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Mpox: Diagnosis and Management for the Inpatient Dermatologist

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Abstract

Purpose of Review

Mpox, though largely a self-limited disease, may have severe manifestations requiring hospitalization, particularly in immunocompromised individuals. This review highlights the history and epidemiology, clinical course, diagnostic pearls, and management of mpox in the context of inpatient dermatology.

Recent Findings

The 2022 outbreak had unique features in comparison to previous outbreaks and endemic mpox, including a predominance of anogenital lesions and an atypical progression of lesion morphologies. The frequency of concurrent STIs is as high as 76%- necessitating co-testing for HIV and other STIs. Intradermal administration of the live, nonreplicating vaccine (Jynneos) requires 1/5th of the standard dose, shows similar immunogenicity, and provides increased vaccination reach.

Summary

Mpox may require hospitalization in cases of severe disease, uncontrolled pain, or with other cutaneous complications. The inpatient dermatologist plays an important role diagnosis of mpox and should recognize the variability in morphologic presentation and need for STI and HIV co-testing.

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Fig. 1

Source: CDC”; “Interim Clinical Treatment Considerations for Severe Manifestations of Mpox — United States, February 2023.” Reference to specific commercial products, manufacturers, companies, or trademarks does not constitute its endorsement or recommendation by the US Government, Department of Health and Human Services, or Centers for Disease Control and Prevention. The material is otherwise available on the agency website for no charge

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Authors and Affiliations

  1. Department of Dermatology, Massachusetts General Hospital, 55 Fruit St. Bartlett Hall 6R, Boston, MA, 02114, USA

    Alexis G. Strahan, John Trinidad & Esther E. Freeman

  2. School of Medicine, Mercer University, Savannah, GA, USA

    Alexis G. Strahan

  3. Department of Dermatology, University of Washington, Seattle, WA, USA

    Sigrid Collier

  4. Department of Dermatology, Weill Cornell Medicine, New York, NY, USA

    Joanna Harp

  5. Medical Practice Evaluation Foundation, Massachusetts General Hospital, 55 Fruit St. Bartlett Hall 6R, Boston, MA, 02114, USA

    Esther E. Freeman

  6. International Foundation for Dermatology, London, UK

    Esther E. Freeman

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A.S., S.C., and E.F. conceptualized manuscript design. A.S. wrote the draft manuscript text and prepared figures and tables. All authors edited, added relevant expertise, reviewed, and approved the manuscript.

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Correspondence to Esther E. Freeman.

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Esther Freeman is a member of the AAD Ad Hoc Task Force to Create Mpox Content. Esther Freeman is the Principal Investigator of the AAD/ILDS Dermatology Registry for COVID-19, Mpox, and Emerging Infections, and serves on the WHO Living Mpox Atlas and the WHO Mpox Guidelines Committee.

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Strahan, A.G., Collier, S., Trinidad, J. et al. Mpox: Diagnosis and Management for the Inpatient Dermatologist. Curr Derm Rep 12, 180–192 (2023). https://doi.org/10.1007/s13671-023-00411-x

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