John W. Melski

Marshfield Clinic

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Arthur R. Rhodes

Rush University Medical Center

Thomas B. Fitzpatrick

Communities In Schools of Orange County

Howard L. Bleich

Harvard University

John A. Parrish

Georgia Institute of Technology

Robert S. Stern

Beth Israel Deaconess Medical Center

Arthur J. Sober

Harvard University

Martín C. Mihm

Brigham and Women's Hospital

Erik J. Stratman

Marshfield Clinic

Terence J. Harrist

Harvard University

Kurt D. Reed

University of Wisconsin–Madison

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Harvard University

Marshfield Clinic

Massachusetts General Hospital

Harvard University Press

Marshfield Clinic

Boston University

Brigham and Women's Hospital

Centers for Disease Control and Prevention

Northwestern University

National Center for Emerging and Zoonotic Infectious Diseases

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Primary and Secondary Erythema Migrans in Central Wisconsin

Archives of Dermatology (1993)

John W. Melski

• Background and Design.—

We report a series of 28 consecutive patients with erythema migrans (EM) who underwent skin biopsies for culture ofBorrelia burgdorferi. Culture results, Lyme serologic findings, and clinical features in patients with only primary EM are compared with those in patients with secondary EM.

Results.—

Culture preparations of skin specimens obtained from six of 12 patients with only primary EM, and from 14 of 16 patients with secondary EM were positive forB burgdorferi. Seven patients with only primary EM were initially seronegative, and only one patient had an annular lesion. A central crusted punctum was present in five of six primary EM lesions that were not culture positive, but in none of nine culture-positive primary EM lesions. Patients with secondary EM were all seropositive and had less cutaneous and more constitutional symptoms than patients with only primary EM. Three patients with secondary EM had abnormal liver enzyme profiles, one patient had complete heart block, and one patient had myocarditis simulating infarction. Less than one third of all patients recalled a tick bite. An isomorphic nonresponse was seen in skin previously involved with secondary EM in one patient who had a drug exanthem from amoxicillin.

Conclusions.—

Borrelia burgdorferican be reliably cultured from skin biopsy specimens of secondary EM. Culture preparation aids definitive diagnosis of Lyme disease in patients with only primary EM who often lack constitutional symptoms, have nondiagnostic lesions, or are seronegative. (Arch Dermatol.1993;129:709-716)

Erythema migrans

Erythema

Erythema chronicum migrans

Constitutional symptoms

LYME

Borrelia Burgdorferi Infection

10.1001/archderm.1993.01680270047005

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Citations (51)

Visualizing Bayesian Analysis Using a Spreadsheet Geometry

Archives of Dermatology (2011)

John W. Melski

10.1001/archdermatol.2011.295

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Citations (1)

Cutaneous Squamous-Cell Carcinoma in Patients Treated with PUVA

New England Journal of Medicine (1984)

Robert S. Stern Nan M. Laird John W. Melski John A. Parrish Thomas B. Fitzpatrick

A 5.7-year prospective study of 1380 patients treated for psoriasis with oral methoxsalen (8-methoxypsoralen) and ultraviolet A photochemotherapy (PUVA) revealed that after adjustment for exposures to ionizing radiation and topical tar preparations, the risk that cutaneous squamous-cell carcinoma would develop at least 22 months after the first exposure to PUVA was 12.8 times higher in patients exposed to a high dose than in those exposed to a low dose (95 per cent confidence interval, 5.8 to 28.5). No substantial dose-related increase was noted for basal-cell carcinoma. The dose-dependent risk of cutaneous squamous-cell carcinoma suggests that PUVA can act as an independent carcinogen. In our study, morbidity associated with these tumors has been limited, but further follow-up is needed. Meanwhile, patients treated with PUVA should be followed closely for the possible development of cutaneous squamous-cell carcinoma.

Methoxsalen

PUVA therapy

tar (computing)

10.1056/nejm198405033101805

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Citations (460)

The many faces and phases of borreliosis I. Lyme disease

Journal of the American Academy of Dermatology (1991)

John W. Melski

10.1016/s0190-9622(08)80384-2

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Citations (0)

The Separation of Susceptibility to Psoriasis from Age at Onset

Journal of Investigative Dermatology (1981)

John W. Melski Robert S. Stern

Genetic predisposition

10.1111/1523-1747.ep12497611

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Citations (38)

Monkeypox: An epidemiologic and clinical comparison of African and US disease

Journal of the American Academy of Dermatology (2006)

Tanya A. Sale John W. Melski Erik J. Stratman

Monkeypox

Orthopoxvirus

Case fatality rate

10.1016/j.jaad.2006.05.061

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Citations (112)

Wells’ Syndrome, Insect Bites, and Eosinophils

Dermatologic Clinics (1990)

John W. Melski

10.1016/s0733-8635(18)30500-x

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Citations (50)

Lyme borreliosis

Seminars in Cutaneous Medicine and Surgery (2000)

John W. Melski

Lyme borreliosis is a worldwide, multistage, and multi-system disease caused by borrelia spirochetes, which are transmitted by ixodes ticks. It is focally endemic in temperature climates of the northern hemisphere. Primary erythema migrans occurs at the site of inoculation. Secondary erythema migrans occurs at sites of hematogenous dissemination. Variations in genospecies account for variations in presentation, including borrelial lymphocytoma. Disseminated disease includes constitutional signs and symptoms, intermittent oligoarticular arthritis, meningitis, cranial neuritis, radiculoneuropathy, encephalopathy, atrioventricular block, and myopericarditis. Late persistent disease includes acrodermatitis chronica atrophicans, chronic arthritis, neurological impairment, and fatigue. There can be difficulties with both clinical and laboratory diagnosis. First-line oral therapies for early uncomplicated disease are doxycycline and amoxicillin. First-line intravenous therapy for complicated or resistant disease is ceftriaxone. Prevention includes avoiding tick habitats, dressing sensibly, judicious use of repellants, and early removal of imbedded ticks. Vaccination is indicated only for frequent or prolonged exposure to tick-infested habitat.

Erythema migrans

Myopericarditis

10.1053/sd.2000.7373

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Citations (11)

Wallace's Line in serum sickness and Kawasaki disease

British Journal of Dermatology (1986)

JeffreyD. Bernhard Arthur R. Rhodes John W. Melski

Journal Article Wallace's Line in serum sickness and Kawasaki disease Get access J.D. Bernhard, J.D. Bernhard Division of Dermatology, University of Massachusetts Medical Center, Worcester, Massachusetts 01605, U.S.A. Search for other works by this author on: Oxford Academic Google Scholar A.R. Rhodes, A.R. Rhodes Division of Dermatology, University of Massachusetts Medical Center, Worcester, Massachusetts 01605, U.S.A. Search for other works by this author on: Oxford Academic Google Scholar J.W. Melski J.W. Melski Division of Dermatology, University of Massachusetts Medical Center, Worcester, Massachusetts 01605, U.S.A. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 115, Issue 5, 1 November 1986, Page 640, https://doi.org/10.1111/j.1365-2133.1986.tb05781.x Published: 01 November 1986

Center (category theory)

10.1111/j.1365-2133.1986.tb05781.x

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Small congenital nevocellular nevi and the risk of cutaneous melanoma

The Journal of Pediatrics (1982)

Arthur R. Rhodes John W. Melski

Melanoma diagnosis

10.1016/s0022-3476(82)80638-0

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Citations (238)