History of Latin American Dermatology

ELBIO FLORES-CEVALLOS, LUIS FLORES-CEVALLOS, ZUÑO BURSTEINconsidered an accidental host who does not play any important role in the conservationof the parasites in nature.”The problem of treatment of the leishmaniasic population in Peru, especially in themalign mucocutaneous forms, is discouraging, not only because of the limitations of thetherapeutic agents available, but also, above all, because of the socioeconomic situationof the carriers of this ailment that affects the less-favored sectors of the population, andwhose mutilating and deforming lesions provoke their social discrimination.One of the first pharmacological therapeutic resources for tegumentary leishmaniasis,introduced in Brazil by Viana in 1912, was emetic tartar, which in 1915 was used forthe first time in Peru by Julián Arce. In 1916, Escomel 48 published his experiences withthis drug, which continued to be used with favorable results for cutaneous cases, butwith just palliative or totally inefficient action on mucocutaneous forms.The marked toxic effect of emetic tartar forced the move from this medicine to otherantimonies, initially trivalent, of intramuscular use, Neo-Antimosan (Repodral, Fuadin)and, later, pentavalent, Neostibosan and Solustibosan, withdrawn by their manufacturersfor not being convenient to their interests; only Glucantime remained, applied intramuscularlyor intravenously with healing results in the initial phases or on purecutaneous forms of the disease, but with irregular response on mucocutaneous forms.Amphotericin B (Fungisone), of intravenous use, utilized in Peru initially by ZegarraAraujo, in 1966 49 , provided, despite its marked nephrotoxicity, therapeutic advantagesin the mucocutaneous forms of Peruvian leishmaniasis (espundia).The use of medicinal herbs used by the ancient Peruvians against this disease is currentlybeing studied, in an attempt to find, through extracts, the active principles that canbe therapeutically useful in cutaneous leishmaniasis. These investigations have been takingplace since 2003, through an agreement between Peru and Japan, by a group of Peruvianand Japanese researchers led, on the Peruvian side, by Dr. Fernando Cabieses(President of the Southern Scientific University, Lima), and by Dr. Zuño Burstein (NationalHigher University of St. Mark, UNMSM), with the participation of the Daniel A. CarriónInstitute of Tropical Medicine, of the UNMSM, with its Director, Dr. Abelardo Tejada,and Dr. Olga Palacios, and of the UNMSM School of Pharmacy and Biochemistry, withDrs. Bertha Pareja and Diana Flores.In health-related Peruvian legislation (Supreme Decree No. 007-75-TR, of August 26,1975), South-American mucocutaneous leishmaniasis (uta and espundia) was recordedas a professional disease in workers who migrate to leishmaniasis-endemic zones.By Supreme Resolution No. 063-75-TR, on September 11, 1975, a commission wasappointed to draft the Regulations for Hygiene and Security Conditions at work centersin leishmaniasis-endemic zones, in order to protect such workers. This committee wasmade up of, among other members, Drs. Arístides Herrer and Zuño Burstein, in representationof the National Health Institute.By Supreme Resolution No. 026-76-TR, on October 21, 1976 50 , the Regulations forHygiene and Security Conditions were approved; they include 5 titles and 52 articles. TheResolution, signed by the President of the Republic, countersigned by the Ministers forLabor and Health, encompasses an overview, objectives, obligations of the companies,workers’ obligations, collective and individual protection measures (providing details onpermanent and provisional camps installed in endemic zones), medical checkups, diagnosisof suspicious cases, notification, record and treatment, pointing out in this chapterthat, in all leishmaniasis-diagnosed cases, the mandatory notification will be established,in harmony with the stipulations of the National Notification System of Transmissible Diseases,for the record, and that the positive cases of leishmaniasis acquired at work centerswill be covered by Peru’s Social Security, in accordance with the standing legal rulesfor its treatment and other ends. Lastly, sanctions are laid down for companies or employeeswho fail to fulfill these Regulations.344