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Skin is all too visible, and has remained so to physicians as well as to their patients, throughout the history of humanity. Called “Derma” in Greek, Hippocrates and other ancient physicians would look at its color and texture to guess what is wrong inside. Thus, skin was supposed to reflect “humors” inside our bodies. We have used applications such as mud, honey, pastes, sunlight, sauna and bathes for centuries. However, the towering concept was that these penetrate much beyond the depth of our skin, and heal our inner self. Skin-deep was too shallow, and Dermatology as a specialty came into existence only in the last 150 years.
Birth of a specialty
Specific attention to “Dermatology” a study of diseases of the skin may have started with either Girolamo Mercuriale (1530–1606) in Italy, Daniel Turner (1667–1741) in England or Jean Astruc (1684–1766) in France\. Their three texts (De Morbis Cutaneis, et Omnibus Corporis Humani Excrementis Tractatus in 1572, De Morbis Cutaneis in 1714 and De Morbis Venereis in 1736) are counted as first ones to describe “maladies of the skin”. However birth of dermatology is attributed to Ferdinand von Hebra (1816–1880) from Vienna.
Ferdinand von Hebra graduated from Vienna Medical School in 1841. The institution was already making strides in clinical medicine, by likes of Carl Rokitansky and Josef Skoda. While Rokitansky pioneered tissue pathology, Skoda focused on clinical observations. The same year as Hebra’s graduation, Skoda created a distinct division of “skin diseases” in the medical department. Thus, Hebra was able to combine keen clinical observations to tissue pathology and related these to diseases of the skin
Pioneers of modern Dermatology
In 1856, Hebra published the first edition of the influential Atlas der Hautkrankheiten (or Atlas of Skin Diseases). The atlas described twelve categories of skin diseases, and their tissue pathology. In 1878 Rokitansky passed away, and Hebra was elected president of the College of Physicians in Vienna. He started another milestone work, the Lehrbuch der Hautkrankheiten (Textbook of Skin Diseases).
While Hebra passed away in 1880, his disciples Moritz Kaposi (1837–1902), Heinrich Auspitz (1843–1878) and Paul Gerson Unna (1850–1929) took over and expanded his work. Mortiz Kaposi was Hebra’s student, and graduated in 1861. Five years later, he published his dissertation Dermatologie und Syphilis. Interestingly he married Hebra’s daughter Martha in 1869, and changed his last name from Kohn to Kaposi when he embraced Catholic faith in 1871.
When Hebra passed away in 1880, he competed with his brother in law Hans, to become head of dermatology at Vienna Medical School. It is said that “Kaposi took Hebra’s daughter, house, chair and clientele, leaving the rest to his brother-in-law.” His contributions to dermatology include the descriptions of skin diseases such as Kaposi’s Sarcoma, Xeroderma pigmentosum and Systemic Lupus.
The Austrians, French and the British
In addition to the Autrians, dermatology also grew with its pioneers in England (Robert Willan (1757–1812), Thomas Bateman (1778–1821)) and France (Jean-Louis Alibert (1768–1837), Jacques Adrien Sabouraud (1864–1938)). Together, Austrian, English and French traditions in late 19th century are considered as pioneers of modern dermatology.
Jean Alfred Fournier was a French Dermatologist, and had a keen interest in Syphilis – a Sexually transmitted disease. Born in 1832, he became a member of French Academy of sciences in 1880. He was the first to describe congenital syphilis. In 1901 he founded an organization devoted to spreading knowledge to combat syphilis, called the Société Française de Prophylaxie Sanitaire et Morale. A type of scrotal gangrene in individuals with diabetes “Fournier’s gangrene” is named after him. He organized the first International Congress of Dermatology and Syphilology
Light-Camera-Action : Photography, Dermoscopy and Photo-therapy
Three parallel developments in late 19th and early 20th Century, further shaped dermatology. Photography, invented in 1840 was first applied to Dermatology in 1865. A French dermatologist Alexander John Balmanno Squire (1836–1908) used it to record skin diseases. Since then, clinical photographs have helped to spread understanding of skin diseases.
In 1920, Johan Saphier developed a surface microscope or dermoscope. This helped to see skin lesions better. But it was Niels Ryberg Finsen (1860–1904), a Danish physician who brought a new dimension to Dermatology. It was photo-therapy, an invention that also earned him a Nobel in th year 1903. Light could heal, but Finsen refined the technique and proved it with scientific experiments.
Nobel
Photo-therapy is currently used to treat a diverse range of skin diseases, including Vitiligo and Psoriasis. Today we use light in narrow bands, so as to tailor therapies. Further advancements in dermatology include introduction of Lasers in 1963, Cryosurgery in 1970s, Cosmetic dermatology and use of Botulinum toxin in 1990s. With advancements in technology, and desire to have a perfect good looking skin in current selfie era, are all bound to make this skin deep specialty grow.
Dermatology in India
Britishers started first departments of Dermatology in India, first being in 1895 in JJ Hospital Mumbai (under Major C. Fernandez), and thereafter in 1923 in Kolkata (under Dr. Ganpati Panja). Later in 1945, first one-year diploma course in Dermatology and Venerology was started in Mumbai. First MD Program in Dermatology started at AIIMS New Delhi in 1962. Later Dermatology (Skin diseases), Venerology (Sexually transmitted diseases), and Leprology (Study of Leprosy) merged in one specialty. Their professional bodies merged in 1973 to form Indian Association of Dermatology, Venerology and Leprology (IADVL).
