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What are the cutaneous clues for diagnosing monkeypox?

Kathryn Schwarzenberger, MD

Clinical Applications

Dr. Schwarzenberger is the physician editor of DermWorld. She interviews the author of a recent study each month. 

By Kathryn Schwarzenberger, MD, FAAD, December 1, 2022

In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with John W. Frew MBBS, MMed, MSc, PhD, FACD, from the Laboratory of Translational Cutaneous Medicine at the Ingham Institute of Applied Medical Research in Sydney, Australia, about his JAAD paper, ‘Monkeypox: Cutaneous clues to clinical diagnosis.

DermWorld: Thank you for your insightful and timely article describing cutaneous clues to the clinical diagnosis of monkeypox. What made you decide to write this article?

Headshot of Dr. Frew
Dr. Frew: Dermatologists are uniquely placed in medicine to aid in identification of monkeypox lesions and clarify differential diagnoses. We know that diagnostic morphology is a unique skill set and we should be encouraging dermatologists to be involved in the emergence of new disease entities and public health responses to conditions such as monkeypox.

DermWorld: In case our readers have not yet read your article, can you share your diagnostic tips for distinguishing monkeypox from other common viral lesions?

Dr. Frew: Distinguishing monkeypox lesions can be challenging as they can mimic other common viral infections such as molluscum contagiosum. Often the combination of location, number, and progression of lesions combine to make the diagnosis of monkeypox the top differential.

DermWorld: Is the physical exam enough? Do we need to confirm the diagnosis?

Dr. Frew: Indeed. Confirmation through PCR is essential, but first the clinical suspicion is needed, and this is where the logical analytical approach to distinguish monkeypox from differentials is required. I hope that the article helps provide this framework to dermatologists and other clinicians alike.

Academy Monkeypox resources

Access clinical guidance from the Academy and the CDC on recognizing and treating monkeypox.

DermWorld: Any thoughts as to why monkeypox arose now? And where do you see this epidemic going?

Dr. Frew: Epidemics have always been with us since time immemorial, but we live in an era where environmental degradation, climate change, and overpopulation are making novel infections more likely to jump to humans. I believe this epidemic will only be one of many more in the future.

DermWorld: I very much appreciated the fact that your article emphasizes the value of the physical exam, which I fear is a very undervalued diagnostic tool in this age of technology. Do you have any thoughts as to how we might continue to excite and educate the next generation(s) of physicians to become master clinicians?

Dr. Frew: Medicine is still very much an apprenticeship — one requires role models and mentors to learn the art of dermatology as well as the science. There’s nothing that can replace experience and patient contact and ensuring that immersive experience under the guidance of experts is (in my opinion) the most effective teaching method available.

DermWorld: The COVID pandemic has made many of us never want to stop wearing masks while seeing our patients. Has monkeypox made you rethink any behaviors?

Dr. Frew: As clinicians, we need to realize that we can’t care for our patients unless we care for ourselves. I certainly feel that masks can be very useful to avoid contracting (and spreading) respiratory illness during high-risk consultations or seasons. Outside of the context of COVID, the question is: will it make a noticeable difference? And of course, some patients and clinicians feel that the mask adds an additional barrier during the consultation which can reduce rapport building. I think this is a topic that will have many different opinions as to the way forward.

John W. Frew MBBS, MMed, MSc, PhD, FACD, is a staff specialist dermatologist at Liverpool Hospital in Sydney, Australia. He also heads the Laboratory of Translational Cutaneous Medicine at the Ingham Institute of Applied Medical Research in Sydney and is Conjoint Senior Lecturer at UNSW Australia. His paper appeared in JAAD.

Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.