Question

What do monkeypox spots look like?

2 August 2022. Related: All topics, Complications and coinfections, Sexual health.

Answer

Answer: Simon Collins

Hi

By mid August, the current monkeypox outbreak in the UK has included more than 3000 cases.

One of the symptoms are small spots that usually then turn into blisters. These are very infectious and take about three weeks to heal completely.

They commonly starts as red skin bumps, often in the genitals or face. They can develop into blisters that can then break down into ulcers or sores. These develop a scab that eventually falls off.

The spots/ulcers can be in any part of the body. This can include in the mouth or in the genital area, including inside the anus.

Sores can be painful, aggressive and unpleasant. They can be itchy but it is important not to scratch. This could spread the virus to other parts of the body. If MPX infecting the eyes can be very serious.

The examples below show different stages of the ulcers. They can vary in size from a few millimetres to a centimetre in diameter.

Other examples are included or linked below. Please click the picture to open larger view.

Source: US CDC MMWR

Source: IAS webinar

Source: EACS webinar

Source: EACS webinar

Other pictures can be found at this link to the US CDC.
https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html

Genital lesions are included in these two papers in the NEJM and the BMJ.
https://www.nejm.org/doi/full/10.1056/NEJMicm2206893 (NEJM)
https://www.bmj.com/content/bmj/378/bmj-2022-072410.full.pdf (BMJ)

The most comprehensive photos for 20 cases at different timepoints are in the appendix of this NEJM paper. DOI: 10.1056/NEJMoa2207323. (21 July 2022).
https://www.nejm.org/doi/full/10.1056/NEJMoa2207323

How are the MPX ulcers different to other infections?

• Ulcers can be similar to several more common infections. These include chicken pox, syphilis, herpes, molluscum, cryptococcal infection, shingles (VZV) or even some heat rashes.
• MPX ulcers are usually deeper and harder than seen with other infections
• MPX ulcers can appear in crops every three to five days, and unlike chickenpox can take several days to evolve into blisters.
• MPX ulcers often have a dip in the centre with a dot in the middle. This is called umbilicated.

More information

For more information see this more detailed link:
https://i-base.info/monkeypox

This Q&A was originally posted on 29 June 2022 and was last updated on 2 August 2022.