A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the 2022 outbreak: Skin lesion morphology, clinical course, and scarring.

Abstract

BACKGROUND:

In the 2022 mpox (monkeypox) outbreak, 79,000 global cases have been reported. Yet, limited dermatologic data have been published regarding lesion morphology and progression.

OBJECTIVE:

The objective of this study was to characterize skin lesion morphology, symptomatology, and outcomes of mpox infection over time.

METHODS:

The American Academy of Dermatology/International League of Dermatological Societies Dermatology COVID-19, Mpox, and Emerging Infections Registry captured deidentified patient cases of mpox entered by health care professionals.

RESULTS:

From August 4 to November 13, 2022, 101 cases from 13 countries were entered, primarily by dermatologists (92%). Thirty-nine percent had fewer than 5 lesions. In 54% of cases, skin lesions were the first sign of infection. In the first 1-5 days of infection, papules (36%), vesicles (17%), and pustules (20%) predominated. By days 6-10, pustules (36%) were most common, followed by erosions/ulcers (27%) and crusts/scabs (24%). Crusts/scabs were the predominant morphology after day 11. Ten cases of morbilliform rash were reported. Scarring occurred in 13% of the cases.

LIMITATIONS:

Registry-reported data cannot address incidence. There is a potential reporting bias from the predilection to report cases with greater clinical severity.

DISCUSSION:

These findings highlight differences in skin findings compared to historical outbreaks, notably the presence of skin lesions prior to systemic symptoms and low overall lesion counts. Scarring emerged as a major possible sequela.

• Authors: Sonya Prasad, Cristina Galvan Casas, Alexis G Strahan, L Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S Leslie, Joanna L Harp, Teodora Pumnea, Devon E McMahon, Misha Rosenbach, Janet E Lubov, Geoffrey Chen, Lindy P Fox, Allen McMillen, Henry W Lim, Alexander J Stratigos, Terrence A Cronin, Mark D Kaufmann, George J Hruza, Lars E French, Esther E Freeman
• Journal: Journal of the American Academy of Dermatology (J Am Acad Dermatol) Vol. 88 Issue 5 Pg. 1066-1073 (05 2023) ISSN: 1097-6787 [Electronic] United States
• PMID: 36641010 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2023. Published by Elsevier Inc.

Topics

• Humans
• Cicatrix
• Mpox (monkeypox)
• COVID-19 (epidemiology)
• Skin Diseases
• Disease Outbreaks
• Blister
• Disease Progression