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.
To characterize skin lesion morphology, symptomatology, and outcomes of mpox infection over time.
The AAD/ILDS Dermatology COVID-19, Monkeypox, and Emerging Infections Registry captured de-identified patient cases of mpox entered by healthcare professionals.
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.
Registry-reported data cannot address incidence. There is potential reporting bias from the predilection to report cases with greater clinical severity.
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.

Copyright © 2023. Published by Elsevier Inc.