available to the public on the recognition and management of skin disease. Progress has been made in increasing the awareness of the general public and the politicians (who control the resources for health care) of the importance of skin diseases. In countries with minimal medical services there are immense challenges— particularly the need for training medical workers in the community who can recognise and treat the most important conditions. This has a major impact on the suffering and disability from skin diseases. The International Foundation for Dermatology and the pioneering Regional Dermatology Training Centre in Moshi, Tanzania, have set an important lead in this regard.