History of Latin American Dermatology

PAULO R. CUNHAGuerra, wrote in his History of Leprosy in Portugal: “There is no doubt that the Portugueseintroduced leprosy in Brazil in 1500, as they had introduced it in Madeira, whereit was unknown before their arrival.”In the early twentieth century, this disease was still a very serious public health problem.“Around 1920, however, age-old prejudices were still predominant, turning the poorleper into a fearful victim of an unforgiving ailment, a pariah of society, with no homelandand no family, scorned and condemned without mercy to a perpetual exile in orderto guarantee the safety of his fellow beings, who, in compensation for the imposed sacrifice,treated him with scorn and sometimes even gave him alms that humiliated and belittledhim.”Eduardo Rabello, in 1933, ended the thesis of isolation in hansenology, foreseeingthat, in the future, it would be easy to halt the disease at the macular phase.In those years, Rio de Janeiro and São Paulo (with Emilio Ribas, Aguiar Pupo andSalles Gomes) united to initiate campaigns on the problem, seeking not only to humanizetreatment, but also to set up prevention elements for the children of hanseniasis patients.Nelson Souza Campos was able to show, in 1937, the curious precocioustuberculoid infiltrates which he called “child nodular leprosy,” and which in Rabello Jr.’sthesis, in 1941, was interpreted as a leprosy-infeckt. In turn, Abrahão Rotberg demonstratedin 1934 the value of the Mitsuda reaction forecast and, in 1937, the notion of theN factor as responsible for the hanseniasis resistance forms.In 1940, Aguiar Pupo was the first to show the epidemiological importance of the noncharacteristicforms of the disease. These ideas would be adopted in Rio de Janeiro at the1946 Pan-American Conference; a little later, in Havana, in 1948, the notion of polarity,postulated by Rabello Jr. since 1938, obtained recognition at the international level.Fogo selvagemFogo selvagem (FS) is an endemic disease in certain regions of Brazil with a totalnumber of 15,000 people affected, being prevalent among young people living in therural areas of the country. In the 1930s, the increase in the number of cases in São Pauloled the State government to create an exclusive hospital for these patients; later, otherhospitals opened in Goiânia and Campo Grande. In 1970, there were an estimated tenthousand known cases of FS in Brazil’s endemic States. In 1983, thanks to the foresightof Prof. Sebastião Sampaio, from São Paulo, and of Prof. Luiz Díaz, from the US, theBrazil-US Joint Group was created for the investigation of fogo selvagem, which produceddozens of scientific works and contributed to a great advance in the knowledge ofthe disease’s pathogenesis and in the development of diagnosis techniques.From the 50s to the 90s, the incidence of FS decreased in São Paulo. Prof. Paulo R.Cunha reported in his Ph.D. thesis at SPU on the last focus in the State, located in theFranco da Rocha and Mairiporã districts. The epidemiological characteristics of the diseaseshow strong evidence that FS is influenced by environmental factors. Research effortsare set on determining the environmental etiological agent that produces theoutbreak of that disease in Brazil.Skin Cancer Prevention CampaignThe so-called “silent epidemic,” namely the growing incidence of skin cancerthroughout the world, also constitutes one of the most serious public health problems inBrazil. Because of this, in 1999 the BSD widened its regional campaign to a nationwidelevel, with the aim of making the population conscious of the terrible consequences ofthis disease that affects a hundred thousand new cases every year. More than thirty thousandpeople are treated annually through this campaign (Figures 14 and 15).108