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Lynch's editorial¹ is laudable in its attempts to maintain an optimistic perspective as it relates to medical dermatology. Lynch's contributions to dermatology are significant and we have long admired his insights and leadership. However, after reading his essay, we believe a key issue has not been fully addressed. Medical dermatology is seriously ill and in danger of dying. The declining interest in medical dermatology is reflected in the attendance at medical dermatology course offerings at American Academy of Dermatology meetings for the past decade, and although improvements in medical information science are desirable and may improve the delivery of care to patients, these improvements will likely not be sufficient to rescue this dying patient.

Medical dermatology is dying because it has become financially unsupportable. Furthermore, unless the system that assigns value to the management of complex medical problems is changed, the expertise associated with medical dermatology will cease to exist. . . . [Full Text of this Article]

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