The control of infective skin diseases--the lessons of leprosy research.

Abstract

One of the major changes seen in the past 100 years has been a shift in emphasis away from infections as common causes of skin disease in non‐tropical countries. In 1888, dermatoses thought to be caused by, or secondary to, syphilis were common in everyday dermatological practice, and papers on this condition and its treatment were issues regularly aired in the medical literature. The first edition of the British Journal of Dermatology, for instance, contains a paper by Unna, on the association between seborrhoeic eczema and syphilis'. Cutaneous forms of other infectious conditions, such as tuberculosis, as well as endemic scalp ringworm were prevalent in dermatological out‐patient clinics. Since then there has been a decline in the importance of infections as causes of skin disease, largely through the discovery of antibiotics and improvements in social conditions, although this picture is likely to alter with the emergence of the acquired immunodeficiency syndrome which threatens to dominate the pattern of disease for years to come. By contrast, infections are still major causes of skin, as well as internal, disease in the tropics, particularly in rural communities. In recognition of the possibility of eliminating the important transmissible diseases through concerted effort, the World Health Organization has designated six infectious causes of disease as targets for a special programme of tropical disease research. These were malaria, schistosomiasis, trypanosomiasis, filariasis, leishmaniasis and leprosy. While the latter three conditions feature prominently as causes of skin disease in the developing world, the advances, as well as the setbacks, in infectious disease research over the last century are perhaps best illustrated by the only bacterial infection in this group—leprosy.