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Message from the Chair

Miozo Sasagawa, Lecturer

Miozo Sasagawa, Lecturer

1 − History of the Department

 The history of the department began with the Department of Dermatology and Urology on June 16, 1920, when lecturer Miozo Sasagawa (who was the first professor of the dermatology course at Jikei University School of Medicine) and eight assistants held their first meeting in the hospital outpatient department which was still unfinished at that time. The clinic started on August 3 of the same year, and there are records that indicate that the number of newly registered patients on the day was only two. Dermatology was first offered in April 1921, with lecturer Miozo Sasagawa in charge of the course. Then, in the following year (1922), the course gained its first professor, Masao Sasagawa.
 After a long history of working together, the Departments of Dermatology and Urology were later separated on April 1, 1963, and were re-established as independent departments, which continues to the present day. For the history of the departments following the separation, refer to the Alumni Bulletin of the Department of Dermatology (first published 1971) and the 80th Anniversary Journal of the Department of Urology. Here, we will look back on the activities of the department from the first professor in charge of dermatology at the department as it formerly existed, Prof. Sasagawa, to the present fifth professor, Masayuki Amagai.

Prof. Masao Sasagawa (First Professor)

Prof. Masao Sasagawa
(First Professor)

(1) Professor Masao Sasagawa (1922–1932)

 In June 1922, Sasagawa, who had returned from studying abroad in Europe as second professor at the Department of Dermatology and Urology, Nagasaki Medical College, was appointed professor in charge of dermatology in the Department of Dermatology and Urology on the recommendation of Shibasaburo Kitasato, Dean of Keio University School of Medicine. Sasagawa supported the Department of Dermatology and Urology in its early days, contributing to the reconstruction of university facilities and developing the department despite the extensive damage caused by the Great Kanto Earthquake that occurred on September 1, 1923. In January 1926, Associate Professor Masaatsu Kitagawa became the new professor in charge of urology and made urology course administration independent, paving the way for other universities to do so. The department accumulated many valuable cases in the first decade after its establishment, gaining 538 moulage wax models of different skin conditions. The term moulage refers to a lifelike wax model made for the purpose of teaching about skin diseases that is finely detailed and colored, made by placing wax onto a plaster mold of the affected area. At present, although its role has been superseded by recording technology such as color photographs, the technology is still applied to waxwork dolls, the wax models of food seen in front of restaurants in Japan, and so on. At that time, the Department of Dermatology had its own moulage specialist, whose high level of technical ability underpinned dermatology treatment and education at Keio University. In particular, Ichiyo Uno (who learned the technique from Tamotsu Ito, the first Japanese person to do so) had a particular genius for the technique, and was commissioned to create the portraits of Yukichi Fukuzawa and Shibasaburo Kitasato, which are displayed in the first meeting room of Kitasato Memorial Library.
 In this period, Sasagawa was interested in a kind of artificial hair transplant (the hair shaft insertion method) and presented his findings on this topic. Sasagawa started receiving treatment for uremia in 1931, but passed away on September 20 of the same year.

Prof. Katashi Yokoyama (Second)

Prof. Katashi Yokoyama (Second)

(2) Professor Katashi Yokoyama (1934–1960)

 After graduating from Kyoto Prefectural College of Medicine in 1918, Katashi Yokoyama immediately joined the Department of Hygiene and Bacteriology at Tokyo Imperial University and studied bacteriology for two years. He joined the Department of Dermatology and Urology at Keio University in 1920 and was an associate professor in 1932 at the time of Sasagawa’s death. The next year (1933), he was requested by Keio University to travel in Europe and the United States to observe dermatology departments there for about 11 months, and after returning to Japan he became a professor in April 1934. Subsequently, Yokoyama was responsible for dermatology and Kitagawa for urology. Under Yokoyama, the Department of Dermatology and Urology gradually expanded, and on the second floor of the main hospital building, in addition to the Nutritional Research Institute, various facilities were installed, including a reception desk, patient waiting room, dermatology initial and revisit examination rooms, urology initial and revisit examination rooms, dermatology and urology injection and bandage change room, preparation room, operating room, teaching room, associate professor / instructor offices and library, moulage room, and laboratories. However, regrettably many of these department facilities were burned down in the chaos of World War II in May 1945, and only the Wasserman reaction laboratory remained, which was a slight distance away within the Nutritional Research Institute. It was fortunate, however, that one month prior to the destruction, the facilities needed for medical treatment had been moved to an annex, and thus it was possible to continue medical treatment in some form.
 Yokoyama saw through the difficult process of rebuilding the department after the war. With the completion of the newly built wooden hospital main building in November 1949 on the site destroyed by the fire, the outpatient department, medical offices, reception, and so on moved to the second floor, and since that time medical treatment has been conducted there for many decades. In February 1946, Yokoyama and Tamura co-authored The Dermatology Textbook (from the 4th edition onwards Dermatology), published by Houmeidou Shoten. Yokoyama's clinical lectures also influenced the education of many dermatologists, and in 1963, Yokoyama’s clinical lectures were compiled, contributing greatly to the development of clinical dermatology in Japan. Yokoyama died from encephalodialysis on September 19, 1960.

Prof. Hitoshi Hatano (Third)

Prof. Hitoshi Hatano (Third)

(3) Professor Hitoshi Hatano (1961–1980)

 In January 1961, Associate Professor Hitoshi Hatano was appointed as a professor, and in April of the same year Masaji Nagashima became an associate professor in charge of dermatology. From 1962, in preparation for the separation of dermatology and urology departments, Kazuya Yamamoto was placed in charge of dermatology as a deputy secretary general alongside Masao Yamafuji as secretary general for urology. Then, on April 1, 1963, the dermatology and urology departments separated and became independent of each other. There were 24 members of teaching staff in the dermatology department under Prof. Hatano (13 in the university, 7 working in the affiliated hospitals, and 4 graduate students). The dermatology outpatient clinic consisted of a reception, pre-surgery room, initial examination room, treatment room, examination room, teaching rooms and library, all on the third floor of Hospital Wing 1, which was completed in 1965. The facilities were relatively small but significantly better than the past when the department had been in the wooden building. The number of dermatology outpatient visits had been 3,987 a year in 1921, and when the Department of Dermatology was established in 1963, this had increased to 9,385. In 1966, the number reached 10,582 passing the milestone of 10,000 per year. There was a total of 16 beds in the wards, including the first floor of Hospital Wing 6 (14 beds), a pediatric ward on the third floor of the Central Wing (1 bed), and the fourth floor of Hospital Wing 1 (one bed in a private room). Nevertheless, the inpatients service was operating at almost full capacity.
 Under the leadership of Hatano, the Department of Dermatology classified various skin diseases based on the appearance of the rash associated with it, promoting understanding of descriptive dermatology and greatly contributing to the development of dermatology in Japan. Daily medical records were mainly described in Latin and German. In particular, he made a major contribution to the education of dermatologists and medical students as the editor of the Japanese journal Clinical Dermatology (Rinsho-Hifuka) and the Japanese text book Standard Dermatology (Hyoujun-Hifukagaku). Following the movement toward the promotion of descriptive dermatology, Nagashima (later a professor of Kyorin University) established a couple of new disease entities, such as prurigo pigmentosa and Nagashima-type palmoplantar keratosis. Hatano also expanded the field of activities outside the department, thus greatly contributing to its development. He became Keio University Hospital Director in 1975, a trustee of Keio University in 1978, Dean of Keio University Graduate School of Medicine in 1979. In 1980, he retired from Keio University and became an honorary professor and head of National Hospital Organization Saitama Hospital. He became director of the Second Tokyo National Hospital (currently National Hospital Organization Tokyo Medical Center) in 1982, before becoming the honorary director of National Hospital Organization Tokyo Medical Center in 1985 after retiring. He became president of the annual meeting of the Japanese Dermatological Association in 1977 and president of the annual meeting of the Japanese Society for Investigative Dermatology in 1981. He also played a public role within many ministries and agencies including the foundation of policies on intractable diseases, and in 1973, he was appointed as Chair of the Research Group at the Ministry of Health and Welfare’s Specific Diseases (Intractable Diseases) Division, as well as serving as a member of Ministry of Education Science Council Special Committee in 1976, and as a permanent member of the Central Pharmaceutical Affairs Council Standing Committee in 1977. With these contributions, he was awarded the Order of the Sacred Treasure (Suihosho), 2nd Class, in 1992. Hatano died at the age of 91 from heart failure on September 16, 2010.

Prof. Takeji Nishikawa (Fourth)

Prof. Takeji Nishikawa (Fourth)

(4) Professor Takeji Nishikawa (1982–2005)

 In May 1980, when Hatano was transferred to National Hospital Organization Saitama Hospital as a director, Takeji Nishikawa became the acting chair of the department, with Koichiro Kamo as acting chief of clinical practice and Keijiro Kitamura as acting chief of medical education for a term of approximately two and a half years. Nishikawa became Professor and Chair for the Department of Dermatology from October 1982. From then until March 2005, he also served as the chief of clinical practice. During Nishikawa's time in the role, the dermatology outpatient department moved to the second floor of Building No. 2 from May 1987, and medical treatment using a system of electronically ordering prescriptions and examinations was initiated. In addition, department office and laboratory functions were integrated from September 1990, and the department expanded to the third floor of Hospital Wing 2. The dermatology laboratory on the third floor of the Nutritional Research Institute moved to the third floor of Hospital Wing 2 from November of the same year, the dermatology ward moved to the second floor of Hospital Wing 6, and the assistant and associate professors’ room moved to the third floor of the annex. One unit of the Research Park was adopted as a project investigating autoimmune diseases within the Integrated Medical Science Research Building, which was completed in 2001.
 Moving from the foundational concept that “descriptive dermatology is important as the starting point of dermatology,” Nishikawa expanded this “from descriptive dermatology to pathophysiological dermatology and molecular dermatology,” thus developing the department into one of international renown, attracting and training large numbers of people. At the same time, he actively conducted joint research with researchers from outside the university, foreign countries, and the cosmetics industry.
 Nishikawa specialized in mycosis, autoimmune blistering disease, cutaneous collagen disease and skin diseases unique to Japan, and has made numerous lasting achievements. Together with Takashi Hashimoto (later Professor at Kurume University), he described the world's first intercellular IgA skin disease (IgA pemphigus) induced by IgA autoantibodies as a disease related to pemphigus that was usually induced by IgG autoantibodies, also identifying one of its target antigens as desmocollin 1. Together with Hiroshi Shimizu (later professor at Hokkaido University), he determined ultrafine localization of pemphigoid and acquired epidermolysis bullosa antigens using immunoelectron microscopy technology. Furthermore, with Amagai and others, he developed a serological diagnosis (ELISA) using recombinant protein antigen for pemphigus. In Japan, this serological diagnosis was approved and covered by national health insurance in 2003 and has been widely used internationally for diagnosis and disease-activity evaluation. He has made a wide range of contributions throughout the course of his academic activities, working with Takashi Harada (later a professor at Tokyo Women’s Medical College Daini Hospital) and Wataru Naka on mycosis, with Shingo Tajima (later a professor of National Defense Medical College) on the dermis, especially elastin biochemistry and molecular biology, and with Masaru Tanaka (later a professor at Tokyo Women’s Medical University Medical Center East) on the development of digital diagnostics using dermoscopy.
 Nishikawa’s activities within the academic community were wide-ranging, serving as the president of the 39th annual meeting of the Japanese Society of Medical Mycology in 1995 and the 100th annual meeting of Japan Dermatological Association in 2001, at which time commemorative stamps of the 100th anniversary were issued. He also served as a board director of the International League of Dermatological Societies (ILDS) for the 3 terms (15 years) from 1992, serving as the Secretary Treasurer for the 2nd term, leading the world’s dermatological associations.
 In addition, while working as a professor, he planned exchanges with dermatology departments and societies around the world. He was invited to the May 1991 Hebra Memorial Lectures of the Austrian Society for Dermatology and Venereology and the July 1998 Arthur Rook Oration of the British Association of Dermatologists in July 1991, thus contributing to the internationalization of dermatology in Japan, and in 2004, he received the Keio Award. He retired in March 2005 and became a professor emeritus at Keio University, and from May of the same year, he started the Samoncho Dermatology clinic with his old co-worker at this department, Itsuro Matsuo (formerly a professor at Teikyo University Hospital, Ichihara), where he continues to work to this day.

Prof. Masayuki Amagai (Fifth)

Prof. Masayuki Amagai (Fifth)

2 — Current Clinical Practice, Research, and Education

Professor Masayuki Amagai (2005–present)

 Amagai has further developed the tradition of “strength in clinical practice and depth in research” built up by his predecessors. He runs the department with the motto “創知育成” coined by him, meaning “create new knowledge and nurture people,” with an emphasis on diversity and communication.
 In 1991, while working as a postdoctoral fellow at the laboratory of Dr. John R. Stanley, the National Institute of Health in the USA, he succeeded in the isolation of the cDNA for pemphigus vulgaris antigen and revealed it to be desmoglein 3 (Dsg3). In 2000, he discovered that the S. aureus exfoliative toxin that induces staphylococcal scalded skin syndrome (SSSS) and bullous impetigo is an enzyme that cleaves desmoglein 1. He also generated a pemphigus model in mice through a unique method using autoantigen knockout mice. Since 2013, he has also served as a team leader at the RIKEN Center for Integrative Medical Sciences and is active in broadening the scope of essential areas of basic research. In 2016, he was elected as an international member of the National Academy of Medicine in USA. Since October 2017, he has been appointed as Dean of Keio University School of Medicine. He became President of the Japanese Dermatological Association in 2018 and served as the president of the 119th Annual Meeting of the Japanese Dermatological Association, which was held virtually because of the COVID-19 pandemic in 2020.

Clinical practice: Working with a policy of taking care of all skin-related diseases, medical treatment in the department is conducted with a system for handling a wide range of skin diseases. In the outpatient department, in the morning, we provide medical services for initial visit patients as well as follow up patients. In the afternoon we provide a wide range of specialized outpatient services, including autoimmune blistering diseases, atopic dermatitis, psoriasis, hereditary diseases, allergies and drug reactions, skin tumors and malignancies, hair loss, nail deformity, laser treatment, and cutaneous collagen diseases. With regard to unusual and difficult cases, we perform clinical conferences with patients’ views, histology presentation of biopsied samples and group discussion among the department staffs to decide on the diagnosis and treatment plan. We perform genetic analysis such as whole-exome sequencing for rare inherited diseases and undiagnosed cases. On the ward, we cooperate with the other departments and medical sections to manage severe diseases such as pemphigus, pemphigoid, and skin malignancies including melanoma. The main wards have moved from the second floor of Hospital Wing 6 and ward 6S of Building No. 2 to the tenth floor of Building No. 1 with approximately 16–20 beds. We perform 60–70 general anesthetic operations a year. The clinical research described below is the driving force of our clinical practice, and we treat patients from across the country.

Research: Our research activities are constantly being developed to achieve high-impact research results on an international level in both foundational and clinical aspects. In research on the elucidation of pemphigus pathophysiology that has been ongoing since the time of Nishikawa, achievements include isolation of pemphigus monoclonal antibody with pathogenicity from pemphigus model mice (Kazuyuki Tsunoda et al.), isolation of Dsg3-specific T-cell clones and the pathophysiology of interface dermatitis by cellular immunity against epidermal autoantigens (Hayato Takahashi et al.), and research is ongoing toward the development of antigen-specific immunosuppressive therapies. In studies on skin barrier function, there have been many research findings, including a discovery of behavior of epidermal Langerhans cells extending dendrites above tight junctions to capture foreign antigens (Akiharu Kubo et al.), a discovery of hair follicle immune function whereby hair follicles produce chemokine as immunosensor to external stimulation (Keisuke Nagao et al.), the induction of differentiation into human hair follicles using iPS cells (Manabu Ohyama et al.); the identification of the causative gene for Nagashima-type palmoplantar keratosis; and the implication that terminal-differentiated epidermal cells (SG1 cells in stratum granulosum) naturally take the form of a Kelvin tetrakaidecahedron.
 Since Keio University Hospital was certified as a clinical research core hospital in 2016, a range of findings in clinical research have also been developed, including efficacy verification of rituximab (anti-CD20 monoclonal antibody) for refractory pemphigus through multicenter joint doctor-led clinical trials (Jun Yamagami et al.); evaluation of the efficacy of TIL treatment for malignant melanoma as a clinical trial (Takeru Funakoshi et al.); analysis of skin microbiota involved in atopic dermatitis, and analysis using medical information big data such as immunological, pathological, and genetic information (Tamotsu Ebihara, Hiroshi Kawasaki et al.); verification of the effects of hydroxychloroquine on skin and systemic lupus erythematosus (Akiko Tanikawa et al.); and new development of a corrective treatment for ingrown toenails (Masataka Saito et al.).

Education: Education is the most important part of running the department and nurturing the people we work with. Many department staff members have grown from the basis of traditions that have been passed down from generation to the next. We value diversity, take in a range of talented individuals from all over the country, and make every effort to make every individual in the department into an excellent dermatologist. For undergraduate students, in addition to classroom lectures, we conduct clinical clerkship for two weeks for grade 5 and 6 students. In the outpatient clinic, students examine the medical history of patients and evaluate skin lesions on their first visit and think of possible diagnosis and treatment plans with guidance from staff doctors. In the ward, students work with the ward physician and make reports on assigned cases. Within the two-week rotation, short lectures are given daily by the dermatology staff, and students learn a wide range of fields of fundamental, clinical, and research dermatology. Junior residents select to rotate dermatology for 1–3 months during their two-year training. In the outpatient department, junior residents or super-rotators will gain an understanding of the process from diagnosis to treatment of various skin diseases, learning skin biopsy procedures, and further giving presentations at clinical conferences. In the ward, residents belong to a team and cultivate an understanding of the dermatological perspective through investigation of the causes and treatments of cases they are in charge of.
 If senior residents choose dermatology in their specialized training, which takes five years to complete, they belong to the department and work as members of the team. Since the clinical training system for junior residents was introduced in 2004, 7–8 specialist physicians have joined the department annually. After basic dermatology training at a university that includes over 50 short lectures, more practical training is provided at over 20 affiliated hospitals located in Tokyo, Kanagawa, Chiba, Saitama, and Shizuoka Prefectures. After 2–3 years of this practical training, senior residents return to the university to undergo more specialized and advanced training. We have an integrated education system with affiliated hospitals and universities that is unique to Keio University.
 We are also active in international exchange programs, taking on large numbers of international students and residents, as well as junior and senior faculties from the USA, Europe, and Asia. Since 1998, we have been conducting an exchange program with the University of Pennsylvania based on a proposal by Dr. John R. Stanley, in which staff members and residents have a short stay of about two weeks, and in 2017, over 25 people had benefited from the exchange.

Members from Department of Dermatology who have become professors, department heads, or presidents at other universities or institutions
(Including those from the former Department of Dermatology and Urology)

(Name / Year Appointed / Destination Institution)
Hajime Tamura/1932/Tokyo Women’s Medical Professional School
Toshiro Nakamura/1945/Tokyo Women's Medical Professional School
Masakatsu Izaki/1955/Iwate Medical University
Muneo Okido/1974/Tokai University School of Medicine
Masaji Nagashima/1978/Kyorin University Faculty of Medicine
Keijiro Kitamura/1985/Saitama Medical Center
Takashi Harada/1993/Tokyo Women's Medical College Daini Hospital
Tetsuo Shiohara/1994/Kyorin University Faculty of Medicine
Itsuro Matsuo/1996/Teikyo University Hospital, Ichihara
Takashi Hashimoto/1996/Kurume University School of Medicine
Akira Ozawa/1999/Tokai University School of Medicine
Hiroshi Shimizu/1999/Faculty of Medicine and Graduate School of Medicine Hokkaido University
Shingo Tajima/2002/National Defense Medical College
Shinichi Takahashi/2004/Tokyo Dental College Ichikawa General Hospital
Masaru Tanaka/2007/Tokyo Women’s Medical University Medical Center East
Kazuhito Hayakawa/2009/Teikyo University Chiba Medical Center
Masashi Akiyama/2010/Nagoya University Graduate School of Medicine
Akira Ishiko/2010/Faculty of Medicine Toho University
Keisuke Nagao/2014/National Institutes of Health
Manabu Ohyama/2015/Kyorin University Faculty of Medicine
Tomoo Fukuda/2016/Saitama Medical Center
Tamotsu Ebihara/2020/President, Tokyo Saiseikai Central Hospital
Tomotaka Sato/2020/Teikyo University Chiba Medical Center

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