History of dermatology in Argentina
Argentina, with a mainland surface area of 2,780,400 km2, is located in southern area of South America, sharing land borders with Chile across the Andes to the west; Bolivia and Paraguay to the north; Brazil to the northeast, Uruguay and the South Atlantic Ocean to the east; and the Drake Passage to the South. It was colonized with the arrival of Spanish expeditions led by Juan Diaz de Solis in 1516 to the Rio de la Plata, which marked the beginning of the Spanish domination in this region. In 1776 the Spanish Crown established the Viceroyalty of the Rio de la Plata, an umbrella of territories from which, with the Revolution of May1810, began a process of gradual formation of several independent states, including one called the United Provinces of Rio de la Plata. With the declaration of independence on July 9, 1816 and the military defeat of the Spanish Empire in 1824, a federal state was formed in 1853-1861, known today as the Republic of Argentina .
In 1780, shortly after the creation of the Viceroyalty of the Río de la Plata, it was proclaimed in a royal decree: "Informed of derangement and abuses that medicine, surgical, pharmacy and phlebotomy’s related exercise, I have decided, for now, to establish and create in it a Court of Porto, as there is in the cities of Lima and Mexico, with the same powers, privileges and exceptions, so that it conforms to the laws, and the correct excise of them, and I have come to choose and appoint Dr. D Michael O'Gorman as the representative of the people in charge of those exercises in medicine”. Dr. O’Gorman was the first physician and dean of many others that we would have in what would become Argentina. In 1803 a law against “healers" is issued and in December of the same year positions were given to physicians and surgeons qualified to practice the profession [1-2]
In 1835, Dr. Tiburcio Fonseca published a thesis on "Structure, function and bonding in general pathology and therapy of cutaneous organ." In its 35 pages scientifically focused on diseases of the skin, Argentina became a pioneer among Latin American countries in this medical specialty .
In 1874, the Academy of Medicine governing the Faculty of Medicine added new specialties to its curriculum including "Clinical skin diseases and syphilis", and designated in 1875 as head and assistant professors to Dr. L. Montes de Oca and L. Melendez. The specialty of what we know today as Dermatology was going to remain as part of Pathology .
For descriptive purposes, three golden periods in the history of dermatology in Argentina can be distinguished with the names of some legends of those eras:
- The period of Baliña and Greco.
- The period of Quiroga and Pierni.
- The actual era.
A service of Syphilography and Dermatology started to function in the Hospital de Clinicas (Figure1) in Buenos Aires, where all the medical teaching activity was concentrated in the beginning. On March 18th of 1892, the dean of the Faculty of Medical Science, M. Gonzalez Catan, established the department of Venereal Diseases and Skin with its own chair, and dermatology was dictated as a subject during the 4th year of the medical career [2,3]
The first professor of dermatology was Baldomero Sommer (Figure 2), son of a Danish father and German mother, who formed his professorship at the San Roque Hospital, today known as the Ramos Mejía Hospital and continued his teaching work until his death in 1918. Sommer, who was president of the Argentina Medical Association from 1897 to 1899, was inspired by the Viennese school of Von Hebra and was influenced by French dermatologists of the hierarchy as Gaucher, Fournier, Darier, Gougerot and Civatte. He taught his students with in vivo patients and “moulages” (moulding), unique in its kind in Latin America in those years. This last practice dates to the Renaissance period, when wax figures were used for this purpose. In 1884, he had already travelled to Europe and worked alongside Moriz Kaposi. Among the disciples of Sommer we could find the bright medical students like Aberastury, Greco, Baliña, Ragusin, Jonquières, Uriburu and Fidanza (Figure 3) [2-6].
It was a golden age for Argentinian Dermatology, including advances in the study of syphilis and other venereal diseases as well as leprosy. All this came to fruition in 1907 with the foundation of the Argentina Dermatological Society located in the San Roque Hospital in Buenos Aires whose first chairman was Sommer . During the presidency of M Aberastury (1922-1926) the Antileprosy National Law Nº 11359 was promulgated. This new law stimulated the control of the disease, the national census of its patients as well as the construction of special living colonies in 5 provinces of the Republic for these patients [2,7-9]. On May 23rd of 1927, the society changed its name to Argentinian Association of Dermatology and Syphilology, which would be what we know today as the Argentina Association of Dermatology (AAD). During that year its chairman was Professor P Baliña (later replaced by N Ragusin), a true legend in the history of dermatology. He was the head of the external offices of dermatology at the Hospital Muniz, Chief of Dermatology at the Hospital Argerich, professor in charge of the Department of Dermatology at the University of Buenos Aires, professor and dean of the University of Salvador in Buenos Aires. He was distinguished three times by the National Academy of Medicine and colleagues appointed him as the Master of the Leprology in Argentina. Throughout the years he won recognition not only among the national medical community, but also internationally, reaching the vice-chairman position of the International Leprosy Association. He died in 1997 at the age of seventy-two, leaving a huge legacy not only as a doctor, but also as a person. Essentially a passionate teacher, he imparted his knowledge from teaching, through tireless research and medical practice. Baliña was the creator of the first medical dermatology residency in our country. He also envisioned an expansion of medicine in the interior of the country, creating the Rural Internship in the curriculum of medical students attending the University of Salvador, leading doctors and students to people with little access to health [2,8,10-12].
In 1934, a group of dermatologists headed by Nicolás Greco, a disciple of Sommer and professor of dermatology at the La Plata University and the Buenos Aires University, decided to set up a new entity called Society of Dermatology, Venereology and Syphilography which joined the Argentine Medical Association. The reasons that led to this split are not clear but certainly, given the moral and scientific hierarchy of the members of those dermatological groups, societies and association, they were all well recognized. In 1934 a subsidiary of the Dermatology Association was constituted in Rosario, followed by Córdoba (1938) and Mendoza (1952). From that same year onwards, there were two well-formed groups who gathered the dermatologists in Argentina; the Sociedad Argentina de Dermatologia (SAD) with its journal Dermatologia Argentina since 1995 and the Asociacion Argentina de Dermatologia (AAD) with its journal Revista Argentina since 1908 [10-15].
Other important dermatologists continued the previous period in time: LE Pierini (Figure 4), M Quiroga (Figure 5), E Fidanza, MA Mazzini, JM Puente, J Pessano, C Orol Arias, E Fernández Blanco, JL Carrera, L Facio, W Basombrío, F Noussitou and A Kaminsky. They were professionals of the most reputable the Dermatology Services at that time in the country .
With Baliña and Greco gone, the first two disciples, Marcial I Quiroga and Luis E Pierini, continued their legacy. That marked three decades of Dermatology in Argentina projecting an international rise. In 1946 Quiroga and Pierini published the book “Introduction to the study of dermatosyphiliology”, whose semiotics and description of elementary lesions were splendidly presented. The work showed the strong influence of European schools in Argentinian dermatology, mainly French, where some Argentinian dermatologists concurred to be trained abroad .
Marcial I Quiroga had an aristocratic and charismatic personality, managed the French language perfectly and traveled almost annually to Europe, especially France to improve its knowledge on dermatology. During his career, he received major awards. At the international level, he was the first Argentinian appointed to the International Committee of Dermatology. Furthermore, he was named honorary member of numerous Dermatological Societies and was President of the National Academy of Medicine. At the dermatological level, he was chief and professor of the first department of dermatology at the Ramos Mejía Hospital in Buenos Aires. His academic quality was evidenced in several books and scientific papers. Quiroga's disciples were the teachers of the next generation: Alejandro A Cordero and Pedro H Magnin. Also notable professors followed him: L Ambrosetti, E Jonquières, A Mom, R Corti, E Molina Leguizamón, N Vivot, G Dhum, CF Guillot, HJ Sánchez Caballero and M Seoa [2,13].
Argentine Association of Dermatology (AAD)
It was founded in 1907 by Sommers and collaborators, bringing together most of the members of the Buenos Aires hospital services, with intense scientific activity, reflected in the Argentine Journal of Dermatology. They organized meetings that have a large audience. Annually, they organized the Argentine Congress of Dermatology in various provinces of the interior. The first president of this emblematic institution was Dr. Sommer (1907-1917), P Diaz (1918-1921), M Aberastury (1922-1926), P Baliña who was reelected during 3 different periods (1927-1932, 1947 and 1986-1987), Ragusin, Puente, P Negroni, A Cordero, A Kaminsky, Vigliolia, Magnin, Cardama, Marini and other brilliant dermatologists. Today’s president is M.del C Arrastia (2013-2016) [2-4,10-12].
Argentine Society of Dermatology (SAD: Sociedad Argentina de Dermatologia)
The Argentine Society of Dermatology was founded in 1934, by Nicolás Greco, university professor and brilliant disciple of Sommer, together with other prestigious dermatologists of that time such as C Orol Arias, MA Mazzini, AA Fernández, A Bigatti, S Rosner, D Biagini, L Trepat, A Muschietti, R Wernicke, E Otahz, C Bancalari, JR Houler, A Schneidewind, S Sovin, O Camaño, J Capurro, E Cortelezzi, F de Biase, E Solari, S Ponce de León, y E del Vecchio [2,5,12].
Until 1973 there were monthly theoretical sessions for graduates at the headquarters of the Argentina Medical Association. Its adherents were not numerous and the presidency was occupied alternately between L. Jaimovich and A Kaminsky. It mostly brought to the organization the disciples of A Kaminsky and L Pierini [2,12].
Under the presidency of J Abulafia (1973-1974) its organization was substantially modified. A new and modern organization appeared, along with the succession of meetings and conferences, which motivated the incorporation of many dermatologists. From then onwards, the presidents were: A Casala (1975-76), O Mangano (1977-78), D Grinspan (1979-80), A Cordero (1981-82), JC Gatti (1983-84), S Stringa (1985-86), JE Cardama (1987-88), A Woscoff (1989-90), HN Cabrera (1991-92), HG Crespi (1993-94), Ana Kaminsky (1995-96), A Cordero (1997-98), CF Gatti (1999-2000), M Larralde (2001-2002), H Cabo (2003-2004) and E Saraceno (2005-2006). M Marini and R Galimberti were presidents before today’s chairman, MA Allevato .
Its congresses are held every two years in different cities of the country. In 1995 the society began publishing its official Journal, ”Dermatologia Argentina”, whose editor in chief was A Woscoff and from 2004, Liliana Olivares and A Sehtman were in charge of it [2,12].
Professionals from the provinces of Argentina are still today grouped into local subsidiaries adhered to the society or the association, in a commendable act of rationality and maturity. These entities are independent, organizing their own activities with authorities and actively collaborating in advancing with the specialty
For some years the AAD and SAD worked together, performing joint meetings. The most significant integration was the Mixed Commission of Dermatology Teaching (COMEDE). Previously there were four graduate courses for dermatological expertise with dissimilar content and demands, which were in the hands of L Jaimovich, P Magnin, F Stengel and H Cabrera. The four doctors resigned to their courses in favor of COMEDE, which opened under the chairmanship of the M Marini (AAD), A Woscoff (SAD) and L Ferreira as dean of the Faculty of Medicine. The University of Buenos Aires recognized the course which lasted three years in total with a final written and oral exam after which, they issued the title of University Specialist in Dermatology. After ten years AAD retired from COMEDE, creating its own ongoing course [16-20]. In May 6th of 2006, the CONADER (National Council of Dermatology) was formally created by R Valdez, Chairman from 2006-2009 and from 2009-2012, together with prestigious members of the SAD and important dermatologists of the actual era in history, such as E Saraceno, M Marini, M Gimenez, L Iturre de Aguirre and A Ruiz Lascano. The mission of this council is to evaluate and unify the formation of dermatologists by the different residencies in the nation, similar to what the Board Certification does in the USA, trying to elevate the standards of education. The Health Ministry of the Nation and the SAD backs it. [16-23]
In 1999, the SAD became independent from the Argentine Medical Association, with its own headquarters in Buenos Aires. The following is heritage of the current era and photos of its illustrious presidents are in the hall of its headquarters. This year, 2015, marks the 81st year of the Argentina Society of Dermatology since its opening 
Contemporary Dermatology moves to the beat of Medicine. It has developed a number of dermatological subspecialty: pediatric, surgery, immunodermatology, oncology, infectious disease and further, as well as super specialization in some specific pathologies [2,12].
In the beginning it was exercised only by P Box and E Forman. From the brilliant performance of Dr. J Abulafia, master of future generations, the number of specialists in dermopathology was expanded. JG Casas, internationally renowned specialist, is professor of Pathology at the Faculty of Medicine of Buenos Aires and president of the International Academy of Pathology for the American region. Other recognized pathologists are RG Schroh, O Bianchi, I Calb, MC Kien, G Magariños, G Sanchez, E Lacentre, A Kowalczuk, J Anaya and A Sanguinetti. In Rosario city some well-known dermopathologists are J Monti and A Bergero; in La Plata city, LR Castellanos and J Cueto (Jr). In Mendoza and Salta provinces, A Ortiz Medina and S Romero are outstanding pathologists. The Argentine Society Dermopathology (SADEPA) dictates courses and organizes meetings, inviting dermatopathologists from abroad.
Some outstanding figures of great seriousness and prestige: H Crespi, D Pierini, AM Pierini (president of the VII International Congress of Pediatric Dermatology); M Larralde de Luna (president of the Latin American Congress of Pediatric Dermatology); R García Díaz, JA Massimo; S Pueyo, Zulema Piccone, N Pizzi de Parra and J Laffargue, among others.
In December of 1989, the Society for Pediatric Dermatology of Argentina was established, which would later become the Argentine Association of Pediatric Dermatology (ASADEPE). Currently, JA Mássimo, M Larralde, AM Pierini and L Valle give a university-postgraduated course of Pediatric Dermatology.
Prof. N Grinspan Bozza, was the founder of the Society of Dermatologic Surgery. It has competent dermatological surgeons like A. González (expert in Mohs surgery), R Garzón, H Costa Cordova, D Ballesteros and G González Rescigno. The Annual Course of Dermatologic Surgery and Aesthetics of Argentina Society of Dermatology had co-directors such as H Costa Cordova, E De Carli and LI Villalba.
This subspecialty had an initiator; D Grinspan and his disciples; J Kriner, S Blaustein, J Diaz, S Belin, E Mc Adden, G Fernández Blanco and S González.
Initiated in Argentina under the stimulus of Prof. Aaron Kaminsky. Courses are offered throughout the year and a large number of Latin American dermatologists attend them. Among other dermatologists pursuing this specialty are Alejandro Cordero (h), A Kaminsky, G Cuomo and R Flom. In most Dermatology services of each hospital there is a section of cosmiatry led by a dermatologist and technical personnel in cosmiatry.
Its story ran parallel to that of Dermatology. According to some theories, leprosy was introduced in America by the early explorers and conquerors. Another factor contributing to the spread of this disease on the continent was the trade of slaves brought from Africa since the early sixteenth century. In Argentina the arrival of slaves was more limited, so it is likely that the disease was introduced from neighboring areas from Paraguay, Brazil and Peru.
In 1760 the first patient was diagnosed in Buenos Aires, and then removed from the city and sent to Lima, Peru. In 1792 the physician M. Rodríguez carried out the first recognition of an outbreak after the diagnosis of four leprosy patients in the province of Santa Fe, probably due to wars of Independence. Outbreaks of leprosy spread to the northeast, northwest and Pampas. The first Insulation Home (currently Muñiz Hospital) was set up in 1883 and Prof. Dr. Aberastury and Farini gave the care of these patients. Later, in 1903 the first National Conference of Leprosy was held. The pioneers of this prevention, diagnosis and treatment era in Leprosy were Dr Aberastury and Dr. Baliña. Between 1927 and 1929 they carried out the first census of leprosy patients, resulting in a total of 2,300 patients. In 1930 the Board of Leprosy in Argentina was based in the Muñiz Hospital. In subsequent years a number of hospital-colonies were created in Posadas (Misiones), Island Cerrito (Corrientes), San Francisco del Chañar (Córdoba), Diamante (Entre Ríos) and the well-known sanatorium-colony in General Rodríguez (Buenos Aires province). In August 1954 a group of 41 physicians interested in leprology created the Society Argentina of Leprosy (SAL) and from 1988, by decision of an Extraordinary Assembly, the SAL became an important section of the Argentina Society of Dermatology. After this event, teachers like JC Gatti and JE Cardama published the Leprosy Treaty and LM Baliña published leprosy books. Standing today in this specialty is R. Valdez (chief of the Dermatology Department at the Austral University Hospital and vice-Dean of the Austral University) (Figure 6), G. Pizzariello, L Olivares, AM San Martin and N Vaquero.
Internationally well-known P Negroni, published several books on the specialty and worked incessantly researching mycology. R Negroni, a figure of international consultation nowadays, brilliantly continued P Negroni’s work. Other mycologists with solid training are Ricardo Galimberti, whose contributions are contained in foreign journals, V Madeo, S Carabelli and L Amante.
E Turjansky and G Stolar were pioneers in cryosurgery, writing books and papers in indifferent journals. Other pioneers were A Torres Cortijo, C Kaminsky and today L Sevinsky and E Rodríguez. The Argentina Society of Cryosurgery conducts periodic meetings at the headquarters of the Argentina Medical Association.
Sexually Transmitted Infections (STIs)
For over 20 years the Latin American countries were members of the Latin American Union of Sexually Transmitted Diseases (ULACETS), founded by Brazil and Argentina, which conducted intense programs in controlling various related dermatoses. Among its presidents were A Woscoff, JC Flichman and M Ambrona. Currently the Argentina Union against STDs (UACETS) consists of R Casco, A Bermejo, and LM Oxilia. UACETS promoted by the Pan American Health Organization recognized congenital syphilis as one of the priority diseases in America. Reference books on the subject are Venereology Treaty of Viglioglia and collaborators, ETS and AIDS by Viglioglia P and A Woscoff and STDs in Times of AIDS by M. Marini and M Oxilia [14,15].
With respect to therapeutic equipment, numerous dermatological services offer PUVA and UVB. Among the pioneers and leading teachers of this art were E Chouela, F Stengel, J Ubogui and L Sevinsky.
It is impossible not to mention all the professionals who studied and excelled in different pathologies in dermatology. I will mention some as H Cabo, in diabetes and dermatoscopy, E Saraceno in Internal Medicine and Skin, S and S Stringa, O Stringa, P Troielli and C Pascutto in collagenopathies, F Stengel and R Valdez in melanoma.
The Argentine Society of Dermatology and Skin Cancer Foundation, presided by F Stengel, organizes annual national campaigns in the month of November to control melanoma and skin carcinomas. These results are analyzed providing guidance for our dermatologists and other countries undertaking the same task.
Congresses and meetings gathered every year a significant number of dermatologists from all over the country and from abroad; The Annual Course of Pierini (64 consecutive courses since it started) and the biannual Congress, in different cities of our Republic. The Ibero-Latin American College of Dermatology (CILAD) created in 1963 holds International Congresses every year in different countries of Latin America. In 2007, Buenos Aires held the XXI World Congress of Dermatology with R. Galimberti as its President.
In 1908 the first dermatological journal was published in Latin America: “The Argentine Magazine Association of Dermatology and Syphilology”. It had been organized by the society of dermatology at that time. Nowadays, there are four dermatology journals with periodic appearance in our country [2,12]:
- Argentine Journal of Dermatology, official organ of the Argentina Association of Dermatology, dates from 1908; some of its last directors were P Magnin, J Abulafia, L Valle and A Palacios Gotlib.
- Argentinian Archives of Dermatology which began in 1951 and was directed successively by L Pierini, D Pierini, S Mosto, A Pierini, F Stengel and A Politi.
- Dermatology Argentina, official organ of the Argentina Society of Dermatology, founded in 1994 and directed by A Woscoff and L Olivares.
- Dermatological therapeutic Updates, directed and edited by L Jaimovich and M Allevato, has great prestige in Latin America.
Currently there are around 3.500 practicing dermatologists in our country of 42.669.500 inhabitants. The majority is in the private sector and in the larger cities so that the big cities are oversaturated whereas the rural areas and smaller towns are underserved. Socioeconomic factors and the government policies are partly responsible for this uneven distribution. In many medical universities of the country there are dermatology departments guided by properly qualified teachers. A few departments are equipped with lasers, phototherapy units, dermatosurgery theatres, patch testing facilities and mycology and histopathology laboratories. Around 34 different medical departments, validated by the CONADER around the country, are actively involved in imparting postgraduate training for doctors who want to specialize in dermatology [16-23].
The Dermatology Society and the Dermatology Association are growing every year as a consequence of partners likely to attend and actively participating in various events, the incessant work of its presidents together with their boards, and the contribution of perfectionist ideas all while adapting to the times we live in.
- Payro RP (1997) Historia del Rio de la Plata. (2nd edtn). Alianza.
- Galimberti R, Pierini YA, Cervini A (2007) Historia de la Dermatologia Latinoamericana (3rdedtn). Ed Privat : 35-47.
- Grinspan D (1990) Sinopsis histórica de la Dermatología argentina. Editado con motivo del 10o Congreso Argentino de Dermatología, Buenos Aires.
- Greco N (1942) Baldomero Sommer y su obra. Sem Med. Buenos Aires 21: 3-55.
- Mazzini MA (1967) Pasado y presente de la primera cátedra de Dermatología, 75-aniversario-de su fundación 1892–1967. Rev Argent Dermatol 3-4: 146- 147.
- Mazzini MA (1965) Clase inaugural del Profesor Miguel Ángel Mazzini. Rev Argent Dermatol 49: 138.
- Aberastury M (1926) Contribución a la Defensa de la Salud Pública. La Prensa Médica Argentina 19: 621-627.
- Baliña PL (1926) Sobre la Manera de Llevar a la Práctica la Ley Nacional Antileprosa. La Prensa Médica Argentina 19: 627-632.
- Nudenberg B (1985) Tres héroes de la lucha contra la lepra y las enfermedades venéreas en Rosario. Edición del autor.
- XXX Aniversario de la Fundación de la Asociación Argentina de Dermatología (1937). Rev Arg Dermatosif 21: 302-328.
- J L Iribas (2007) Cincuentenario de la AAD (1907-1957). Rev Argent Dermatol 88: 166-173.
- Woscoff, A (2000) El fin de una ilusión. Dermatol Argent 6: 89-90.
- Gatti F y Chinchilla DA (2009) Leyendas Dermatologicas del CILAD. C. F. Ed.Platt Grupo impresor.
- Vigliolia P, Woscoff A (1997) Enfermedades de transmisión sexual y SIDA. López Libreros Editores SRL. Buenos Aires.
- Marini M, Oxilia M (1999) Las Enfermedades de Transmisión Sexual en los Tiempos del Sida,1st edition, Editorial Marymar S.A. Buenos Aires.
- Valdez R, Saraceno E, Marini M (2010) Conformación de un Consejo Nacional de Dermatología (CONADER) Cuerpo de profesores de Dermatología con competencia en la formación de posgrado. Revista Argentina de Educación Médica 4: 3-9.
- Valdez, R (2006) Propuesta para un Consejo Nacional de Dermatología (CONADER) Dermatología Argentina 12: 254-255.
- Ley de Educación Superior (LES) 2452 (1995) , artículos 4 y 39. Boletín Oficial 28204.
- www.sad.org.ar/CONADER/ reglamento
- Valdez R (2005) Propuesta de un panel de control en Dermatología. Su aplicación para la acreditación de hospitales en la formación de especialistas. Dermatol Argent 11: 192-197.
- Borrell Bertz RM (2005) La educación médica de postgrado en la Argentina: el desafío de una nueva práctica educativa. Edición OPS.
- World Federation for Medical Education (2005) Educación Médica de Posgrado: estándares internacionales de la Federación Mundial de Educación Medica.