Does Monkeypox Leave Scars?

The current outbreak of monkeypox—a viral infection usually only found in Central and West Africa—has now seen over 1,200 cases across nearly 30 non-endemic countries, according to the CDC. It appears that one of the longer-lasting effects of monkeypox might be rash lesions.

lesions monkeypox
Stock image: Monkeypox lesions on the skin. iStock / Getty Images Plus

While the disease itself is considered to be relatively mild, and in most cases will naturally clear up in a few weeks, it can more seriously affect immunocompromised people, children, and pregnant women. Symptoms of monkeypox include a fever, headaches, back and muscle aches, chills and tiredness, and, most characteristically, a pox-like rash. This rash usually appears between one and three days after developing a fever, and generally progresses from the face to the rest of the body before scabbing over and eventually falling off after around two weeks.

According to NPR, not everyone gets lesions all over their bodies like you would with something like chickenpox, and in some cases, patients have only one or two small lesions that may even be confused with marks associated with sexually transmitted diseases, such as herpes and syphilis.

Donald Vinh, an infectious disease doctor at McGill University, told NPR: "[one] patient's skin lesion that [a colleague] sampled to confirm the diagnosis is extremely subtle. It's not what you're seeing on the Google pictures of monkeypox."

While these lesions aren't itchy like chicken pox, as Andrea McCollum, the poxvirus epidemiology team lead in the CDC's division of high consequence pathogens and pathology, told STAT, they are generally painful.

"The lesions themselves often are described as being very painful, irrespective of where they occur on the body," she said. "It's only during that healing phase [with monkeypox] when there's crusting and the skin is regenerating a bit, patients mention itching."

These monkeypox lesions may also lead to hypo- or hyper-pigmentation and scarring, and lighter areas where lesions were in people with dark skin. The lesions may also turn into keloid scars, which are raised scars that are enlarged and can be shiny, hairless, hard and rubbery and red or purple at first, before becoming brown or pale.

"The scarring... is not the monkeypox itself but when these pox lesions start to weep and break down they get secondary bacterial infection that generally causes the scarring, I believe," Professor Paul Hunter, an epidemiologist at the U.K.'s University of East Anglia told Open Access Government.

Keloid scars are often treatable, however, by means of steroid injections, application of steroid-impregnated tape or silicone gel sheeting, and even freezing early keloid scars with liquid nitrogen to stop them growing.