Dermatological manifestations of monkeypox

Abstract

Objective: This study aimed to identify the primary mucocutaneous manifestations secondary to
Monkeypox infection and determine the prevalence of coinfection with other sexually transmitted
infections (STIs). Methods: Searches were conducted in the PubMed, LILACS, SciELO, Cochrane Library, and
Virtual Health Library databases using the descriptors “monkeypox,” “dermatological,” “dermatology,”
“cutaneous,” “skin,” and “mucocutaneous,” combined with the Boolean operators “and” and “or.” All articles published between January 2017 and October 2022 that addressed mucocutaneous manifestations secondary to Monkeypox infection, regardless of language, were
included. Technical notes from the Brazilian Ministry of Health and World Health Organization recommendations were also incorporated. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the quality of the studies. Data were independently evaluated by three reviewers. Exclusion criteria included the absence of photographic records of the lesions, lack of laboratory confirmation of infection, “letter to the editor” publications, duplicates, and articles primarily focused on systemic manifestations without association with the integumentary system. Results: A total of 22 publications were included in this study. The most frequently affected anatomical sites were the genital and perianal regions, though lesions were also reported on the torso, face, oropharynx, limbs, palms, and soles. There is a possibility that the infection may present nonspecifically as a maculopapular rash. Lesions are typically multiple, with either localized or
widespread distribution. In the latter case, the progression is centrifugal, beginning on the face.
The most prevalent characteristic of the elementary lesion is central umbilication, which eventually
develops a crusted appearance. Umbilicated papules are often associated with pain, which gradually transitions to varying degrees of pruritus. Coinfection with HIV and other STIs was particularly notable among men who have sex with other men and/or have multiple partners and who use condoms inconsistently.
Conclusions: Monkeypox can present with various cutaneous manifestations, none of which are
pathognomonic of the disease. The chronological evolution of the elementary lesions (papule, vesicle,
pustule, crust) is not always precise, with multiple stages potentially coexisting in the same area of the body. The primary behavioral factor associated with infection is unprotected sexual activity, especially among men who have sex with other men. Coinfections with HIV, syphilis, gonorrhea, chlamydia, and/or herpes were observed in the majority of cases.