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Skin rash
After the incubation period and the prodrome (initial) symptoms, patients enter a second stage, called the exanthema stage. This is perhaps the more important, with the most noticeable signs and symptoms. It is characterized by a skin rash that evolves from macules to papules. They transform then into vesicles and pustules. Finally, they crust and undergo desquamation. In more simple words, the skin rash initially looks like red dots on different body parts. These red dots become raised after that. Then, they are filled with transparent liquid that turns into pus. As they continue evolving, the vesicles and pustules burst and dry off, leaving a crust that finally peels off. These changes in the skin rash evolve over 14 to 21 days.
The skin rash usually appears in the extremities, the trunk, the face, and the scalp. Both covered and uncovered areas can be affected, including the soles and palms.
In some cases, patients may even develop skin ulcers after the vesicles and pustules burst. In other cases, they may undergo necrosis or tissue decay. The lesions are usually painless, and when pain is present, it is probably because there’s a skin infection. Children typically have mild manifestations of monkeypox, with reddened papules that look like insect bites. Milder skin manifestations are also expected in people who receive a smallpox vaccine.
