An unusual main symptom of monkeypox has been discovered by new research.
A new review of UK monkeypox infections details symptoms of the current outbreak and has identified the main symptom of recent cases as pseudo-pustules. Researchers say the finding is very important as this feature is rare in other diseases and thus a "very clear sign of monkeypox".
It comes as two further cases of monkeypox have been identified in Scotland, according to the latest figures. Data from the UK Health Security Agency reports 61 monkeypox cases in Scotland as of July 28, with 2,546 total UK cases of which most (2,436) are in England.
Pustules are lesions where the top layer can be scraped away, but this isn't possible with pseudo pustules. They look similar to 'real' pustules, but the difference is that they are white, solid, and don't contain pus.
The features of this monkeypox outbreak are described by the medics as unusual. Recent cases tend to have far fewer skin lesions, often in one location, rather than the typical widespread rash seen in previous cases - possibly due to skin-to-skin contact during sex.
Other symptoms include ulcers, which happen when lesions meet moist areas of the body, such as the nose, mouth or genital areas. In some cases, these ulcers can be the most common lesions.
The article, which was published in the British Journal of Dermatology, examined 185 patients. The study also found that HIV did not seem to affect the severity of the disease.
"A crucial aspect of managing a fast-moving disease outbreak is having as much information as possible," Dr Ignacio García Doval, coordinator of the research from the Spanish Academy of Dermatology.
"Our research shows that the symptoms of the current outbreak are unusual and there is evidence that this is due to skin-to-skin contact during sex. Rather than the typical widespread rash seen in past cases, recent cases tend to have far fewer skin lesions, often in one location."
Dr Doval noted that the main skin symptom of recent monkeypox cases are pseudo-pustules.
He said: "It is particularly important for healthcare professionals to note the appearance of these skin lesions. Monkeypox is often described as causing pustules, pus-filled lesions, but in this outbreak, the main skin symptom is actually pseudo-pustules, white, solid papules which look like pustules, but which don't contain any pus. This feature is very rare in other diseases, so is a very clear sign of monkeypox."
He added that none of the patients in this research died, but warned how difficult the disease is and how monkeypox can lead to scarring.
"No patient involved in this research died and hospitalisation was uncommon, however, the disease is very uncomfortable and can have long-term consequences, including scarring in visible areas."
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