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. 2023 Apr 1;159(4):424-431.
doi: 10.1001/jamadermatol.2023.0041.

Mpox-A Rapidly Evolving Disease

Edward W Cowen  1 , Eric R Tkaczyk  2   3 , Scott A Norton  4 , Kieron S Leslie  5
Affiliations

Mpox-A Rapidly Evolving Disease

Edward W Cowen et al. JAMA Dermatol. .

Abstract

The 2022 mpox outbreak has rapidly emerged onto the global medical scene while the world continues to grapple with the COVID-19 pandemic. Unlike COVID-19, however, most patients with mpox present with skin findings, the evolving clinical presentation of which may be mistaken for other common skin diseases, particularly sexually transmitted infections. This Special Communication provides an overview of the evolution of mpox skin findings from its initial description in humans in 1970 to the present-day multinational outbreak.

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Conflict of interest statement

Conflicts of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Distribution of skin lesions in primary varicella, smallpox and mpox Clade I and Clade IIb
Primary varicella is characterized by a central predominance of lesions. In contrast, smallpox and mpox Clade I favor an acral predominance. Hundreds to thousands of lesions may develop. In contrast, Clade IIb mpox is characterized by a limited number of lesions (typically < 10) that vary in location—many cases have a facial, genital and/or perianal predominance. Clade IIa distribution not shown due to paucity of cases. Created with BioRender.com
Figure 2.
Figure 2.. The Spectrum of Mpox Skin and Mucosal Disease.
A, Pustule. A firm dome-shaped lesion with an opalescent surface. B, ‘Kissing’ pseudopustular perianal lesions, coalescing into flat-topped plaques that resemble condyloma lata. C, Pseudopustular ‘doughnut’ lesions with central crust. Note the strikingly uniform morphological characteristics seen with synchronous evolution of lesions. D, oral ulcer on soft palatal mucosa.
Figure 3.
Figure 3.. Mpox Mimics Other Skin Conditions.
A, Mollusciform papules. B, Keratoacanthoma-like facial nodule. C, Perianal ulcers mimicking herpes simplex virus. D, Chancriform tongue papule.
See this image and copyright information in PMC

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