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Cooperating with the CDC to help clinicians treat mpox

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, July 1, 2023

In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Esther E. Freeman, MD, PhD, FAAD, a member of the Academy’s Ad Hoc Task Force to Develop Mpox Content, about content the task force created at the request of the Centers for Disease Control and Prevention and the World Health Organization about caring for the skin in patients with mpox and treating severe lesions.

DermWorld: I understand that through the Academy task force, you collaborated with CDC and WHO by developing content for the agencies to help clinicians seeing mpox patients provide them with proper treatment of the skin. Can you tell me how that came about?

Esther Freeman, MD, PhD, DTM&H, FAAD
Esther E. Freeman, MD, PhD, FAAD
Dr. Freeman: In August 2022, John T. Brooks, MD, chief medical officer of the CDC Multinational Mpox Outbreak Response, reached out to the Academy seeking content on managing scarring in mpox patients. The task force, led by George Hruza, MD, MBA, FAAD, quickly agreed that we’d be willing to develop content on this topic. We felt it was important, as dermatologists, to share our expertise on wound care management and skin care for patients with mpox at the national level, and with non-dermatologist physician colleagues.

It’s interesting how this request from the CDC followed on our AAD involvement with the COVID-19 outbreak. Because of the AAD/ILDS COVID-19 Dermatology Registry, colleagues across different specialties were aware of dermatologists’ role in characterizing and treating skin manifestations of outbreaks. This COVID work led to the CDC asking us to collaborate with them on the subsequent mpox outbreak.  

DermWorld: Would any of the recommendations for caring for the skin surprise the average dermatologist?  

Dr. Freeman: The recommendations we developed with the CDC are primarily aimed at 1.) health care workers who are taking care of people with mpox and 2.) patients, in terms of how to take care of their skin. There are handy one-page PDFs that you can print out and share with colleagues and patients. Most of our recommendations regarding wound care are those familiar to the dermatologist, that we discuss with our patients on a daily basis: how to clean the wound, applying a petroleum-based product, and how to minimize scarring.

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DermWorld: And then I understand that the CDC asked for another piece of guidance related to severe lesions? 

Dr. Freeman: Yes, in February the CDC asked for content about this topic. Again, the task force quickly agreed to develop content, reviewed the relevant literature, and created guidance that any clinician who sees an mpox patient could use when treating severe lesions. That guidance was then included in a CDC Morbidity and Mortality Weekly Report (MMWR).

DermWorld: What are some of these recommendations?

Dr. Freeman: Some severe and atypical mpox skin lesions can be tricky to care for, particularly in the peri-anal area. Much of the guidance focuses on creating a moist, clean wound healing environment and on protecting surrounding intact skin. But there are also more detailed issues around how to handle exudative wounds, especially around the buttocks and groin areas. Routine or empiric use of topical antibiotics are not recommended in this situation. We also remind physicians to evaluate for co-infections, such as staph, and other STIs including HIV, syphilis, and herpes simplex virus.

DermWorld: How did the CDC use the content the AAD created? 

Dr. Freeman: Our content is being shared from more than 15 different pages on the CDC website. In this way, I think mpox is a great example of how the AAD and the CDC can work together on outbreaks. We also worked with the AAD’s communications staff to create public-facing information that adheres to the same recommendations but is written for the lay audience in a printable one-page PDF format.

More recently, we have been engaging with the WHO on mpox, and I’m delighted to share that the first-of-its-kind Living Atlas of Mpox Lesions is now published and freely available on the WHO website. This atlas provides labeled reference photos of mpox lesions in different stages of the disease, across different skin tones. This was a collaboration with many dermatologists around the globe, led by AAD members Drs. Kieron Leslie (UCSF) and Edward Cowen (NIH). We are further involved with the WHO for Mpox Clinical Guidelines, where I serve as one of the dermatologists who sits on the Mpox Clinical Guidelines Committee. 

DermWorld: Obviously, this was a worthwhile effort for the AAD to help with, and it’s an honor to be asked for help by the CDC and WHO. How do endeavors like this help position dermatology with our colleagues in the house of medicine? 

Dr. Freeman: As dermatologists, we have a really important role to play in outbreaks. We have the ability to recognize and characterize skin lesions in a way that no one else can. It’s critical that we work with colleagues in other fields in the house of medicine to share this expertise. By working with the CDC and the WHO, we are ultimately helping front-line health care workers respond to these rapidly emerging situations. I do think it changes the perception of the specialty, when we are working hand in hand with our critical care and infectious disease colleagues, and they see dermatologists contributing a unique skillset to outbreak response. I’ve found it very rewarding to be able to contribute in this way.

Esther E. Freeman, MD, PhD, FAAD, is associate professor of dermatology at Harvard Medical School and director of MGH Global Health Dermatology. She is the principal investigator for the AAD/ILDS Dermatology COVID-19, Monkeypox, and Emerging Infections Registry. She is a co-author for UpToDate on COVID-19 Dermatology. She has no additional relevant or financial conflicts of interest. The mpox guidance created by the AAD at the CDC’s request is available online: Caring for skin and Treating severe lesions.

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

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