Dermatological complications of Mpox infections

Abstract

Mpox has re-emerged as a clinically significant orthopoxvirus infection, with evolving transmission dynamics and diverse cutaneous presentations in the post-2022 outbreak era. Because skin and mucosal lesions represent both the primary diagnostic clue and a major source of transmission, dermatologists play a central role in recognition, diagnosis, and management. Clinically, mpox manifests as a staged eruption progressing from macules and papules to vesicles, pseudopustules with central umbilication, and crusts. However, contemporary cases frequently present with localized anogenital or mucosal disease, pleomorphic lesions, and overlap with sexually transmitted infections, challenging traditional textbook descriptions. Histopathology provides critical diagnostic support, particularly in atypical cases. Stage-dependent findings include acanthosis, ballooning degeneration of keratinocytes, intraepidermal neutrophilic collections, and full-thickness epidermal necrosis. Pathognomonic cytopathic features—most notably Guarnieri bodies—reflect cytoplasmic viral replication and help distinguish mpox from herpesvirus infections. Pronounced tropism for follicular and eccrine structures further characterizes the disease. Accurate lesion-based PCR sampling, clinicopathologic correlation, and meticulous dermatologic wound care are essential to minimize complications, scarring, and dyspigmentation. As mpox continues to evolve, dermatologic expertise remains pivotal in early diagnosis, differential assessment, and prevention of long-term cutaneous sequelae.