Alice Augusta Ball: The African-American chemist who pioneered the first viable treatment for Hansen's Disease.

Alice Augusta Ball (1892-1916) was a young and dynamic chemist who achieved extraordinary milestones in her short lifespan of 24 years. As an African American and as a woman in the early 20th century, her work and achievements set a benchmark. Her breakthrough work on the extraction of the water-soluble ethyl esters of chaulmoogra oil changed the lives of millions of people affected by Hansen's disease who were socially boycotted and segregated to leprosy colonies and asylums. The chaulmoogra oil esters, which continued to be used for almost two decades, were the first viable treatment of leprosy. Unfortunately, Ball did not receive recognition and honor for her work, and she was forgotten soon after her untimely death.

Psoriasiform Pemphigus Foliaceus in an African American Female: An Important Clinical Manifestation.

A 50-year-old African-American woman presented to the dermatology clinic with a pruritic eruption of 3 years' duration. On clinical examination, the patient had well-demarcated, pink, atrophic plaques and superficial erosions over the inframammary folds and mid-chest. She also had well-demarcated, hyperpigmented, hyperkeratotic scaly plaques over the abdomen, suprapubic region, elbows, knees, and back with sporadic small superficial blisters. A punch biopsy of the right abdomen was performed and revealed psoriasiform epidermal hyperplasia, focal parakeratosis, and acantholysis throughout the superficial spinous and granular layers. Only a sparse inflammatory infiltrate was present in the underlying dermis. Clinical and histological findings supported the diagnosis of pemphigus foliaceus (PF), but psoriasis was included in the differential diagnosis due to the presence of discrete plaques with an erythematous border. We hypothesize that patients with psoriasiform presentations of PF may be misdiagnosed with plaque psoriasis. It is important to distinguish between PF and psoriasis as there is evidence that ultraviolet light, a common treatment for psoriasis, may exacerbate PF. We document and highlight this atypical psoriasiform presentation of PF in a patient with skin of color to raise awareness and improve diagnosis and outcomes.

J Drugs Dermatol. 2018;17(4):471-473.

Rasch analysis of the Outcome Questionnaire with African Americans.

Effectively diagnosing African Americans' mental health with a single intake checklist has posed an unresolved challenge, as most intake checklists were developed from White perspectives. In this study, Rasch analysis was used to assess the psychometric characteristics of a common measure of clinical distress, the Outcome Questionnaire (OQ; Lambert, Lunnen, Umphress, Hansen, & Burlingame, 1994), for a sample of African American students split into a calibration and validation subsample. OQ subscales were first identified and were then held up under cross-validation with a second subsample. Rasch analysis of the OQ clearly indicated the measure was multidimensional among African American students with 2 subscales titled Well-Being and Psychological Distress. Our results also indicated appropriate response scale use, adequate person separation, strong stability across subsamples, and little differential item functioning. Moreover, our analysis showed items of the 2 subscales to be well-targeted for African American students. However, if subscales were to be revised for African American students, some items at the same logit position might be deleted and replaced with either very easy or more difficult items or with items at intermediate positions to extend and to fill in gaps in construct coverage. Implications for theory and research on multicultural mental health scales were discussed.

A continuing focus of Hansen's disease in Texas.

To describe epidemiologic and clinical characteristics of Hansen's disease cases in Texas, information was abstracted from records of 810 patients reported from 1973 through 1997. Annually, from 18 to 54 patients were reported. Average annual incidence rates ranged from 1.9 to 2.4 cases per million population. A majority of the patients were male (63%) and white (77%). More than half (53%) of the patients were born in the United States; a majority (83%) of the patients born in the United States were born in Texas. Most (76%) patients were diagnosed with multi-bacillary leprosy. Foreign-born patients were more likely to be younger at onset and have multi-bacillary disease compared with patients born in the United States. Within Texas, an endemic focus of Hansen's disease exists along the Gulf of Mexico coast.

Overcoming prejudice.

PIP: People of African descent comprise a large proportion of Brazil's population. While racism exists in the country, it is commonly denied. Most Afro-Brazilians live in poor areas, with poor health care services, sanitation, schools, and transport. Since HIV is linked to poverty, Afro-Brazilians are more affected by HIV than is the overall population. Although Afro-Brazilians contribute to Brazil's culture, they do not benefit from that contribution. Recognizing this considerable social problem, Project Araye was created in 1996 to address issues of race and HIV. Building upon religious and cultural traditions, the project is staffed by Afro-Brazilians who are knowledgeable in both health issues and Afro-Brazilian culture. Project Araye supports a wide range of diverse community leaders in linking sexual health and HIV with other health concerns which affect Afro-Brazilians such as sickle-cell anemia, diabetes, and leprosy. One important challenge has been overcoming the target population's denial of HIV and encouraging Afro-Brazilians to accept that HIV also affects them. Community leaders include religious leaders, rap musicians, artists, and other people respected by various communities. Activities include visits to samba dance schools, Umbanda and Candomble temples, and street youth groups to provide HIV-related information.^ieng

Sarcoid dactylitis in black South African patients.

Six black South Africans with sarcoid dactylitis are described. By the term sarcoid dactylitis we mean sarcoid involvement of the bone and soft tissue of the fingers. Three of the six patients developed dactylitis during the course of chronic sarcoid. These patients had multisystem disease. In all three patients dactylitis developed after the diagnosis of sarcoid was established. However, in the other three patients dactylitis was the presenting feature of sarcoidosis, and none of these patients had evidence of chronic fibrotic sarcoid elsewhere. This finding is at variance with the observation that bony sarcoid is always a feature of chronic, poor prognosis, fibrotic sarcoid of all organ systems; these patients may form a sub-group with bony involvement and good prognosis. The significance, however, of this latter localized presentation of sarcoid is that clinically and histologically it is easily confused with tuberculoid leprosy and has been misdiagnosed.

Cancer mortality among patients with Hansen's disease.

For the evaluation of cancer risks associated with immunodeficiencies experienced by patients with Hansen's disease (leprosy) and for the assessment of possible adverse effects of dapsone therapy, a follow-up study was conducted of 1,678 patients admitted to the National Hansen's Disease Center in Carville, La., between 1939 and 1977. Overall, no substantial cancer mortality was observed (standardized mortality ratio = 1.3), nor was there any excess among patients exhibiting defects in cellular immunity by virtue of lepromatous forms of the disease. Notable was the absence of any significant excess of lymphoma (5 observed vs. 2.3 expected), despite the predominance of this tumor in certain other immunodeficiency states. Several cancer sites (oral, bladder, and kidney) occurred excessively, but reasons for the elevations were obscure. Although dapsone has been implicated as a carcinogen in laboratory animals, the use of sulfones, including dapsone, did not appear to affect significantly the risk of any cancers in this population.

Sporadic ulcero-osteolytic neuropathy in Blacks. A report of two cases.

The triad of a peripheral neuropathy, skin ulceration and destruction of bones and joints of the feet is called ulcero-osteolytic neuropathy, when other common causes of similar lesions have been excluded. Malnutrition, alcoholism and local trauma predispose to the development of the condition. It is to be differentiated from burnt-out leprosy, and is a chronic condition that eventually leads to characteristic deformities.