Major contributions to dermatology from India

INTRODUCTION

India, the land of scholars and philosophers, has made ground breaking contributions in the field of science and technology and medical science is no exception. In fact, it is one of the earliest fields to develop in the history of Indian civilization. Although the term dermatology came in use in the 18^th century, skin diseases already had a place in Indian literature since ancient times. Modern dermatology was introduced in India by the British, so the growth of Indian dermatology took place much earlier when compared to the rest of the Asian countries. And since then, many great contributions have been made by Indian doctors in the field of dermatology.

The Vedic period: Historical material about skin and its diseases are available in the Rigveda, the earliest texts of Indo-Iranian Aryans. The various Ayurvedic texts detailed not only about diseases but also about the daily care of the normal skin such as oil massage, trimming and care of hair, beards and nails, as well as the use of perfumes and toiletries.^[1]

In Charaka Samhita, the concept of anatomical structure including various layers of the skin has been mentioned, which says that the skin formed the outer boundary of the body, is composed of six layers, and is also the residence of touch sensation. Among the various diseases of the skin, dialogues on leprosy, vitiligo, cellulitis, smallpox, acne, melasma, fungal infections, etc., are quite fascinating.^[1]

In Sushruta Samhita, which deals with the surgical aspect of disease management, approximately 121 surgical instruments and more than 300 procedures are mentioned, which included different types of incision and drainage procedures of abscesses and infected wounds, various types of cauterization, and dermabrasion.^[1]

The term Kustha was probably used to represent a number of skin ailments along with leprosy of the modern sense. The classification of Kustha into seven types in the Charaka Samhita and 18 types (seven Mahakustha and 11 Kshudrakustha) in the Sushruta Samhita represents the astute observation of the ancient Indian physicians.^[1]

Later on, the Siddha system came and skin diseases were grouped under the term Kuttam. There are ample discussion on various skin ailments such as thinvup-pun (urticaria), paru (acne), and sarumap-pun (dermatitis).^[1]

Coming to modern dermatology, the major contributions from India can be discussed under dermatology, venereology, and leprology.

DERMATOLOGY

Major contributions in dermatology were made by:

“INDIAN” SIGNS IN DERMATOLOGY^[17]

DERMATOLOGICAL DISEASES^[1]

LPP

It was first described by Bhutani et al. in 1974.^[6]

MYCOLOGY IN DERMATOLOGY

VENEREOLOGY^[56]

• 1881: Donovanosis was first recognized by Kenneth McLeod in Madras.^[57]

• 1902: Caddy was the first to record cases of LGV in India under the title “Climatic bubo,” a disease that was thought to be due to climatic influences (mainly tropical).^[58]

• 1905: Colonel Charles Donovan identified the causative organism of Donovanosis in Madras. He described the intracellular “Donovan bodies” in the exudates from an oral lesion of the disease in a ward boy of a general hospital in Madras.^[59]

• 1954: Dr. Rajam RV and Dr. Rangiah PN of Institute of Venereology, Madras, wrote the WHO monograph series on Donovanosis (granuloma inguinale and granuloma venereum).^[60]

• 1956: Madras Medical College, VD department was redesignated as Institute of Venereology in 1956 and later renamed as Institute of STD (first of its kind in Southeast Asia), which was recognized by the WHO as a teaching and training center for the whole of India and Southeast Asia. Dr. RV Rajam, an international figure known for his research works on venereal diseases, was the founding director of the institute.^[60]

• 1989: Chacko and Nair introduced an enriched egg-beef selective medium, for the culture of gonorrhea, which is equally efficacious as the Thayer-Martin medium, but much cheaper and easily made from locally available ingredients in India.^[61]

LEPROLOGY^[1]

The first known asylum for leprosy patients was established in Calcutta early in the 19^th century. 1869: Dr. Bhau Daji Lad claimed effective treatment of leprosy with hydnocarpus oil.^[1]

• 1883: Carter made the first demonstration of lepra bacilli in India.^[62]

• 1941: Dharmendra described the “Lepromin” antigen.^[63]

• 1942: Dr. RG Cochrane used oral DDS in the management of leprosy in Madras.^[1]

• 1956: Reconstructive surgery was started in Vellore by Dr. Paul Brand for leprosy.^[1]

• 1959: Dr. Gopal Ramu, whose pioneering work, was the discovery of the use of chloroquine for the treatment of reactions in leprosy.^[64]

• 1976: Dr. R. Ganapati founded the Bombay Leprosy Project in September 1976 and was considered Mahaguru of Leprosy Workers. He contributed with his research works on various aspects of leprosy including nerve function assessment, reactions, relapse, and resistance, and in 1983, he was honored with the prestigious “Padma Shri” award by the Govt. of India.^[65]

• 1979: ICRC vaccine was developed by Dr. M.G. Deo in 1979 at the Cancer Research Institute, Mumbai, which contains ICRC bacilli (which are cultivable leprosy derived mycobacteria probably belonging to mycobacterium avium-intracellulare complex).^[66]

• 1980: Mycobacterium indicus pranii (MIP) vaccine was developed by Dr. G.P. Talwar, the Founder-Director of the National Institute of Immunology in 1980.^[67] The vaccine was originally called Mycobacterium w (M.w) and later renamed as MIP (indicus referring to India and pranii referring to Prof. Pran and National Institute of Immunology). MIP vaccine has also been found useful in the treatment of Category II “Difficult to treat” tuberculosis patients, for anogenital warts, preventive and therapeutic action on SP2/O myelomas and as an adjunct to HCG-LTB vaccine for preventing pregnancy.

• 1993: Dr. Charles K Job was the recipient of the prestigious Damien-Dutton Award in 1993, which is given to those who do outstanding work in leprosy globally. He was both a pathologist and a dermatologist and has published the maximum (314) number of papers on leprosy.^[68] His main research was on pathology and immunology of leprosy, the transmission of leprosy and electron microscopic studies and he was also a consultant to the World Health Organization.

• 1977: Dr. KV Desikan reported the survival of Mycobacterium leprae in nasal secretion under tropical conditions for up to 9 days. He received Damien-Dutton Award in 2000.^[69] His original work on survey, education, and treatment was the basis of the national as well as global leprosy control programs.

CONCLUSION

There are many more noteworthy contributions by Indian dermatologists that have not been included here since it is beyond the scope of an article with a preset word limit. The recent expansion of dermatology into different super specialty branches such as dermatopathology, dermatosurgery, pediatric dermatology, and cosmetic dermatology offers enormous scope for further research works, scientific studies, advancements, and discoveries to be made in dermatology. We can expect many more innovations and significant contributions from our Indian doctors and researchers in the coming years.