History of dermatology

The history of dermatology concerns the development of the practice of researching, defining and treating skin diseases, from ancient times to the present. The field has its origin in the earliest forms of medicine, later becoming a distinct field with its own specialised practitioners and researchers.

Earliest roots

Mesopotamia

Readily visible alterations of the skin surface have been recognised since the dawn of history. Among the first to take an interest in skin diseases were the Mesopotamian peoples, who sought to understand the reasons for these problems, often resorting to explanations rooted in religion, astrology and divination, and were the first to observe and define various dermatopathies. Skin conditions were considered a sign of divine punishment, the actions of demons and spirits, or as the result of black magic.^[1][2]

One of the most influential sources of understanding views on skin conditions in Mesopotamia comes from the Babylonian chief scholar Esagil-kin-aplim, who wrote a diagnostic manual called Sakikkū. One passage describes a complex skin condition which is associated with a sexual encounter. Another work, Alandimmû, observes the human physical appearance, with a section dedicated to dermal marks, such as moles, and spots.^[2]

While matching the descriptions of diseases in the few surviving cuneiform medical texts to specific ailments is challenging, it appears likely that Babylonians and Assyrians were the first to define and describe warts, pustules and scabies in writing.^[3] It is also possible to draw some conclusions about their attitude to skin conditions. Doctors of the era clearly sought to define disease according to certain criteria, using observations such as such as heat, smell, breath and bodily fluids, to help draw a diagnostic conclusion.^[1][2]

Ancient Egypt

Among the oldest preserved medical documents relevant to skin diseases are the ancient Egyptian Smith Papyrus and Ebers Papyrus dating to c. 1600 BCE and c. 1550 BCE respectively, though it is likely their contents were copied and passed down with their ultimate origins being much older folk remedies.^[4][5]

These scrolls describe various diseases, including skin complaints such as

Ancient Egyptians believed in a form of proto-humorism, that skin diseases were a symptom of health problems inside the body, caused by a blockage in the flow of bodily fluids. This turned the fluids into pain-making substances that could cause diseases anywhere in the body.^[4]

While many of the procedures do not resemble those prescribed by modern medicine, the papyri are notable for their evidence of an early system of thorough inquiry into skin diseases, recommending a systematic examination, diagnosis and treatment, something that would later be more formalised by Greek schools of medicine.^[4][7][8]

Ancient Greece and Rome

Ancient Greek physicians adopted many treatments of the Egyptians, with the likes of Homer and Diodorus attesting to their respect of Egyptian medicine, though they rejected the use of incantations as a method of treatment.^[8] However, Greek and Roman medicine did not see the skin as an organ in itself, but rather a mere covering for the body. Similarly to the Egyptians, they viewed skin diseases as merely a representation of a humoral imbalance.^[9]

Greek medicine, with its focus on the harmony between external beauty and internal goodness, laid the foundation for dermatological practices, emphasizing a healthy diet and physical activity. Empedocles of Agrigento made early inroads into understanding skin diseases and the concept of cutaneous respiration, suggesting the skin's role in gas exchange similar to the lungs.^[10]

Hippocrates described skin diseases and proposed the first classification of skin diseases with two categories: diseases of the skin itself (idiopathic) and diseases due to an imbalance of humors that a merely manifested on the skin (exanthematic).^[11][12] Around a century later, his work would be compiled into the Corpus Hippocraticum, which described the anatomy and physiological processes of the skin, including sweating and glandular secretion.^[12]

Rome, while indebted to Greek medical knowledge, also absorbed insights from Etruscan magical medicine, which revered water's regenerative powers and utilized plants for their antiseptic properties. Key Roman figures in dermatology include Aulus Cornelius Celsus and Claudius Galen. Celsus, in his De Medicina, detailed various skin conditions with precise terminology, covering diseases like ulcers and leprosy. Galen expanded on dermatological diseases, especially those affecting the genitals, and explored the causes of hair color and the notion of sexually transmitted diseases.

16th century

The major development in the formalisation of the study of skin came from Andreas Vesalius, who first analysed and described the skin's substance, its layers, pores, fat and nerves.^[9] During his first public anatomical dissection in 1540, Vesalius showed and explained to the witnesses the difference between the 'inner skin' (dermis and/or hypodermis) and the 'outer skin' (epidermis) and their respective properties.^[13]

In 1572, Geronimo Mercuriali of Forlì, Italy, completed De morbis cutaneis (translated "On the diseases of the skin"), and is known as the first scientific work to be dedicated to dermatology. One source lists Jean Astruc (1684-1766) as the founder of modern dermatology.^[14] In 1799, Francesco Bianchi wrote the book Dermatologia which is the first comprehensive textbook of modern dermatology written for the students of medicine.^[15]

19th century

In 1801 the first great school of

By the mid-19th century, dermatology had become a widely-recognised field.[17] Publications such as Gustav Simon's Die Hautkrankheiten durch anatomische Untersuchungen erläutert (Skin Diseases Illustrated by Anatomical Investigations)^[18] and Ferdinand von Hebra's Atlas der Hautkrankheiten (Atlas of Skin Diseases)^[19] sought to illustrate a wide range of dermatological conditions and allow physicians to recognise symptoms in their patients. Hospitals such as Berlin's Charité had established dedicated dermatological departments, which led to significant advances in the description of conditions and their potential treatments.

See also

• Vienna School of Dermatology
• List of dermatologists
• List of cutaneous conditions

Notes

References

• Copeman PW (February 1995). "The creation of global dermatology". J R Soc Med. 88 (2): 78–84.
  PMID 7769599
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• Tilles G, Wallach D (1989). "[The history of nosology in dermatology]". Ann Dermatol Venereol (in French). 116 (1): 9–26.
  PMID 2653160
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• Jackson R (May 1977). "Historical outline of attempts to classify skin diseases". Can Med Assoc J. 116 (10): 1165–8.
  PMID 324589
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• King JM (April 1983). "Historical review of early dermatology by J. M. King, MD, Nashville, Tenn. Originally published May 1927". South. Med. J. 76 (4): 426–36.
  PMID 6340211
  .

External links

• History of Dermatology Society
• French Society for the History of Dermatology
• American Association for the History of Medicine
• The Canadian Society for the History of Medicine

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