5 things to know about monkeypox and skin

The WHO declared monkeypox a public health emergency on Saturday.

Monkeypox has been classified as a public health emergency of international concern by the World Health Organization, and the United States is one of the countries where human-to-human transmission is taking place.

Now, the WHO advises nations like the U.S. to “implement response actions with the goal of stopping human-to-human transmission of monkeypox virus,”, especially among high-risk groups, who at the moment include men who have sex with men.

However, experts say concern should not be limited only to people in high-risk communities. According to the American Academy of Dermatology, health care providers should “not limit concerns to men who report having sex with other men. Those who have any sort of close personal contact with people with monkeypox could potentially also be at risk for the disease.”

Generally speaking, close, direct contact—including intimate contact—is how monkeypox is transmitted. Droplets from direct face-to-face contact with an infected person can also spread the disease.

Monkeypox symptoms can include particular skin changes. The following are five details about monkeypox and the skin:

1. Pustules with surrounding redness

Lesions that resemble blisters are the typical appearance of monkeypox. The pustules usually develop into blisters, which finally scab over, in the course of the rash’s typical progression.

The rash can appear everywhere, including on the face and extremities, according to the American Academy of Dermatology.

Early reports from Yale University dermatology professor Dr. Christine Ko noted that monkeypox can “look like pustules with redness around them.”

Additionally, dermatologists describe red rashes in the genital or groin area. Ko said the monkeypox rash can also look like “swelling under the skin and redness associated with that.”

According to the Centers for Disease Control and Prevention, monkeypox lasts two to four weeks. People are contagious “until the rash has fully healed and a fresh layer of skin has formed,” the CDC said.

2. Swollen lymph nodes along with a rash are more suggestive of monkeypox

The presence of painful, enlarged lymph nodes is a major indicator of monkeypox and helps separate it from many other viral infections.

Lymph nodes swell, typically during a fever, and can become implicated a few days before any rash appears.

“Redness in the groin or genital area with painful swellings, which are lymph nodes, can be concerning for monkeypox, especially in the setting of rectal pain,” Ko told ABC News.

“If you have something on yourself, especially in the genital area, make sure you get it checked out before you have sexual activity,” Dr. Warren Heymann, professor of medicine and pediatrics and head of the Division of Dermatology at Cooper Medical School of Rowan University, told ABC News.

3. Don’t panic; although monkeypox is now a public health emergency, most skin findings will not be monkeypox.

• Here are some other conditions that look like monkeypox, but aren’t:
• Bullous impetigo: This is a superficial bacterial skin infection with overlying crusted blisters.
• Blistering fungal infections: Fungal infections are usually pink scaling rashes, but occasionally a fungal infection can cause a blistering rash.
• Syphilis: The rash of syphilis can mimic monkeypox. Because monkeypox can be sexually transmitted, other sexually transmitted diseases like syphilis, gonorrhea, or chlamydia can be co-transmitted at the time of contact.
• Contact dermatitis: Irritant and allergic contact dermatitis rashes sometimes develop blisters.
• Other viral infections. Viruses like herpes, varicella (the virus that causes chickenpox), molluscum virus (commonly seen in kids), and hand-foot-mouth disease are all much more common viruses that can mimic monkeypox rashes.
• Folliculitis- infections of hair follicles can develop pustules and could look like monkeypox

It’s important to keep an eye out for blistering rashes. Keep contact to a minimum until it is evaluated by a medical practitioner if you have one that is unexplained or if you have any systemic sickness with a blistering rash.

Right now, “you don’t need to panic because the likelihood is that you are dealing with something else, but the suspicion should be higher if you have swollen lymph nodes,” Heymann said.

4. There may be a spread of monkeypox, even without a rash

At the start of the monkeypox outbreak, “no one was prepared to really test for it. Now that situation is different,” Heymann said.

There are now viral cultures made with PCR, a technique used in many COVID-19 tests.

Nearly 2,900 cases of monkeypox have been reported to the CDC, but doctors warn that there may be many more cases that haven’t been counted.

“A lot of viruses, including monkeypox, you can transmit when you are just starting out with symptoms,” Ko said.

While the CDC says, “people who do not have monkeypox symptoms cannot spread the virus to others,” experts caution people may not always recognize early signs of monkeypox as a contagious viral illness.

“It is not exactly clear if asymptomatic individuals can transmit monkeypox, however it is known that other viruses, even SARS-COV-2, can be transmitted by asymptomatic individuals, but more study is needed about the current outbreak of monkeypox,” Ko said.

5. Even though monkeypox is transmitted by close contact, including sexual contact, the rash appears over several parts of the body

A rash that starts in the groin is described in early descriptions of monkeypox. Experts do warn that monkeypox is a systemic viral disease with extensive skin signs that can affect the eyes.

Dermatologists are still learning about the different groin rashes and symptoms that can accompany monkeypox, according to Ko, but what has surprised her is how unevenly spaced out monkeypox eruptions can be.

“If you are having blisters, especially tense blisters, or pustules, certainly with any systemic illness, and if you don’t feel well,” monkeypox should be considered, Heymann said.