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

Overview

BACKGROUND: In the 2022 monkeypox (mpox) outbreak, 79,000 global cases have been reported. Yet, limited dermatologic data have been published regarding lesion morphology and progression. OBJECTIVE: To characterize skin lesion morphology, symptomatology, and outcomes of mpox infection over time. METHODS: The AAD/ILDS Dermatology COVID-19, Monkeypox, and Emerging Infections Registry captured de-identified patient cases of mpox entered by healthcare professionals. RESULTS: From August 4-November 13 2022, 101 cases from 13 countries were entered, primarily by dermatologists (92%). Thirty-nine percent had fewer than five 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 cases. LIMITATIONS: Registry-reported data cannot address incidence. There is 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.