Monkeypox: A dermatologic primer

Monkeypox: A dermatologic primer

Authors of a JAAD article review historical outbreaks, modes of transmission, and clinical manifestations of monkeypox as well as the diagnostic methods and treatment options for the virus. Dermatologists will play a key role in recognizing and diagnosing infections and educating and preparing frontline health care workers to detect new cases early, the authors note.

Typically, within one to five days from the onset of fever, a rash evolves and resolves over a two- to four-week period of time. First, the rash appears as macules (1-2 days), then develops into papules (1-2 days), followed by vesicles (1-2 days), and ultimately pea-sized, hard pustules (5-7 days) before crusting, scabbing, and eventually falling off (7-14 days). Once the eschar has fallen off and the wounds have healed with a fresh layer of skin, the patient is no longer considered infectious — about two to four weeks from the first lesion. 

[Registry now accepting monkeypox cases. Learn more or enter a case.]

Reports from the current outbreak suggest that there may be a less severe prodrome with the characteristic vesicular lesions presenting in the genital and perineal region more frequently and potentially limited to that anatomic site. Monkeypox should be in the differential diagnosis for new genital lesions and evaluation for potential sexually transmitted infections.

The main clinical differential diagnosis is smallpox, although the presence of lymphadenopathy and crop-like, less-centrifugally distributed lesions may indicate monkeypox. Herpes infections (both herpes simplex virus and varicella-zoster virus) tend to have smaller individual lesions and more frequently occur in limited anatomic areas. Herpes-family infections may be reliably diagnosed by rapid polymerase chain reaction testing. 

[AMA adds codes for monkeypox testing, vaccination. Learn more in Derm Coding Consult.]

Primary treatments are supportive, although early identified close contacts may benefit from ring vaccination, either with the vaccinia vaccine (replication-competent vaccine, approved for smallpox) or the newer Jynneos' Imvamune (replication-deficient vaccine, approved for monkeypox). The replication-competent vaccinia vaccine has a considerable adverse event profile with many contraindications. For individuals with a history of atopic dermatitis, a rare and potentially lethal complication known as eczema vaccinatum can occur with vaccination by replication-competent vaccinia vaccine. Read more about other potential treatments, and infection control and public health guidelines.

Access Academy content on recognizing monkeypox.

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.