Hansen’s disease sufferers had been visiting the hot spring, Kusatsu-Spa, in Gunma, Japan, for Toji (which means ‘hot springs treatment’ in Japanese) since the middle ages, as it was known reportedly for a long time to be effective in curing the disease. In 1869, Kusatsu-Spa was hit by a massive fire. The innkeepers, who suffered devastating damages, were trying to reconstruct the economy quickly by promoting the medical benefits of the hot spring. This made many Hansen’s disease patients to visit and of which many stayed on a long term bases. They would use the hot spring with ordinary visitors. And, they had received the treatment of the spotted moxa cautery with the hot-spring treatment.
  Later on, Kusatsu- Spa became well known throughout Japan and as the numbers of ordinary visitors increased, they voiced their concerns in sharing the hot spring with the Hansen’s disease patients. Therefore, the innkeepers decided to move the patients to another district called Yunosawa and suggested to make a special village of just the patients.
  In 1887, the representative of the patients came to an agreement with the mayor of Yunosawa to establish a treatment centre there. Yunosawa became part of an administrative area of Kusatsu Town. The area seemed to become a local-governing area mainly shaped by Hansen’s disease sufferers and the first legal residential area where Hansen’s disease sufferers were given citizenships and may convalesce freely.
  However, in 1931, leprosy prevention law was passed, and the Japanese government built a new medical treatment centre of Hansen’s disease, 4km away from Kusatsu- Spa, which is called National Sanatorium Kuryu Rakusen-en. After deliberations with the representative of the Hansen’s disease patients living in the Yunosawa area and the governor of Gunma Prefecture, who received the order from the Japanese government to move them, had agreed to the mass relocation in 1941.
  This is how Yunosawa had closed its 55 years history and many Hansen’s disease patients had moved to the National Sanatorium Kuryu Rakusen-en . The ‘Freely recuperate Zone’ within the centre houses affluent patients who had enough funds to build their own houses. I was able to hear from many residential People who have historical knowledge of the above and would like to report it here.

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  Until the Japanese Leprosy Prevention Law was abolished in 1996, leprosy patients, regardless of their severity, had to be treated by accredited doctors. The majority of them had to be confined in a sanatorium to be treated, since only few hospitals/sanatoria had outpatient clinics for leprosy patients. This de facto confinement limited their occupational, social, financial, and family options, but no clear criteria/guidelines allowing discharge existed. The importance of leprosy outpatient clinics was almost never debated until 1962, when Tofu Association (a foundation established in 1952 to support the confined patients) and the National Suruga Sanatorium planned the opening of the clinic. This clinic looked after total of 4,977 patients until the abolishment of the Law. Since 1996, 349 persons consulted the clinic as of 2010. The importance of the continuation of these clinics is beyond dispute, even in low-endemic countries. However, the diminishing number of patients and demands in this country makes the management difficult. Thus, coordination with the local clinics and dermatologists is inevitable.

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We report the results of an examination of gross images of two patients with Buruli ulcer and a histopathological evaluation of surgically removed skin from two other cases at the non-ulcerated and ulcerated stages, respectively. Histopathologically, dermal nodes were found in the non-ulcerated specimen; while wide necrosis of skin and fibrin deposition, as well as Langhans giant cell, epitheloid cells, and vasculitis, were observed in the ulcerated specimen, with granuloma in the lymph nodes. M.ulcerans was positive in a Fite stain and in a PGL-1 immunohistological stain. Based on these cases, we discuss the histological characteristics of Buruli ulcer.

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  Treatment of erythema nodosum leprosum (ENL, type 2 reaction) using thalidomide provides effective alternative choice to steroid therapy. Yet, the Japanese National Health Insurance approves thalidomide prescription only for the treatment of multiple myeloma under the Thalidomide Education and Risk Management System (TERMS^®). Benefit of thalidomide therapy for patients with ENL is already an established fact based on various reports from other countries, but limited experiences and standards in Japan have hindered application of the medication to our patients. This led us to compose a local guideline. Based on and following the TERMS^®, we suggest starting thalidomide from 50-100mg/day and then onwards adjusting the dose according to the symptoms of each patient, not to exceed the maximum recommended dose of 300mg/day, for the treatment of ENL.

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  Sentinel surveillance for drug resistance in leprosy by global leprosy programme has launched in 2006. Possible contribution of Japanese researchers to global leprosy control in the future were discussed on the base of circumstances of the project and our assignment in the sueveillance.

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  Leprosy Research Center is engaged in the international collaborative research project since 1989. The project was consists of two parts. One part is the JICA training course which has been practiced since 1989. Another part is the international collaborative research which was started in Indonesia in the year 1991. Author has participated in this project since 1998. Then, we started collaboration with various organizations including Pakistan, Vietnam, and Myanmar. The contents of the collaborative research were mainly technical assistances for leprosy diagnosis and we have trained young doctors, staff to conduct serological diagnosis and molecular biological diagnosis of leprosy. The projects between the countries were succesful. Throughout the collaboration with foreign countries, author felt strongly that one of most important things in such collaboration was better communication and relation between people having different cultural background.

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  Human immunology and relationship between immune mechanism and infection were explained. Humoral immunity and cellular immunity collaborate properly and eliminate microorganisms. In immunocompromised host these mechanisms are broken. For prevention of healthcare associated infections, standard precausion is important basically. Additionary, according to the status of the patient, contact precaution, droplet precaution or airborne precaution should be applied.

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