History of Latin American Dermatology

RAFAEL FALABELLAprocedures seek job solutions in these highly attractive disciplines; already in the present,the demand for body, face and hair beautification services keeps a major numberof dermatologists busy. This forces us to think that, during the learning stage, anoverview of this situation will have to be provided in order to attain a balance that allowsdermatologists to work reasonably within the scope of cosmetology and aesthetics withoutabandoning Dermatology as a fundamental science in their daily activity. Otherwise,our specialized field will become something insignificant and superficial, a non-medicalactivity with no importance, which will gradually surrender its field of action to otherspecialized fields; in this way, there would be the risk of disappearing completely fromthe medical arena, regardless of the fact that it is currently a profound science with discoveriesthat have not yet been attained by other specialized fields 10 , as is the case, forinstance, with the use of humanized antibodies constructed through manipulation ofmolecular biology for the treatment of psoriasis 11 or the transplant of cultivated skin inepidermolysis bullosa therapy 12 .Over the last twenty years, we have had remarkable development in the area of dermatologicalsurgery, which has created acute controversies about our role as skin surgeons;while some think that our specialized field is medical in character, patients seekthe dermatologist to obtain their surgical services with the conviction that this specialistknows the tegument exhaustively and will perform an excellent job in the surgical area.Without delving into unnecessary debates, it is a fact that Dermatology is already includedamong specialized medical surgical fields and that it is taught at all the Dermatology serviceswith important differences from one school to the next. The future of this disciplinewill depend on the degree of technical complexity applied to it, but it will have to add moderntechniques of molecular biology to its syllabus, which allow the implementation ofmedical surgical therapies for the treatment of various dermatoses; thus, we might foreseethe use of autologous cultivated skin with all its components to substitute deformingscars due to burns, or to correct giant pigmented congenital nevi, replacing the areas ofaffected skin by skin designed by experts and obtained by means of in vitro cultures.■ Research, the the engine engine of development; of development; its role in Dermatology its role in DermatologyIn a more technologically developed world, research has undergone radical changesover the last fifty years, going from the clinical dermatologist to the full-time doctor inbasic sciences, from small to large research labs, to the importance given to the understandingof the basic processes of normal and affected skin, and, finally, from clinical observation,histology and immunology to cell cultures, molecular biology, genetics,genomics and proteomics 13 . At the same time, the reduced interest among the new generationsin research and academic medicine generate a great concern over the future ofthe specialized field, and efforts are made to identify the factors involved in this phenomenon14 . A survey conducted among a group of dermatologists on their attitude regardingcosmetology yielded a result of unprecedented interest for this discipline and aclear trend among the youngest to devote themselves to practical tasks instead of academicones 15 .These trends are not entirely alien to Latin America. With the awakening of our countries,it is possible to expect the contribution of resources for research into the most importantproblems to improve, as well as total control of leprosy or the eradication ofleishmaniasis, which affect countless patients. Nevertheless, the survival of Dermatologyas a specialized field will also depend to a large extent on the creation of Master’s andPh.D. programs that implement a strategic alliance between graduate schools and the institutionsdevoted to research that handle these technologies which are already a realityin many countries of Latin America.446