PDF
ePub
Citation
Print
INTRODUCTION
The beginning of modern medicine and Yonsei University College of Medicine
An American medical missionary, Horace N. Allen, planted the seed for modern medicine in Korea. Established in 1885 during the Gapsin Coup, Gwanghyewon was the nation's first modernized hospital (Fig. 1A). In the same year, it was renamed Chejungwon “House of Civilized Virtue”. From the beginning, the medical services at the Chejungwon covered various sub-specialties of modern western medicine, including dermatology and venereology. From 1986, Horace N. Allen provided the first basic medical education in Korea. After Oliver R. Avison's nomination as the fourth director of the Chejungwon in 1893, the institution began to emphasize the importance of medical education for future generations. In 1904, the Chejungwon changed its name to Severance Hospital in commemoration of Louis Severance, who donated a large sum of money to build a new hospital building near Sungnyemun gate1. In the same year, the name of early medical school changed to Severance Hospital Medical School. The first seven medical licenses in Korean history were awarded to graduates of Severance Hospital Medical School in 1908, who all later became paramount figures in the establishment of modern medicine. The name of the medical school was aptly changed to Severance Union Medical School in 1913; later renamed as Severance Union Medical College in 1921, along with the appointment of lectures from various mission boards. Eventually, the early roots of Chejungwon provided solid foundation of Severance Hospital and Yonsei University College of Medicine in Yonsei University Health System (YUHS), as we know it today (Fig. 1B). Current facilities of YUHS encompass three colleges (Medicine, Dentistry, Nursing) and five hospitals (Severance Hospital, Gangnam Severance Hospital, Dental Hospital, Yongin Severance Hospital).
YONSEI DERMATOLOGY: EARLY YEARS TO CURRENT DEPARTMENT
Kung Sun Oh (1913~1942, dates indicate the years served at Yonsei University College of Medicine): founder of Yonsei Dermatology
Kung Sun Oh was the second Korean to receive medical education in the US. In 1907, he graduated from the University of Louisville, School of Medicine. During his medical school years in the US, Kung Sun Oh studied dermatology under John Edwin Hays. Kung Sun Oh returned to Korea after graduation and served medical missions in medically isolated areas in Korea. Kung Sun Oh first came to Severance Union Medical School in 1913, as he was commissioned by the mission board of the US Southern Presbyterian Church to be dispatched to Medical School as an assistant professor2. As the first Korean professor at Severance Union Medical School, he provided supplementary teaching in Korean to medical students on diverse subjects, including internal medicine, surgery, and basic science, as well as dermatology (Fig. 1C)3. In 1916, Kung Sun Oh visited Tokyo Imperial University for a year, to study dermatology and urology under Ikuzo Toyama. In May 1917, the Department of Dermatology and Urology was established at Severance Union Medical School and Kung Sun Oh was appointed as the first chair of the department. Since then, he served the department for 18 years. During his professorship, Kung Sun Oh visited University of Vienna in 1930 to seek latest knowledge in field of dermatology. Afterwards, he dedicated his life to education, especially to the development of Medical School45.
Kung Sun Oh was revered for his contributions to social welfare service in Korea. In 1919, he established Korea's first orphanage named Gyeongseong Orphanage. Additionally, he established Gyeongseong Nursing Home for the elderly in 1931. After his retirement, he took care of more than 2,400 orphans as the director of the orphanage and devoted the rest of life to social work until his passing. He received the Order of Cultural Merits, Republic of Korea Medal and Sopa Award from the Korean Children's Association for enhancing child welfare in Korea6.
YONSEI DERMATOLOGY: BRIEF HISTORY OF THE DEPARTMENT
Following in the footsteps of Kung Sun Oh, Young Joon Lee became the second chair of the Department of Dermatology and Urology between 1934 and 1942 and served as the third Dean of Severance Union Medical College. He also served as a congressman, Secretary General of the Korean Red Cross and the Vice Speaker of the National Assembly. Hak Song Lee, served as the third chair between 1943 and 1946 of the department, and played a pivotal role in establishing the present day internship and residency training program at Severance Hospital. In 1943, he was appointed as the Superintendent of the Severance Hospital. In 1949 he became the chairman in the department of Urology at Seoul National University College of Medicine. Sang Yo Lee was the fourth chairperson of the Department of Dermatology and Urology at Severance Union Medical College between 1947 and 1949. Sang Yo Lee and Chong Soon Wang joined as the first board members of Korean Dermatological Association (KDA), which was separated as independent organization from Chosun Dermato-Urology Association in 1954. Chong Soon Wang (1939~1981) was the fifth and seventh chairperson. He served as the first president of the department of Urology after the separation of the two departments in 1960. Nam Zoo Lee (1949~1966) served as the sixth chairperson and when the department separated in 1960 into two independent departments, he became the eighth chairperson of dermatology. The inauguration of the first chair of the independent department marked the beginning of the Yonsei Dermatology. During his term, Nam Zoo Lee was commissioned as the 20th president of the KDA. Hak Song Lee and Nam Zoo Lee served as early committee members of KDA who were appointed to establish qualification board exam systems. Tae Ha Woo (1959~1975) served as the ninth department chairperson and served as the 31st (1982~1984) president of the KDA. Tae Ha Woo donated the first office for its use as KDA headquarters in 1981 in Gangnam-gu, Seoul. Sungnack Lee (1975~1990) served as the tenth chairperson, and during his service, he actively promoted international academic exchange, inspired passion for research, and contributed to the acquisition of new medical knowledge from abroad. He also played a major role in elevating the departmental status to an international level by securing and establishing a sub-specialty for each professor. Following this, in chronological order, Jung Bock Lee, Yoon-Kee Park, Dongsik Bang, Seung Hun Lee, Kwang Hoon Lee, and Min-Geol Lee served as chairpersons. Currently, Kee-Yang Chung is serving as the 17th chairperson of the department since 2015. All professors have contributed to the development of Korean dermatology by continuously engaging in academic research and focusing on training the next generation.
CLINICAL AND BASIC RESEARCH ACTIVITIES OF YONSEI DERMATOLOGY
From the very beginning, Yonsei Dermatology has played a pivotal role in the advancement of dermatological science and introduced key diagnostic and treatment pearls in Korea.
Venereology: sexually transmitted diseases and syphilis
Around 1924, Kung Sun Oh first documented the prevalence of sexually transmitted disease in Korea during his service as a professor of dermatology and urology at Severance Union Medical College. He campaigned against prostitution to prevent transmission of venereal infections. Following his footsteps, in 1972, the department introduced the first fluorescent treponemal antibody-absorption (FTA-ABS) test in Korea in cooperation with the Department of Clinical Pathology. Further full-scale research was initiated when Sungnack Lee served as the chair of the department. Jung Bock Lee initiated the basic laboratory work in the field of syphilis in 1982, and Min-Geol Lee and Hyung-Il Kim joined the team to establish the 19S(IgM)-FTA test for syphilis diagnosis. The test has been clinically applied to diagnose active syphilis since 19847. In the meantime, Jung Bock Lee received a Fogarty International Research Fellowship from the National Cancer Institute (NIH) in the US, and studied the diagnostic role of enzyme-linked immunosorbent assay (ELISA) for specific immunoglobulin M in neurosyphilis8. During the 1980s and 1990s, Jung Bock Lee and Min-Geol Lee heavily focused on molecular and biochemical tools to enhance the accuracy of diagnosis of syphilis. Based on our advanced laboratory techniques for syphilis serology, we hosted six annual course works titled ‘International Laboratory Course on Serologic Tests for Syphilis’ from 1986 to 1992 to educate doctors from Southeast Asia and Africa.
Behçet's disease
Until the 1980s, Behçet's disease was an unfamiliar disease entity in Korea. Sungnack Lee had experienced the importance of Behçet's disease while studying with Theodor Nasemann. Together with Dongsik Bang, he helped introduce Behçet's disease to Korea. In 1983, the very first Behçet's disease specialty clinic in Korea was opened at Severance Hospital. The clinic significantly contributed to heighten public perception of the disease in Korea, and nowadays, more than 10,000 patients are registered in its cohort9.
In 1985, the first presentation on Behçet's disease in Korea was given at the 4th International Conference on Behçet's disease (ICBD), preceding academic achievements in following years. After his visit to Kawasaki Medical University and Juntendo University in Japan, Dongsik Bang focused on microstructural studies of Behçet's disease patients and underlying pathophysiology of its cutaneous manifestations. The team demonstrated the pathogenic role of human herpes virus, and established the first successful animal model for the disease10. In following years, the team demonstrated the presence of autoantibody in patient sera, which led to the identification of a novel target, α-enolase in vascular endothelial cells, for autoimmunity11. The steady effort of the research team for over 30 years eventually validated the underlying pathophysiology of the disease. Sungnack Lee published an international textbook through Springer-Verlag entitled “Behçet's disease: a guide to its clinical understanding” with the Korean Study Group of Behçet's disease12.
In 2006, Dongsik Bang participated with a group of experts to prepare guidelines for the European League Against Rheumatism (EULAR) guidelines. In 2008, Sungnack Lee and Dongsik Bang were elected as President and Secretary General of the International Society for Behçet's Disease (ISBD), and actively involved themselves as executive committee members to date. Sungnack Lee and Dongsik Bang served as the founding members and laid the cornerstone for the expansion of research in Behçet's Disease.
Photomedicine and vitiligo
Beginning and development in the fields of photomedicine and vitiligo were achieved by Yoon-Kee Park and Seung-Kyung Hann. In 1981, Yoon-Kee Park opened the first phototherapy center of Korea in Severance Hospital. In 1984, Yoon-Kee Park designed the first Korean phototherapy apparatus to benefit patients with novel technology. Subsequently, a specialty clinic for vitiligo and psoriasis patients was introduced in 1986. Yoon-Kee Park started photo-chemotherapy protocol using psoralen for psoriasis and vitiligo treatment for the first time in Korea. Yoon-Kee Park and Seung-Kyung Hann published a paper presenting the effective results of autologous epidermal grafting and PUVA in 100 vitiligo patients13.
In 1990, the first national symposium for photomedicine was organized to introduce clinical protocols of phototherapy to Korean dermatologists. In 1991 and 1992, International Course on Phototherapy and Phototest was hosted to instruct foreign dermatologists.
The group continued basic research on pigmentary disorders. For the first time in Korea, culture of melanocytes was successfully isolated from the skin of vitiligo patients with self-developed media. In the mid-1990s, they revealed the autoantibodies present in vitiligo patient sera that react with an autoantigen at a molecular weight of 65 kd in the surface of melanocytes14. In recognition to this contribution, Yoon-Kee Park was honored with a Yonsei Academic Award in 1992. Seung-Kyung Hann classified facial segmental vitiligo according to its involved distribution and configuration, and the publication has been highly quoted151617.
Contact dermatitis and atopic dermatitis
Yonsei Dermatology was the first in Korea to introduce a patch test kit to diagnose allergic contact dermatitis in 1969, when Tae Ha Woo was a department chair18. His foresight to the latest diagnostic tool led to the burgeoning of future research in skin immunology.
In 1986, allergy specialty clinic was established in Severance hospital. In 1995, Kwang Hoon Lee initiated developed allergen-specific immunotherapy using house dust mites for atopic dermatitis patients for the first time in Korea. Since its beginning, the specialty clinic for allergen-specific immunotherapy has registered over 800 patients and the successful treatment outcomes were published in 201319. Kwang Hoon Lee and his research team have carried out basic and clinical research on abnormalities in atopic dermatitis, connections between stress and immune regulation, and new targets of atopic dermatitis, and his work has been published in high impact journals202122.
In recognition of his academic and clinical achievement, Kwang Hoon Lee was selected as the Korean representative for the International Eczema Council (IEC), and has been serving as an executive director since 2015. As the paradigm is quickly shifting towards treating immune disorders with biologics, current members are actively involved in global clinical trials of novel biologics under development.
Psoriasis and skin dendritic cells
A specialty clinic for psoriasis was opened by Yoon-Kee Park in 1986. The research of psoriasis in Yonsei Dermatology was begun by Yoon-Kee Park and Wook Lew. In 2004, Wook Lew visited the laboratory directed by James Krueger in Rockefeller University, who discovered the critical role for interleukin (IL)-23/IL-17 axis in psoriasis. A review article written by Wook Lew on the pathogenesis of psoriasis published during his visit to the Rockefeller University has achieved more than 200 citations to date23.
After the 2000s, the immunologic aspect of psoriasis was emphasized as a key pathogenic trigger. Min-Geol Lee is now conducting several international multicenter clinical trials for novel biologics. The research team in psoriasis specialty clinic focuses on identifying the underlying pathomechanisms of psoriasis using human tissues and diverse genetically-engineered mouse models24.
Min-Geol Lee started the research of skin dendritic cells in Korea. When he visited NIH under the supervision of Mark Udey, he demonstrated co-stimulatory molecules and E-cadherin expression in Langerhans cells and epidermal dendritic T cells2526. Min-Geol Lee continued to decipher the role of dendritic cells in skin disease, and reported numerous basic research publications27. Min-Geol Lee served as the vice-president for the 12th International Symposium on Dendritic Cells, elevating the status of dendritic cell research field in Korea.
Skin barrier
In the 1990s, Seung Hun Lee was the first to introduce the concept of a ‘skin barrier’ to Korea. He first demonstrated that calcium ion is a crucial signal for permeability barrier recovery when he studied in a laboratory supervised by Peter Elias at University of California, San Francisco28. After returning to Korea, he reported that protein kinase C (PKC), especially PKC-delta, mediates extra-intracellular calcium signaling29. He also found that electrical or mechanical techniques, such as iontophoresis and sonophoresis, which modulate the epidermal calcium gradient, can trigger the barrier recovery processes, even without barrier perturbation30. He also demonstrated that protease activated receptor-2 plays an important role in regulating skin barrier function31.
Seung Hun Lee has played a pivotal role in establishing and developing the Korean Society for Skin Barrier Research since 1995. In 2010, the Pan Asian Pacific Skin Barrier Research Society was organized by skin barrier researchers in the Asia-Pacific regions, and Seung Hun Lee was elected as the first president. Human Barrier Research Institute was established in Gangnam Severance Hospital, which has sought to share information on the latest research trends in barrier function of human body. Seung Hun Lee has successfully led the institute organizing academic symposium encompassing fields of human barrier as an integrated system involving skin, gastrointestinal and respiratory system.
Bullous skin disease
A bullous disease clinic in Gangnam Severance Hospital is the only clinic in Korea now to provide diagnosis, treatment, and research for autoimmune and genetic bullous diseases. Soo-Chan Kim introduced diagnostic methods of immunofluorescences, immunoblotting, and immunoprecipitation. To date, a total of 1,211 patients with autoimmune bullous diseases were registered in this clinic. Soo-Chan Kim firstly reported that envoplakin is an autoantigen of paraneoplastic pemphigus (PNP), and suggested new diagnostic criteria of PNP by analyzing Korean patients32. Moreover, the Gangnam Severance bullous specialty clinic was the first to use rituximab in patients with pemphigus in Korea. The group reported the efficacy, therapeutic dosing, and prognosis of rituximab treatment in these patients33.
Soo-Chan Kim has also performed indirect immunofluorescence mapping and electron microscopic examination to diagnose epidermolysis bullosa (EB). To date, more than 180 patients with epidermolysis bullosa have been registered with the bullous disease specialty clinic. New cases of epidermolysis bullosa were firstly identified, and the mutations were analyzed in COL7A1 gene in the patients with dystrophic EB and KRT5 and KRT14 gene in the patients with EB simplex in Korea3435. The Korean Epidermolysis Bullosa Society for patient groups was established to support patients and their families in 2003.
Dermatologic surgery and skin cancer
The dermatologic surgery specialty clinic seeks to cure skin cancers. It was established by Kee Yang Chung when he started Mohs micrographic surgery (MMS) after training with Tatyana Humphreys at Thomas Jefferson University. Since the first case in July of 2000, the total number of patients who had MMS at Yonsei Dermatology has reached 2,300 to date.
In the 2000s, Min-Geol Lee led the dendritic cell-based immunotherapy for treating advanced stages of melanoma, and performed investigator-initiated clinical trials to evaluate the effect of a dendritic cell vaccine36. The clinical and basic research on skin cancers have been avidly pursued under the direction of Kee Yang Chung. Under his guidance, the dermatologic surgery group focus on genetic and clinical features of Korean skin cancer patients, and have proposed innovative surgical techniques37. Kee Yang Chung established multidisciplinary management of malignant melanoma, the most lethal form of skin cancer. Furthermore, Yonsei Dermatology also seeks treatments of rare skin cancers, such as dermatofibrosarcoma protuberance, extra-mammary Paget's disease38.
In 2012, Yonsei Dermatology organized the first Cutaneous Anatomy Workshop in Severance Hospital, providing a detailed lecture on human facial anatomy and hands-on cadaver dissection. As a selected mentor of the international travelling mentorship program directed by the American Society for Dermatologic Surgery and a board member of the Dermatologic and Aesthetic Surgery International League, Kee Yang Chung has provided advanced dermatologic surgery training for Korean and foreign-trained dermatologists.
KUNG SUN OH MEMORIAL LECTURE AND INTERNATIONAL SYMPOSIUM OF CUTANEOUS BIOLOGY RESEARCH INSTITUTE
The Kung Sun Oh Memorial Lecture was initiated in 1977 to commemorate late Professor Kung Sun Oh, the founder of the first dermatology department in Korea. The memorial lecture marked the beginning of international academic exchange in the field of dermatology. It was among the early attempts to introduce Korean dermatology internationally and to absorb advanced dermatological scientific knowledge from the global community. For the memorial lecture, distinguished dermatologists from around the world were invited as guest lecturers39. The first invited speaker was Theodor Nasemann from Germany in 1977. Since then, the memorial lecture has been hosted annually. Yonsei Dermatology celebrated its 40th memorial lecture in 2017. All lecturers, who have been invited to the Kung Sun Oh Memorial Lecture are listed in Table 1.
Since 2003, the International Symposium of Cutaneous Biology Research Institute is hosted on the same day as the Kung Sun Oh Memorial Lecture to broaden the scientific discussion by inviting more distinguished speakers from Korea and overseas. The 15th International Symposium was held in 2017.
Yonsei Dermatology trusts that both events have greatly contributed to the development of modern dermatology and medical science in Korea.
CLOSING REMARKS
Looking back on our past 100 years, Yonsei Dermatology has achieved great clinical and academic milestones in the history of Korean Dermatology and modern medicine in Korea. Yonsei Dermatology looks forward to future years, daring to lead the next generation of great minds in the field of dermatology and cutaneous biology research.
XML Download