LAMPYRIS 101 review
Archives of Dermatology - 2003;139:1087-1088
(...) Thus, is the new Weedon the final answer, the only book anyone could ever need to learn dermatopathology? No, it surely is not. I have always told residents to purchase either Weedon's or Lever's texts but also read Bernie Ackerman's "gold book" from cover to cover. Even though Weedon devotes considerable effort to the diagnostic approach, he cannot be as complete or didactic as Ackerman. The more recent silver version of Ackerman's book attempts to come closer to the middle, adding more detailed disease descriptions to the almost-patented pattern approach, but still fails to cover all the bases. Finally, there is a new competitor-electronic sources such as Raffa Gianotti and Heinz Kutzner's Lampyris 101 (http://www.lampyris101.com), which for less money offer many times the number of illustrations and allow one to very rapidly match pictures, combine diagnostic clues, and reach a differential diagnosis. This simply is not possible with Weedon's or Ackerman's textbooks.
Journal of the American Academy of Dermatology - June 2003, part 1 Volume 48 Number 6
As a reviewer, it is always exciting to have the opportunity to alert one's colleagues to something that is truly new. Lampyris 101 is a CD-ROM, not a book, and a revolutionary advance in the literature of dermatopathology that should be of interest to all students, teachers, and practitioners.
I can distinctly remember starting to learn dermatopathology as a resident at the University of Minnesota in 1974 with multiple weekly slide sessions with Bob Goltz, Juan Rosai, and Pepper Dehner. The only books that were available were the pale blue Lever, and the 2nd edition of Pinkus; everything was confusing and the literature was worse. However, at least Pinkus tried to classify diagnoses by pattern: for example, lichenoid and psoriasiform. In November of 1974, a fellow resident, Paul Sayers, returned from a meeting in New York with 9 handwritten pages that were to influence my entire appreciation of dermatopathology. What were they? Bernie Ackerman's 9 patterns of inflammatory skin disease. I wore out these sheets waiting for the gold Ackerman. Since then, I have learned a lot of dermatopathology (but, unfortunately, forgotten more), read many books, written a few, but rarely encountered anything truly new.
A few weeks ago Drs Gianotti and Kutzner sent me a copy of Lampyris 101 to test and review. I was a bit skeptical as I am not exactly a computer wizard, as anyone who has tried to e-mail me has already learned. But my fears were unfounded. The program is very user-friendly, can be managed by almost any modem computer, and the technical supportfrom, most often, Dr Gianotti, but also his teamis superb. The program requires 30 megabytes of hard drive, while the extensive picture collection needs 580 megabytes but remains on the CD-ROM.
In simplest terms, Lampyris is a wonderful electronic expansion of Ackerman's patterns of inflammatory diagnosis. But I must immediately add that Drs Gianotti and Kutzner and their computer wizards have developed a program that far exceeds anything Ackerman (or Pinkus) could have imagined. There are a number of ways to approach an issue with Lampyris 101. If one is trained to think in terms of pattern diagnosis, then one can choose from 10 patterns of inflammatory disease, most of which will sound familiar: superficial perivascular; superficial and deep perivascular; panniculitis; vasculitis; nodular; subepidermal vesicular; intraepidermal vesiculopustular; diffuse; folliculitis; and alopecia. With just a few mouse clicks, these patterns can be rapidly narrowed. For example, under superficial perivascular, there are 13 subcategories including spongiotic psoriasiform bandlike, where the possibilities include mycosis fungoides, lichen striatus, and urticarial bullous pemphigoid. One can then click on each disease for more detailed information and see an amazing array of photomicrographs showing every imaginable variation on the theme. The CD-ROM currently contains 4800 photomicrographs. The new Lever will have about 1000; if we estimate that half will be devoted to inflammatory skin disease, then we see that a CD-ROM improves the most important aspect of any dermatopathology learning resource by a factor of 10.
On the other hand, what if the clinician has submitted, with the question rule out lupus erythematosus, a slide? Then one can start with lupus erythematosus, identify the differences between discoid and systemic disease, receive a list of 20 to 40 histologic findings associated with the disease, and have a chance to see many of these findings illustrated. In addition, one can do face-to-face comparisons not only with the diseases the authors consider most likely differential diagnostic problems but also with any disease. Here, all of the histologic findings seen in each disease are listed and only those that the diseases share appear in red. For example, I compared juvenile xanthogranuloma with bullous pemphigoid. They both contain eosinophils and lymphocytes but all other features are entirely different. I found the ability to instantly compare 2 diseases the most valuable feature of Lampyris 101, the one that provided me with the most fun and the most information.
In another mode, one can start out with a single histologic finding and then add other findings to refine and narrow the diagnosis. For example, with eosinophils and dyskeratotic keratinocytes, one arrives at incontinentia pigmenti, Grover's disease, and photoallergic dermatitis in about 2 seconds. As Dr Gianotti writes in the introduction, it is futile to fight against the computer. Each of us requires much longer to produce such information, either by straining our gray matter or paging through available textbooks. Having so much information available so quickly allows one to devote one's energy to studying the slide.
There are many other features of Lampyris 101 that will be of interest to more imaginative and computer-skilled users of the program. One can easily change any of the information that the authors have provided: adding diseases; changing criteria; shifting pathways; and storing new pictures. In the introduction, the authors suggest that one could even use Lampyris 101 simply as a framework to create a similar system for any other branch of pathology, but I am not qualified to comment on such possibilities. I must confess that I like the program just the way it is.
I consider Lampyris 101 a very valuable tool both for teaching and learning dermatopathology, and for the daily practice of the discipline. If one is honest, one must admit when confronted with difficult slides, most of us resort to paging through text books, reading criteria, and matching pictures. Lampyris 101 does all this for us, far more quickly and in a far more sophisticated way than anyone could have imagined a few years ago. I encourage all those interested in dermatopathology to acquaint themselves with this superb addition to our intellectual armamentarium. Here comes the best part. All you have to do in visit the World Wide Web site (www.lampyris101.com), where you can sample the pictures, go through the tutorial, use the program several times in your own daily work, and then decide. I promise you, the decision will be easy.
H. C. Burgdorf
Archives of Dermatology Vol.139, N.1, 2003
J.Cutaneous Pathol 2003;30. 216
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