History of Dermatology in Pakistan
Pakistan emerged as a sovereign country on world map on 14th August, 1947. Like all walks of life, there was acute shortage of medical and health facilities in the new born state. The majority of specialist doctors and teachers were Hindus and had left for India. There were only two medical colleges, King Edward Medical College and Lahore and Dow Medical College, Karachi, with no postgraduate medical institute in the whole country. Although, venereology out-patient clinics were run in the major hospitals, there was not a single qualified dermatologist at that time. Five to six lectures covering the common dermatological diseases were delivered by the internists. It can be said that dermatology, as a specialty, virtually started from scratch.
For descriptive purposes, three general periods of dermatology in Pakistan can be distinguished, from 1947 to 1975, from 1976 to 2000 and then from 2001 onwards.
From 1947 to 1975: Early progress
During the period from 1947 to 1975, a few names, who pioneered dermatology in public sector, teaching hospitals and military medical services, stand out prominently. These are Dr. Nusrat Ali Shaikh, Prof. Syed Ghulam Shabbir, Brig. Dr. Syed Muhammad Jaffer, Lt. General Mahboob Ahmad and Dr. Dur-e-Kamil.
Considering the scarcity of qualified dermatologists in the country, two class fellows and graduates of 1948 from KEMC, Lahore, opted for dermatology as postgraduate subject. Dr. Nusrat Ali Shaikh and Dr. Syed Ghulam Shabbir did their MRCP (Edinburgh) with dermatology as special subject in 1955 and 1957, respectively.
After returning from UK, Dr. Shaikh (Figure 1) joined the Skin and Social Hygiene Centre, Karachi. This was the first institute in public sector established for care of dermatological patients in 1952. He served as director of the center from 1956 to 1978. He, along with Prof. Syed Ghulam Shabbir, started MCPS in dermatology. He was the founder President of the Pakistan Association of Dermatologists but unfortunately died a year later in 1980.
Another legend of that era was Prof. Syed Ghulam Shabbir (Figure 2). He succeeded in establishing dermatology as an independent specialty in a teaching hospital in 1960 when a 20-bedded in-patient ward was started in Mayo Hospital, Lahore. He was the first Assistant Professor of the subject in the country. Dr. Tahir Saeed Haroon happened to be the first medical officer in the new-born unit. In 1964, the first chair in dermatology was created and Dr. Syed Ghulam Shabbir was elevated as Professor of Dermatology. Due to his tireless efforts the department was relocated to a larger new building and the bed strength was increased to 56 in 1970. A leprosy clinic was added in 1972. He also started the histopathology laboratory on self-help basis. He described a genodermatosis 'laryngo-onycho-cutaneous syndrome syn. Shabbir syndrome' in Punjabi children, which is characterized by refractory, granulating erosions affecting periorificial areas, laryngeal, ocular and genital mucosa and early decaying teeth. After his retirement in 1987, Prof. Shabbir served as Professor Emeritus till his death in 2002. He trained many MCPS and MD students in the subject.
The history of military dermatology is also rich in eminent dermatologists. Major (later Brigadier) Dr. Syed Muhammad Jaffer (Figure 3) was the pioneer. He graduated from the King Edward Medical College, Lahore in 1944 and joined the military services in the same year. He trained in dermatology with Dr. Stephen Gold at the British Medical Hospital, Banglore, and at St. John's Institute, London from 1948 to 1950 and then set up dermatology services at Military Hospital, Rawalpindi. He was an early Vice President of PAD. He participated actively in postgraduate training and organized MCPS in dermatology. His trainees included Major (later Lt. General) Mahboob Ahmad and Major (later Major General) Ashfaq Ahmad Khan. He headed the department till his retirement in November, 1977, except for a brief period from 1963 to 1964. He was replaced by Major Dr. Ashfaq Ahmad Khan in 1977.
Late Lt. General Mahboob Ahmad (Figure 4) did his MRCP (Edinburgh) in 1963. He led the department at military Hospital, Rawalpindi for a brief period from 1963 to 1964. He was then transferred to internal medicine department. Remaining out of the mainstream, he practiced, taught and supported dermatology. He served as Vice President of PAD, as well.
Dr. Dur-e-Kamil (Figure 5) will be remembered as the founder of dermatology in NWFP. He also graduated from the KEMC in 1955 and did his fellowship in dermatology from Canada in 1966. He was posted as Consultant Dermatologist at Lady Name Reading Hospital, Peshawar. Later, he helped with the establishment of leprosy unit at Name Mission Hospital, Peshawar. He was actively involved in imparting postgraduate training in dermatology at Name Lady Reading Hospital, Peshawar and had many publications to his credit. He died in 1990.
Dr. Abdul Basit is credited to be the founder dermatologist in the East Pakistan. He founded the first dermatological society (which later became the Bangladesh Dermatological Society) at Dhaka, in 1962.
From 1976 to 2000
This period marked the dawn of golden era in the history of dermatology when the second generation of dermatologists was ready to take over. Out of a score of dermatologists at that time, two names, Dr. Tahir Saeed Haroon and Dr. Ashfaq Ahmad Khan, stand out. These two contemporaries played a vital role in the recognition and proliferation of the specialty. Structured postgraduate training of FCPS was started and Pakistan Association of Dermatologists was founded during this period.
Prof. Tahir Saeed Haroon (Figure 6) can be called a Champion of dermatology in Pakistan. Prof. Haroon, an alumnus of 1961 from King Edward Medical College, Lahore, did his MRCP from Glasgow in 1973. During his stay in UK, he trained with Dr. Alan Lyell (famous for Lyell's disease) and later served as a consultant dermatologist at Bradford, West Yorkshire, only the second Pakistani to do so at the time. After returning to Pakistan in 1976, he established the department of dermatology at Jinnah Postgraduate Medical Centre, Karachi. As a real academician, he started courses for MCPS dermatology and then along with General (R) Dr. Ashfaq Ahmad Khan organized FCPS dermatology. He was the co-founder of PAD along with Dr. Nusrat Ali Shaikh, serving as the first General Secretary. He also organized the first PAD National Conference at Karachi in 1982. In 1989, Prof. Haroon moved to the King Edward Medical College, Lahore to head the department of dermatology at Mayo Hospital, Lahore. With him, the centre of dermatological activities shifted from Karachi to Lahore. The vision, vitality and enthusiasm of Prof. Haroon transformed the Mayo dermatology unit into a state of the art department. The existing facilities were upgraded and new sections pertaining to dermatopathology, mycology, immunofluorescence, laser, patch test, dermatosurgery, audiovisual aids and library were added. He was a true research worker and academician. He authored more than one hundred articles published in peer-reviewed national and international journals and various books besides contributing chapters to a number of textbooks. He trained 40 FCPS, 30 MCPS and 1 MD student. Even after his retirement in 2002, he remains the driving force behind the dermatology affairs of the country, PAD and JPAD. He is currently the President of the PAD, having served in the same capacity from 1984 to 1988.
Maj. General Dr. Ashfaq Ahmad Khan (Figure 7), also a graduate of KEMC, in 1964, was basically an internist who later on received training in dermatology from UK. He was an excellent clinician and academician. He emphasized the significance of core knowledge of medicine for the externists. He upheld the standards of postgraduate qualification in dermatology. He was co-organizer of FCPS (dermatology) in Pakistan. Under his command, Military Hospital, Rawalpindi became a centre of excellence in Pakistan. He trained many MCPS, FCPS and MD (dermatology) students. General Ashfaq was President, PAD from 1997 to 1998. He was succeeded by Brig. Simeen Ber Rahman in 1999.
During 1970's, many new medical colleges and postgraduate institutes were established in the country. This ushered the opening of new avenues for the young dermatologists in the country. New departments were set up and new teaching posts were created.
Amongst the contemporaries of that period who merit mention are Prof. Iqbal Chaudhary (Figure 8) (Nishtar Medical College, Multan), Prof. Zafar Ahmad (Dow Medical College/ Civil Hospital, Karachi), Dr. Aleem Saeed Qureshi (Figure 9) (The Aga Khan Medical University, Karachi), Dr. Mahmud Hasan Zubairy (Karachi), Prof. Ali Khan Tareen (Figure 10) (Bolan Medical College, Quetta), Dr. Manzoor ul Hasan (KEMC, Lahore), Prof. Abdul Ghafoor Qamar (Figure 11) (Quaid-e-Azam Medical College, Bahawalpur), Prof. Raza Muhammad Khan (Figure 12) (Khyber Medical College, Peshawar), Dr. Khadimullah Kakakhel (Khyber Medical College, Peshawar), Dr. Javed Anwer (Liaquat Medical University, Hyderabad), Dr. Hamid Zaib Khan (CDA Hospital,Islamabad) and many others. All these strived hard for the recognition and upgradation of dermatology in their respective institutions.
Dr. Aleem Saeed Qureshi was the first Joint Secretary of PAD, later General Secretary. He along with Prof. TS Haroon drafted its constitution. A graduate from Nishtar Medical College, Multan, in1960, did his MCPS in dermatology in 1977. He then joined the Aga Khan University, Karachi as a consultant dermatologist. He was very actively involved in the affairs of PAD till his death in 1995.
Dr. Khurshid Hassan Alvi (Figure 13) has also been closely associated with PAD since its early days. Later he served as President from 1998 to 2000.
n 1996, the first unit of Pediatric dermatology was established at Institute of Child Health, Lahore, by Dr. Farhana Muzaffar.
From 2001 onwards
Since 2001, dermatology has gained sufficient momentum to keep it progressing in the fields of clinical work, research and academics. After the retirement of Prof. Tahir Saeed Haroon in 2002, Dr. Sabrina Suhail succeeded him at the Name Mayo Hospital. In 2004, the Dermatology Department, King Edward Medical University/ Mayo Hospital, Lahore was split into Two Units. Unit-I is headed by Prof. Syed Atif Hasnain Kazmi, with Dr. Shahbaz Aman as Associate Professor and Dr. Muhammad Nadeem & Dr. Muhammad Saleem Khan as Assistant Professors while the Unit-II is headed by Prof. Sabrina Suhail Pal with Dr. Khawar Khurshid as Associate Professor and Dr. Zahida Rani & Dr. Faria Asad as Assistant Professors. Prof. Syed Atif Hasnain Kazmi inaugurated the first Teledermatology Unit at Mayo Hospital, Lahore in 2004 and installed an IPL facility for poor patients in June, 2011.
Other principal figures of the third generation of dermatologists include Prof. Zarnaz Wahid (Dow Medical College/ Civil Hospital, Karachi), Prof. Muhammad Jahangir (Allama Iqbal Medical College/ Jinnah Hospital, Lahore), Prof. Muhammad Azam Bokhari (Services Institute of Medical Sciences/ Services Hospital, Lahore), Prof. Iqbal Tareen (Bolan Medical College, Quetta), Prof. Ghulam Mujtaba (Nishtar Medical College, Multan), Prof. Muhammad Khalid (Quaid-e-Azam Medical College, Bahawalpur), Prof. Tariq Rashid (Fatima Jinnah Medical College/ Sir Ganga Ram Hospital, Lahore), Prof. Shahid Javaid Akhtar (Punjab Medical College, Faisalabad), Dr. Hamid Zaki, Dr. Daulat Ram Pinjani and Dr. Manzoor Memon (Institute of Skin Diseases, Karachi), Prof. S.M. Shamim (Baqai Medical University, Karachi), and many more, all spiritual heirs to Prof. Tahir Saeed Haroon. Other prominent names are Prof. Azer Rashid (Khyber Medical College, Peshawar), Prof. Zubair Khan and Dr. Mairaj Muhammad Khan (Lady Reading Hospital, Peshawar), Dr. Abdul Mannan Bhutto (Chandka Medical College, Larkana), and Dr. Imranullah Khan (Ayub Medical College, Abbotabad).
After 1999, the Military Dermatology was led by Brig. Dr. Simeen Ber Rahman. She had been actively engaged in research activities especially leishmaniasis and had been instrumental in upgradation of her department. Other worth mentioning stalwarts of military dermatology are Col. Ahsan Hameed, Col. Khalid Hussain, Brig. Rehanuddin, Brig. Syed Dilawar Hussain, Brig. Zafar Iqbal Sheikh, Brig. Nasser Rashid Dar and Col. Asher Mashhood.
Dermatology community today
Currently there are around 420 practicing dermatologists in the country (one dermatologist per 350000 population), in contrast to none in 1947 and a score in 1970's. 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 (where the 70% of country's population dwells) are underserved. Socioeconomic factors and the government policies are partly responsible for this uneven distribution. Separate dermatology departments are functioning in almost all medical colleges in the public sector whereas only a few in the private sector have the dermatology faculty. These departments are manned by properly qualified teachers. A few departments are equipped with lasers, phototherapy units, dermatosurgery theatres, patch testing facilities and mycology and histopathology laboratories. Private sector is sharing the burden of cosmetic dermatology; however, the academic activities are mainly confined to the teaching hospitals. Different departments round the country are actively involved in imparting postgraduate training for MD, FCPS and DCPS in dermatology. At present there are 7 chairs in dermatology in the whole country.
Milestones in the history of dermatology in Pakistan
Figure 1 - Dr. Nusrat Ali Shaikh, the founder President of PAD (1979).
Figure 2 - Professor Syed Ghulam Shabbir, the founder of the first teaching dermatology department in Pakistan. President PAD (1980-84).
Figure 3 - Brig. Syed Muhammad Jaffer, the pioneer of dermatology in the military. Vice President, PAD.
Figure 4 - Lt. General Mahboob Ahmad, another eminent figure of military dermatology. Vice President, PAD.
Figure 5 - Dr. Dur-e-Kamil, the first Consultant Dermatologist in the North Western Frontier Province. Vice President, PAD.
Figure 6 - Professor Tahir Saeed Haroon, a legendary teacher and academician and founding General Secretary of PAD. President, PAD (1985-1988 & 2002-2004).
Figure 7 - Major General Dr. Ashfaq Ahmad Khan, a legend in the military dermatology and President, PAD (1997-1998).
Figure 8 - Professor Iqbal Choudhary, a respected Senior Dermatologist. President, PAD (1989-1992)
Figure 9 - Dr. (late) Aleem Saeed Qureshi, the founding Joint Secretary of PAD. Later General Secretary. A moving force behind PAD.
Figure 10 - Professor Ali Khan Tareen, the founder of dermatology in Baluchistan. President, PAD (1993-1994)
Figure 11 - Prof. Abdul Ghafoor Qamar. President, PAD (2001-2002)
Figure 12 - Prof. Raza Muhammad Khan, one of the pioneers in Dermatology in NWFP. President, PAD (1995-1996).
Figure 13 - Dr. Khurshid Hasan Alvi. President, PAD (1999-2000).
Figure 14 - Dr. Badar Dhanani former President, PAD (2005-2006).
Dr. Iqbal Tareen
Dr. Naeem Iqbal
Dr. Zakin Ahmad
Prof. Atif Kazmi
DR. ZAFAR IQBAL SHAIKH
Dr. Pervaiz Iqbal
Prof. Syed Shams Uddin