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Monkeypox

Monkeypox: Caring for skin


The monkeypox virus causes lesions to form on the body. While these can be located anywhere, many individuals during the current outbreak have experienced lesions in the anogenital region, though involvement of other areas including the face, extremities, and mucosal areas such as the mouth have also occurred.1-3

While the number of lesions can vary widely, a recent CDC report indicated that the majority of cases in the current outbreak develop less than 50 lesions.4,5 No matter the number, monkeypox lesions can lead to both atrophic and hypertrophic scarring.6,7

For individuals who have developed lesions from a monkeypox infection, care should be taken to ensure lesions heal properly with minimal scaring. Though data on lesion healing in monkeypox infections is limited, information on wound healing in general, as well as care for similar skin lesions form other infections, can aid in understanding how to best care for monkeypox lesions and prevent scaring:

  • Wash skin with a mild soap and water.8 To avoid potential transmission, ask patients not to share towels, bath linens, or clothing with others.

  • Monkeypox lesions are considered infectious until they have healed (scabs have fallen off and a fresh layer of intact skin has formed). Therefore, the CDC recommends that all rashes should be covered to the extent possible (for example, by wearing long sleeves and long pants). Monkeypox isolation and infection control at home guidelines are available from the CDC.

  • In general, all lesions of monkeypox are considered infectious (capable of transmitting infection) through contact, and it is advisable to keep affected sites and individual lesions covered.

  • Antiseptics or anti-bacterial agents are only required if there is concern for bacterial infection.8-15

  • If the lesion becomes infected, patients should contact their physician or other health care provider immediately.

  • After lesions have healed, if there is concern for scarring, silicone-based gels or sheeting may also be used.10,16

  • Sun protection (broad spectrum SPF 30 or higher) should also be emphasized for several months after lesion resolution to avoid hyper or hypopigmentation of lesions or scars.10

  • Individuals with monkeypox lesions should be instructed not to scratch or unroof lesions or scabs, which may lead to secondary infection. Dermatologists should suggest keeping fingernails short to avoid unintentional scratching.9,17

  • To help soothe skin, baths may be taken. Alternatively, sitz baths and warm or cool compresses may help in soothing lesions in the anogenital region.17-19

  • Certain patients may qualify for monkeypox-specific therapeutics; consultation with appropriate specialists as necessary may be indicated to identify the most up-to-date options.

References
  1. Monkeypox: Signs and Symptoms. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP). https://www.cdc.gov/poxvirus/monkeypox/symptoms.html. Accessed August 22, 2022.

  2. Bragazzi NL, Kong JD, Mahroum N, et al. Epidemiological trends and clinical features of the ongoing monkeypox epidemic: A preliminary pooled data analysis and literature review. J Med Virol. 2022.

  3. Srivastava G, Srivastava G. Human Monkeypox Disease. Clin Dermatol. 2022.

  4. Philpott D, Hughes CM, Alroy KA, et al. Epidemiologic and Clinical Characteristics of Monkeypox Cases - United States, May 17-July 22, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(32):1018-1022.

  5. Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022.

  6. Ogoina D, Iroezindu M, James HI, et al. Clinical Course and Outcome of Human Monkeypox in Nigeria. Clin Infect Dis. 2020;71(8):e210-e214.

  7. Xiang Y, White A. Monkeypox virus emerges from the shadow of its more infamous cousin: family biology matters. Emerg Microbes Infect. 2022;11(1):1768-1777.

  8. Hunt SC, Azad S. ABCDEFGHI Systematic Approach to Wound Assessment and Management. Adv Skin Wound Care. 2022;35(7):366-374.

  9. Reynolds MG, McCollum AM, Nguete B, Shongo Lushima R, Petersen BW. Improving the Care and Treatment of Monkeypox Patients in Low-Resource Settings: Applying Evidence from Contemporary Biomedical and Smallpox Biodefense Research. Viruses. 2017;9(12).

  10. Meaume S, Le Pillouer-Prost A, Richert B, Roseeuw D, Vadoud J. Management of scars: updated practical guidelines and use of silicones. Eur J Dermatol. 2014;24(4):435-443.

  11. Jourdan M, Madfes DC, Lima E, Tian Y, Seité S. Skin Care Management For Medical And Aesthetic Procedures To Prevent Scarring. Clin Cosmet Investig Dermatol. 2019;12:799-804.

  12. Proper wound care: How to minimize a scar. American Academy of Dermatology https://www.aad.org/public/everyday-care/injured-skin/burns/wound-care-minimize-scars. Accessed August 22, 2022.

  13. Ogawa R. The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago. Plast Reconstr Surg. 2022;149(1):79e-94e.

  14. Powers JG, Higham C, Broussard K, Phillips TJ. Wound healing and treating wounds: Chronic wound care and management. J Am Acad Dermatol. 2016;74(4):607-625; quiz 625-606.

  15. Bolton LL, Faller N, Kirsner RS. Herpes Zoster (Shingles) Patient-Centered Wound Outcomes: A Literature Review. Adv Skin Wound Care. 2021;34(5):239-248.

  16. Gold MH, McGuire M, Mustoe TA, et al. Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatment. Dermatol Surg. 2014;40(8):825-831.

  17. How to Care for a Child with Chickenpox. American Academy of Dermatology. https://www.aad.org/public/everyday-care/itchy-skin/rash/chicken-pox. Accessed August 22, 2022.

  18. Genital Ulcers. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/23320-genital-ulcers. Accessed August 22, 2022.

  19. Roett MA, Mayor MT, Uduhiri KA. Diagnosis and management of genital ulcers. Am Fam Physician. 2012;85(3):254-262.

Download the PDF

Take a PDF of this guidance for your practice or to share with others.

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Additional resources

Isolation at home

Read CDC guidance on monkeypox isolation and infection control at home.

Minimize scarring

See Academy guidance for patients on how to care for wounds to minimize scarring.

Recognizing monkeypox

Use Academy guidance to recognize the signs of monkeypox in patients.

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