What is evidence-based dermatology?

Although the term 'evidence-based' has been recently introduced, the evidence based idea is very old indeed; in ancient world, Aristoteles placed a rule for all investigators of the time that they should support each of their statements with all available evidence. In 1991, Sackett defined the term evidence based medicine (EBM) as a conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. Some other authors define EBM as the best way of linking and integrating clinical research with clinical practice. Until now, our decisions on reaching the diagnosis and especially on the choice of therapy for our patients have been based on data acquired through our experience, from the experience of our colleagues, and from the routine at the particular medical institution. The best therapy for each individual patient is chosen according to these data. However, the problem is that this practice may be obsolete and too infrequently submitted to critical review. In the literature, this model of performance is called 'eminence based medicine'. The result of this approach is that patients are being differently treated at different hospitals, which means that not all patients have due access to the same conditions of medical treatment. EBM relies on the importance and value of research evidence, however, just the evidence is not enough to make a definitive decision, as it depends on the benefit to risk ratio, cost, physician's experience, and patient's preference. The most important evidence derives from reviews of controlled randomized trials conducted by different institutions. The most reliable sources of evidence are Cochrane Library (which also includes results of Cochrane Skin Group), Medline, Embase, secondary publications, primary publications , and national guidelines that should not be mistaken for EBM. As dermatologists, we are interested in evidence based dermatology in particular, which is defined as the use of EBM for people with skin problems. What is specific about the skin? Skin is a large and visible organ, however, it is not just an organ covering the body but a sensitive dynamic barrier between the outer world and internal organs. It is also a very important organ of social and sexual contact. All these facts probably are the reason why, unlike other organs where up to some 100 different diseases are usually described, dermatology textbooks list about 2000 different skin conditions. Skin manifestations can be caused by primary skin disease or …