How does monkeypox start? Plus 5 photos to show how the bumps are progressing

Photo of a journal article titled “Monkeypox: A Contemporary Review for Healthcare Professionals” featured in the Open Forum Infectious Diseases Journal, Volume 9, Issue 7, published July 2022.

Due to increasing awareness of the monkeypox virus, its spread and community involvement, the number of confirmed cases has been trending down in recent weeks. In this article, we’ll cover more common questions and describe what the monkeypox rash looks like and what to expect at each stage of progression.

How does monkeypox start?

Monkeypox can be difficult to diagnose because there is no uniform way to first appear. While some people experience flu-like symptoms before a rash is visible, others may see the rash appear first and experience flu-like symptoms later — or not at all.

Depending on where the rash appears, some monkeypox sores begin where pain can be felt but not necessarily seen. This is especially true in cases where the rash begins in the mouth or in the internal areas of the anus or genitals.

In short, there is no single way to identify how monkeypox starts, but we do know how it spreads and how to protect yourself from infection.

When is the monkeypox rash no longer contagious?

The monkeypox rash is contagious at every stage until the skin lesions have healed with new skin replacing the scabs.

“Although each individual lesion may follow a typical pattern of progression, there are often multiple lesions, each at different stages of progression, at any given time,” says Sara Hurtado Bares, MD, infectious disease physician at Nebraska Medicine. “While a skin lesion may appear for the first time in one area, new lesions often appear as the disease progresses, and it often takes up to four weeks from the onset of symptoms to when patients do not are more contagious.”

What the rash looks like and what to expect at each stage

First step: macules
The macules appear as flat, round pink spots without a bump, lasting one to two days.

Second stage: papules
The papules range from a flat, pink spot to a raised bump that usually lasts one to two days.

Third stage: the vesicles
At this point, the bumps change from raised to filled with a clear fluid for another one to two days.

Stage Four: Pustules
The blisters progress from a clear fluid-filled bump to an opaque pus bump. The pus bump grows larger, becomes firmer, and may develop a small divot in the center. The bump may start to form a small crusted crust in the center. This step takes about a week or two.

Fifth step: the crusts
Over the course of a week or two, the pus bumps will form a crust and crust. The scabs will remain for about a week before they begin to fall off.

If you’re concerned about potential scarring, read about seven ways to protect your skin from scarring. “There are also effective over-the-counter treatments for treating scars, including silicone scar sheets and ointments,” says board-certified dermatologist Jennifer Adams, MD. “These can help reduce the appearance of scarring, especially in the early stages. Avoid topical steroid creams and ointments. If you are seen for a chronic skin condition like eczema or other issues, discuss with your doctor about how to reduce the risk of spread.”

Is it a monkeypox rash or something else?

Especially in the early stages, it is not easy to distinguish between a monkeypox rash and other types of skin bumps. If you have been in close contact with someone who has been diagnosed with monkeypox or are considered to be at higher risk for exposure, contact a doctor.

An easy way to get help for a rash you’re not sure about? Arrange a virtual visit (E-Visit) to see a Nebraska Medicine dermatologist.

  • Login to One Chart
  • Click on the “menu” at the top left
  • Click on “E-visit”
  • Choose the “skin problem” option and follow the instructions to send a photo and information to a dermatologist for a quick evaluation

Learn more by visiting other useful resources on monkeypox.