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WWW Resources for dermatology. A critical appraisal.

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(3) WWW Resources for dermatology. A critical appraisal.

by Thomas Ray M.D. and Arthur C. Huntley M.D.

Dermatology Online Journal, July 1995
Volume 1, Number 1


Current medical resources on the Net today have a great range in quality from poor to excellent. This study attempted to create objective criteria for that which makes a resource valuable, and then to evaluate the current resources. A suggested list of Internet resources for practitioners and students of dermatology is given. The existing dermatologic resources should be compelling for the student, teacher, investigator, and especially the clinical practitioner to actively use the Net.




Notwithstanding the fascination of most physicians using the Internet today, a substantial criticism of this medium is that the available resources have little practical value for the education or practice of medicine. Exponents of this assertion claim that current Internet resources are not compelling enough to attract or hold the interest of more than a minority of physicians. However, the exponential growth of the Internet continues to generate the appearance of new and more diverse resources, as well as the upgrading of older items. As academic sites world-wide attempt to provide compelling practical resources, it is probable that the Internet will evolve into the tool-of-choice for medical informatics and data access. The user base will swell accordingly and the paradigm of medical practice will adjust.

Does the current material on the Net fall short of expectation? Basic problems of posted medical material can be classified into three areas: scholastic quality, relevence, and ease of access. Quality is a major issue. The Internet allows anyone with hardware and a connection to "publish", and a great deal of material appears to be posted without editorial oversight or peer review. On surfing the net, one can encounter empty content, untrue statements and incorrectly labeled images, as well as superbly written, illustrated and informative resources. Yet much of the medical material on the Internet lacks a measurement or assurance of veracity.

Relevance is an important issue. Sites may post material of high scholastic quality yet the material may not be of use to the viewer. An example would be the award winning PDQ Physicians Database project, which posts an electronic synopsis about numerous forms of cancer. Some audiences will find this an outstanding resource, yet a dermatologist examining these thoughtfully written documents would find little of practical value. Content is critical for relevance, and relevance, like beauty, is in the eye of the beholder or, in this case, the user.

The third problematic area of the medical Internet is termed the ease of access. It encompasses several issues: Is the material freely available? Is it easily accessed? Is it well written to take advantage of the medium? One outstanding medical resource on the Internet today, Medline, is not free to access. Material posted in a location with a constricted Internet connection may not be easily accessed. Items transferred in simple book format may be more difficult to read and use in computer format than the printed page. Well written material should be optimized for the power of the computer, and the assets of the Internet and hypertext WWW medium.

With these three criteria in mind, we attempted to perform an ad hoc peer review of selected major resources for dermatology. Defining the target audience as practitioners, investigators and students of dermatology, we examined current Internet resources and made a quasi-objective assessments of their value.


Sites providing information of primary interest to dermatologists were examined. Evaluated resources were selected from sites known by personal use, referenced by other sites, or retrieved by Web search engines (Lycos, InfoSeek, WebCrawler, etc). An evaluation scale was created to reflect the above identified problems of quality control, relevance, and ease of access. In evaluating relevance, the target audience was assumed to be a practicing dermatologist, a dermatologic educator or investigator, or a student of dermatology. Following the score for relevance, we list our assumed target audience best suited for the resource. In some instances, patients, as well as physicians, may be the best audience. The point scale is as follows:

A. Degree to which material is subject to quality control:

  • 3 points: established and peer reviewed
  • 2 points: peer reviewed
  • 1 point: university based, but not peer-reviewed
  • 0 points: no peer review, no academic affiliation
B. Relevance or Usefulness for the defined target audience
  • 3 points: must have available
  • 2 points: probably useful, recommended
  • 1 point: perhaps of some use
  • 0 points: probably not useful
C. Ease of Access
  • 1 point free to the user
  • 1 point no obstruction to access (inadequate provider-Internet connection)
  • 1 point takes advantag of the medium


The resources were grouped by category: periodical, non-periodical, reference, discussion. For each resource an evaluation was made for hypothetical target audience of students and practitioners of dermatology. The hypertext references for each item present a more extensive discussion and access information or links. Here then, listed by category are some of the sites of most note:


British Medical Journal: total score 7

  • 3 estabilished peer reviewed
  • 2 probably useful educational material for dermatologist or medical student
  • 2 free, adequate access

Emerging Infectious Diseases (EID): total score 6

  • 3 established peer reviewed
  • 2 material of probable use to dermatologists and medical students
  • 1 free

Dermatology Online Journal: total score 6

  • 2 peer reviewed
  • 1 material of possible use to dermatologists
  • 3 free, adequate access, special use of medium

Medscape: total score 3

  • 0 commercial venture
  • 1 possible educational use for material (medical student)
  • 2 free, adequate access

Rhett Drugge's Global Dermatology Grand Rounds: total score 3

  • 0 non-university based, non -peer reviewed
  • 1 possible use by students and for dermatolgy CME
  • 2 free, adequate access


Erlangen Atlas of the Skin: total score 7

  • 1 university based
  • 3 useful material for education, especially for medical students and dermatology residents
  • 3 free, adequate access, special use of medium

Mie Department of Dermatology:total score 4

  • 1 university based
  • 1 possible use by dermatologists and students
  • 2 free, adequate access


Jerome Litt's Drug Reaction Database: total score 9

  • 3 reference to establihed peer reviewed material
  • 3 must have available for practice
  • 3 free, adequate access, special use of medium

Medline: total score 8

  • 3 established reference base
  • 3 must use resource
  • 2 adequate availability, special use of database searching

Support Group/Patient Advocacy (Tom Ray and the DNA) List: total score 6

  • 1 university based
  • 2 probable use by practitioners and patients
  • 3 free, adequate access, special use of medium

Dermatology Laboratory Tests Resources (Rochester) - Lowell Goldsmith M.D.: total score 6

  • 1 university based
  • 2 probable use by practitioners
  • 3 free, adequate access, special use of medium


RxDERM-L Dermatology Treatment Discussion/Archives - Huntley: total score 6

  • 1 archives moderated
  • 2 probable use by dermatologists
  • 3 free, adequate access, special use of medium

Derm-L Dermatology Discussion List - Langdon: total score 5

  • 1 university based (moderated)
  • 2 probable use by practitioners
  • 2 free, adequate access

Acaderm-L Academic Dermatology Discussion List - Huntley: total score 4

  • 0 unmoderated
  • 2 probable use by academic dermatologists
  • 2 free, adequate access

Keratinocyte Research Discussion List: total score 4

  • 0 unmoderated
  • 2 probable use by dermatologists doing epidermal cell research
  • 2 free, adequate access


Despite the attempt to make these evaluations objective, the reader may consider the resources to be under- or over-rated. The evaluations do reflect the prejudices of the authors. Nevertheless, the issues raised about quality, usefulness and information access appear to be key factors for assessment.

Our assessment indicates that there are excellent resources currently existing on the Internet. Contrary to previous assessments, the dermatologic material on the Web appears to be of practical value for both the education and practice dermatology. The existing resources should be compelling for the student, teacher, investigator and especially the clinical practitioner to actively use the Net.

All contents copyright (C), 1995.
Dermatology Online Journal
University of California Davis