A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the 2022 outbreak: Skin lesion morphology, clinical course, and scarring - 14/04/23

Doi : 10.1016/j.jaad.2022.12.035

Sonya Prasad, MSc ^a,^b, Cristina Galvan Casas, MD ^c,^d, Alexis G. Strahan, MSN ^a,^e, L. Claire Fuller, MD ^f,^g, Klint Peebles, MD ^h, Andrea Carugno, MD ^i,^j, Kieron S. Leslie, FRCP, DTM&H ^k, Joanna L. Harp, MD ^l, Teodora Pumnea, MD ^m, Devon E. McMahon, MD ⁿ, Misha Rosenbach, MD ^n,^o, Janet E. Lubov, BSN ^a,^p, Geoffrey Chen, BA ^q, Lindy P. Fox, MD ^k, Allen McMillen, MS ^r, Henry W. Lim, MD ^s, Alexander J. Stratigos, MD ^t, Terrence A. Cronin, MD ^u, Mark D. Kaufmann, MD ^v, George J. Hruza, MD, MBA ^w, Lars E. French, MD ^m,^x, Esther E. Freeman, MD, PhD ^a,^q,^⁎
^a Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
^b Icahn School of Medicine, The Mount Sinai Hospital, New York, New York
^c Department of Dermatology, University Hospital Mostoles, Madrid, Spain
^d Fundación Lluita contra les Infeccions, Hospital Germans Trias i Puyol, Badalona, Barcelona, Spain
^e Mercer University School of Medicine, Savannah, Georgia
^f Chelsea and Westminster NHS Foundation Trust, London, UK
^g International Foundation for Dermatology, London, UK
^h Department of Dermatology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
ⁱ Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
^j Ph.D. Program in Molecular and Translational Medicine (DIMET), University of Milan-Bicocca, Milan, Italy
^k Department of Dermatology, University of California San Francisco, San Francisco, California
^l Department of Dermatology, Weill Cornell Medicine, New York, New York
^m Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
ⁿ Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
^o Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
^p Wright State University Boonshoft School of Medicine, Dayton, Ohio
^q Medical Practice Evaluation Foundation, Massachusetts General Hospital, Boston, Massachusetts
^r American Academy of Dermatology, Rosemont, Illinois
^s Department of Dermatology, Henry Ford Health, Detroit, Michigan
^t First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
^u Department of Dermatology and Cutaneous Surgery, University of Miami, Melbourne, Florida
^v Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
^w Department of Dermatology, Saint Louis University, Saint Louis, Missouri
^x Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida

^∗Correspondence and reprint requests to: Esther E. Freeman, MD, PhD, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Bartlett Hall 6R, Boston, MA 02114.Department of DermatologyMassachusetts General HospitalHarvard Medical School55 Fruit StBartlett Hall 6RBostonMA02114

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.

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Key words : general dermatology, global health, immunocompromised, infectious disease, international health, medical dermatology, monkeypox, mpox, skin lesions, vaccine, viral infection, virus

Abbreviations used : AAD, ILDS, Mpox

Plan

Detailed skin lesion morphology

Results

Patient and reporter population

Exposure and diagnosis

Clinical presentation at sign/symptom onset

General clinical presentation

Lesion morphology

Medical history and hospitalization

Treatment and resolution

Discussion

	Funding sources: The AAD/ILDS Dermatology Registry for COVID-19, Monkeypox, and Emerging Infections is supported by a grant from the ILDS and by in-kind support from the AAD.
	IRB approval status: Reviewed by Massachusetts General Hospital Institutional Review Board, deemed not human subjects research.

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Vol 88 - N° 5

P. 1066-1073 - mai 2023 Retour au numéro

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A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the 2022 outbreak: Skin lesion morphology, clinical course, and scarring - 14/04/23

Abstract

Background

Objective

Methods

Results

Limitations

Discussion

Plan

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