History of Latin American Dermatology

History of Dermatology in Perutegumentary leishmaniasis, where the most diverse clinical modes of the process reproduce;such a feature is not present in other regions of the world, where, usually, a specificclinical mode predominates over large territorial areas; such is the case of theOriental Button (pure cutaneous leishmaniasis) in the Old World.Instead, in our country, which has such varied ecological conditions, there are clinicalmanifestations that we closely associate with their territorial origin. Therefore, wespeak of uta for the Andean leishmaniasis, and we give the name of espundia to that ofjungle origin, assigning more or less specific clinical characters to each.Classically, and from early date, the existence of two types or clinical forms of tegumentaryleishmaniasis has been considered in Peru. Palma, in 1908 3 , Escomel 4 , Arce 5and Monge 6 , in 1914, Weiss, in 1924 7 , and other Peruvian researchers accepted the differentiationbetween uta and espundia, even without knowing the etiology of either clinicalcondition. But it was basically Escomel, in 1942 8 , and Weiss, in 1943 9 , theleishmaniasic etiology of both processes having been discovered, who established two perfectlyidentifiable clinical forms of leishmaniasis in Peru. One benign type, comparable tothe Oriental Button, which primarily affects children, cures spontaneously, leaving the personimmune for the rest of his life, rarely produces mucous lesions and only with continuity,and is exclusive to Andean regions; it is called uta or Peruvian Andean leishmaniasis.The second type, a serious form, found primarily in adult men, with constant and metastaticalinvolvement of the respiratory mucosa, of jungle territorial origin, corresponds to espundiaor American jungle leishmaniasis. This criterion was accepted in 1950 by theNomenclature Committee of the Brazilian Society of Dermatology and Syphilography, andby the Ibero-American Society of Dermatology, at its Rio de Janeiro meeting.Nevertheless, from the analysis of cases by various Peruvian researchers, such asCornejo Ubillus 10 , we can ascertain that there are clinical forms of leishmaniasis describedin areas that do not correspond to the classical geographical distribution. Weisshimself, in 1953 11 , questions his original belief that in the Andes only the uta form waspresent, due to later verifications of the existence of some Andean focuses, though rare,of espundia, as well as jungle focuses of uta. These facts, says Weiss, seem to eliminatethe possibility of essential differences between the two classical forms; however, the statisticalregional, and even local, differences are so accentuated, that they cannot bepushed aside.Setting aside considerations that explain the different clinical modes centering on parasitologicalfactors — such as the serological differentiation of different tegumentaryleishmaniasis-producing strains, immunoallergic conditions of the host, the role played byreservoirs and even vectors, among others — and based on his experience at the Dos deMayo Hospital, having studied 158 cases of tegumentary leishmaniasis from the most diversespots in the country, Burstein 12 suggested the following classification for tegumentaryleishmaniases that occur in Peru, at the Seventh International Congress of TropicalMedicine and Malaria, held in Rio de Janeiro in 1963:1. Andean cutaneous leishmaniasis (equivalent to the classic uta).2. Andean mucocutaneous leishmaniasis.3. Jungle cutaneous leishmaniasis.4. Jungle mucocutaneous leishmaniasis (equivalent to the classic espundia).This criterion was accepted at the First Peruvian Congress of Microbiology and Parasitology,in 1964 13 14, 15, and is based on evolutionary clinico-epidemological concepts(Figures 25, 26, 27).It is indispensable to accompany these denominations with the evolutionary typificationof the process in order to give the classification a dynamic sense; to that end,Dostrowsky’s criterion 16 has been adopted, which, applied to cutaneous leishmaniasis(Oriental Button), considers it recent (or precocious) if the process is shorter than a year,and late if it has over a year of evolution.339