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What monkeypox looks like compared to 7 skin conditions including acne, herpes, and syphilis

What monkeypox looks like compared to 7 skin conditions including acne, herpes, and syphilis
LifeScience2 min read
The monkeypox rash progresses in stages and can be mistaken for other skin conditions.UKHSA
  • Monkeypox causes a rash that can look similar to other illnesses such as acne, herpes or syphilis.
  • Two dermatologists told Insider the key differences between monkeypox and seven other rashes.

Monkeypox can cause a rash that looks similar to other illnesses, including herpes or syphilis — but there are some key differences, dermatologists told Insider.

Alongside a fever, a rash is one of the main symptoms of monkeypox. A recent study found that of 528 monkeypox cases diagnosed in 16 countries between April and June of this year, 95% had a rash, Insider previously reported.

Monkeypox has spread rapidly in recent months. More than 21,000 people across 344 countries have caught it in an unusual outbreak that began in May outside of regions where it is typically found, data from the Centers for Disease Control and Prevention shows. In the US, there were 4,907 confirmed cases as of Thursday, mostly in New York.

A high number of cases have been diagnosed in gay, bisexual, and other men who have sex with men, according to the CDC, but it is not a "gay disease." Anyone can catch it from having close contact with an infected person or touching contaminated items such as bedding.

Pregnant people, kids under 8 years old, those with eczema, and people with weakened immune systems may be at risk of severe monkeypox.

Don't try to diagnose new rashes at home, doctors said

Dr. Carrie Kovarik, a professor of dermatology at the Hospital of the University of Pennsylvania, told Insider, "We don't expect patients to diagnose themselves, but I think having monkeypox on their radar at least is good, especially for patients who may be at risk for more severe disease."

Other diseases can cause similar rashes, and it's possible to be co-infected with monkeypox and another infection.

"My message is these skin conditions are not things that you should be trying to diagnose or manage yourself at home," Dr. Esther Freeman, director of Global Health Dermatology at Massachusetts General Hospital, said.


Monkeypox lesions crust over and heal on their own within two to four weeks.      UK Health Security Agency

A monkeypox rash usually starts with a bump that fills with pus, which crusts over before an ulcer develops, Freeman said. This scabs over and heals over the course of two to four weeks.

"When fresh skin is seen underneath, the lesion is no longer infectious," she said.

According to the CDC, a monkeypox rash can occur on multiple parts of the body including: the face, mouth, hands, feet, chest, genitals, and anus.

Kovarik said that most monkeypox patients attending her clinic in Pennsylvania aren't "covered head-to-toe," in spots. Instead, they have lesions confined to one body part, or concentrated around one region of the body with "a few scattered elsewhere," she said.

A monkeypox rash can be the only symptom that people infected with monkeypox get.

But other symptoms that can either occur before or after the rash include a fever and swollen lymph nodes.


Cold sores are caused by the herpes simplex virus.      Boy_Anupong/Getty Images

Monkeypox lesions can look similar to genital herpes, and cold sores in the mouth caused by the herpes simplex virus.

"You can get these clusters of bumps of monkeypox in the genitals that start as a bump and then become a blister, and then become a scab just like herpes does," Kovarik said.

But, monkeypox lesions have a "pretty characteristic" central indent, and the spots tend to be a bit bigger than HSV lesions, she said.

Freeman said that both monkeypox and HSV can cause lesions anywhere on the body, because they're spread by direct contact.

Testing is the best way to tell the difference between monkeypox and HSV, the dermatologists said.

Molluscum contagiosum

Molluscum contagiosum
Molluscum contagiosum generally causes "hard bumps."      Kickstand/Getty Images

Molluscum contagiosum is "probably one of the things that can look most similar to monkeypox," Freeman said.

Both cause indented lesions and, like monkeypox, the molluscum contagiosum virus spreads through direct skin contact. This means it can be seen in similar areas of the body, Freeman said.

"We can see it in the groin and the anus, but we can also see it anywhere on the body such as the knees, hands, arms," she said, referring to molluscum contagiosum.

Kovarik said molluscum contagiosum generally causes "hard bumps," whereas monkeypox lesions were pus-filled.

Most healthy people with molluscum contagiosum don't tend to get sick and the rash gets better without treatment within a year, the dermatologists said.

The CDC recommends seeking treatment for molluscum contagiosum if lesions are in the genital area.

Hand, foot, and mouth disease

Hand, foot, and mouth disease
Hand, foot, and mouth disease is highly contagious.      Lolo stock/Getty Images

Hand, foot, and mouth disease can be confused for monkeypox because both illnesses can cause fevers as well as lesions on the hands, feet and mouth, the dermatologists said.

The lesions usually get better without treatment within ten days, according to the CDC.

The best way to tell between monkeypox and hand, foot, and mouth is with a lab test, the dermatologists said.

"If you're sick and have a fever and a new rash, it's a very reasonable to go and see your family doctor," Freeman said.


Skin rashes mark the second stage of syphilis, which can occur if people don't receive treatment.      CDC/ Dr. Gavin Hart

Syphilis, a sexually transmitted disease, is known in dermatology as the "The Great Pretender" because it can look like many other diseases.

Similarly to the monkeypox rash, syphilis progresses through multiple stages, the dermatologists said.

Without treatment with antibiotics, syphilis can be fatal.

"I think if you just have any concern about a new sexually transmitted infection then you should really promptly seek care," Freeman said.


Shingles is a painful rash that usually develops on one side of the body, often the face or torso.      Schwin Pikulsawad/Getty Images

Shingles is caused by the reactivation of the chickenpox virus, which can live in the nerves of the body for many years after an initial infection.

Freeman said that in healthy people, shingles causes a patch of painful, fluid-filled bumps in a very specific pattern related to the nerves, on one side of the body. People with weakened immune systems can get atypical rashes, she said.

Kovarik said that it can be tough to distinguish between shingles and monkeypox because both can cause flu-like symptoms and a cluster of painful bumps.

However, monkeypox patients get characteristic indented lesions, while shingles patients don't.

Shingles can be treated with antivirals and the CDC recommends that people who may have the condition contact their healthcare provider.


A chickenpox rash first appears on the chest, back, and face, and then spreads across the entire body.      Getty Images

People with chickenpox get an itchy, blister-like rash, caused by the varicella-zoster virus.

Kovarik said a chickenpox rash is usually scattered all over the body, and the spots blister and then scab. In contrast, monkeypox lesions, which are pus-filled bumps with a central indent, tend to cluster together, she said.


Acne causes bumps, known as comedones, that generally appear on the face.      SeventyFour/Getty Images

Acne is a skin condition that causes bumps, known as comedones, that usually appear on the face, and occasionally on the back or chest.

Freeman said that, unlike monkeypox, the lesions don't become ulcerated or spread to other parts of the body.

"Acne isn't accompanied by fever or swollen lymph nodes," she said.

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