Monkeypox (Mpox) is a viral illness characterized by a distinct rash that progresses through several phases on the skin. Scarring is a common outcome following an Mpox infection, though the severity and type of mark left behind varies significantly among individuals. The potential for lasting skin changes is directly related to the depth of the initial lesion and the care taken during the healing process. Understanding the rash’s biology is the first step toward minimizing lasting cosmetic effects.
The Lesion Progression and Scar Formation
The characteristic Mpox rash involves several distinct stages. It begins with flat spots (macules) that become firm, raised bumps (papules), which then fill with clear fluid (vesicles), and subsequently with pus (pustules). The lesions are often deep-seated, well-circumscribed, and rubbery, indicating that inflammation and tissue destruction extend beyond the superficial layer of the skin. This deep involvement is the primary mechanism leading to scar formation, as the injury penetrates the dermis.
Scarring occurs when the body replaces lost or damaged tissue with fibrous connective tissue, mainly collagen. The most destructive phase is the transition from the pustule to the final, hardened crust, or scab. If the inflammation is deep enough to destroy tissue within the dermal layer, the healing process cannot perfectly regenerate the original skin structure. The severity of tissue loss dictates the depth of the resulting scar once the scab naturally falls away.
Characteristics of Monkeypox Scars
Mpox lesions can result in permanent or semi-permanent skin changes, often similar to those seen after smallpox or severe chickenpox. The most frequently observed type is the atrophic scar, which appears as a pitted or sunken area on the skin. Atrophic scars form due to a net loss of collagen during repair, leading to a depression in the skin’s surface. These “pockmarks” are common on the face and areas where the skin is tightly bound to underlying structures.
A less common outcome is the formation of hypertrophic or keloid scars, which are raised and thickened. These occur due to an overproduction of collagen, leading to a scar that may extend beyond the original wound boundary. Secondary bacterial infection of open lesions increases the likelihood of prominent scarring by compounding tissue damage. Lesions located in areas with high skin tension or mobility, such as joints and the genital area, may also be more prone to developing raised scars.
Discoloration is another common sequela, manifesting as hyperpigmentation (darker skin) or hypopigmentation (lighter skin) where the lesions once were. These pigment changes may fade over many months but can be long-lasting. The body’s inflammatory response causes this disruption in melanin production.
Minimizing Scarring During Recovery
Managing lesions properly during the acute phase is the most effective way to minimize long-term scarring. A primary goal is to strictly avoid scratching, picking, or rubbing the lesions, even when they become intensely itchy during the crusting stage. Any physical disturbance can deepen the wound, delay healing, and significantly increase the risk of a permanent scar. Keeping fingernails trimmed short helps prevent unintentional damage.
Maintaining excellent hygiene is paramount to prevent secondary bacterial infections, which can dramatically worsen tissue destruction and scarring. Lesions should be gently washed with a mild, fragrance-free soap and water. Healthcare providers may suggest applying a thin layer of a simple, fragrance-free ointment, such as petroleum jelly, to keep the lesions moist. Covering the lesions with a non-stick bandage after applying the ointment can promote healing and reduce the temptation to scratch.
Moisturizing the skin promotes an optimal healing environment once the lesions are no longer open or weeping. For itch relief, cool, damp washcloths or warm baths may be used to soothe the affected areas and prevent scratching. After the scabs have naturally fallen off and fresh skin has formed, applying broad-spectrum sunscreen with an SPF of 30 or higher to the healed areas is important. Sun protection helps prevent hyperpigmentation, ensuring the new skin blends more seamlessly with the surrounding tissue.