Updated:03/06/2022 12:40h
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We’ve been seeing pictures of mostly unsightly skin lesions caused by the monkeypox virus in the press for weeks. And it seems like a good time to analyze the skin manifestations of this disease, which causes very recognizable lesions.
The Poxvirus family comprises a group of double-stranded DNA viruses that cause diseases such as smallpox, cow virus infection, monkeypox or molluscum contagiosum, among others. Until its eradication in 1980, smallpox was considered the infection with the greatest impact of this group due to its worldwide distribution, sometimes endemic and high mortality.
How does it act? smallpox virus enters the body through the respiratory tract and, after an incubation period of 7 to 17 days, it produces a picture of high fever, headache, malaise, nausea, vomiting and characteristic skin lesions.
These present as erythematous macules –which are flat and non-palpable– that progress to vesicles or pustules up to a centimeter deep. They generally progress slowly, all at once and leave quite deep scars in their evolution.
The facial area is especially vulnerable to this complication, probably due to the high number of sebaceous glands and their predisposition to infection. The reason why smallpox produces this characteristic scarring remains unclear. Factors such as the high number of lesions, the expression of cytokines (that “storm” of the immune system) or even the patient’s skin microbiome could be involved.
The eradication of smallpox as a double-edged sword
The eradication of smallpox is one of the best examples of controlling an infection through vaccination. It was a success that mass immunization strategies allowed the The last case of smallpox was declared in 1977.suppressing the natural circulation of the virus and allowing its subsequent exclusion from the vaccination schedule of the general population.
However, one of the possible consequences of cessation of vaccination against smallpox is the loss of the cross-immunity that it conferred against other orthopoxviruses. A clear example can be found in the recent declaration of monkeypox cases in humans.
Monkeypox is an endemic zoonosis in Africa with periodic emergence in humans and the possibility of person-to-person contagion through close contact with lesions, body fluids, contaminated items from an affected patient, or respiratory droplets. After an incubation period of 6-16 days, the infection presents with fever, headache, asthenia, and myalgia.
Subsequently, skin lesions appear in varying numbers in the form of raised lesions that progress to vesicles. They then erode producing crusts.
Marks on the palms of the hands and the soles of the feet
Unlike smallpox, in this case the face is not the main affected. The lesions extend from the trunk to the extremities, and are often located on the palms of the hands and soles of the feet. Mucous membranes, conjunctiva, and cornea may also be affected.
Unlike smallpox, the lesions do not develop all at once. And they are associated with a striking and often generalized swelling of the lymph nodes.
Another detail of interest at the skin level is that monkeypox produces necrosis and ulceration of the skin in its evolution, with the consequent risk of infection and scar.
Infections why? Above all, because the alteration of the barrier function contributes to the entry of microorganisms, producing Bacterial cellulitis and secondary sepsis in up to 20% of patients. It can be prevented by using occlusive dressings in the most affected areas, creating a clean and humid microenvironment, so that the recovery of the eroded skin is favored.
In addition, any injury or continuity solution should be considered as a possible source of contagion. Punctate and hypopigmented scars are also common as a result of infection.
In order for sequelae to be minimal, in addition to preventing superinfection, it is necessary to prevent scratching and treat only under professional supervision: no home or inappropriate treatments. Otherwise, smallpox will leave an indelible mark.
Eduardo Lopez Bran. Professor of Dermatology at the Faculty of Medicine, Complutense University of Madrid.
Alvaro Iglesias Puzas. Medical Specialist in Dermatology. San Carlos Clinical University Hospital, Complutense University of Madrid.
This article was originally published on The Conversation.
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