Infection, symptoms and protection – explains dermatologist Yael Adler

by Madeline Jaeger

How do we protect ourselves from monkeypox and what distinguishes it from, say, classic chickenpox? In an RTL interview, dermatologist Yael Adler, 48, explains what you need to look for with your skin, how you can protect yourself—and where extra caution is needed now.

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Monkeypox: What exactly does smallpox or pustules look like?

Yael Adler (YA): There are two aspects to skin: First, you have a patchy rash that is still relatively nonspecific. The rash of monkeypox looks like many rashes on the skin (rashes on the skin). Then small blisters follow, which turn into cloudy blisters. And they’ve got a hole in the middle – that’s actually very specific to monkeypox.

Sometimes the mucous membrane is also affected. But visually, there is not a single palpable indicator on the skin that only indicates monkeypox. Many symptoms must combine to form the described rash, for example fever, severe back pain and headache. Fortunately, we have not had any suspected cases in my practice so far.

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So, is there a risk of confusion with other diseases?

YA: Yes, from an infectious point of view, errors in diagnosis and confusion can occur initially. Especially when the rash is in the intimate area, which was noticed recently. It can also be a sexually transmitted disease such as syphilis.

When these blisters open, they often look like small ulcers and this can also happen with a sexually transmitted disease. Therefore, the diagnosis is not so easy, and there is no such only way. That’s why you have to see monkeypox differentially and take a PCR swab to make sure it’s really monkeypox.

What makes monkeypox different from chickenpox, chickenpox, blisters, or a rash?

yes: With chickenpox you have a lot of small blisters, which in turn crust over. Then they bloom at different times. This is also called the “starry sky”. Smallpox exists in various stages in parallel, from small bumps to vesicles and in the form of a dry crust. Chickenpox is much smaller and does not bulge centrally like monkeypox.

Allergic rashes also look different, often large areas on the skin with blisters or smaller blisters and are often associated with itching. Each initial rash should be seen as a warning sign to see a doctor, because it could be a viral infection or a drug allergy, for example, which should definitely be clarified.

We want your opinion: How would you rate the risk of developing monkeypox?

If I had chickenpox as a child, am I immune?

yes: No, unfortunately not. These are different viruses. But the smallpox vaccine, which was given until 1976, is a protective agent.

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Does monkeypox always start with a rash and then smallpox?

YA: Monkeypox almost always begins with a reddish or patchy rash that is not yet noticeable and spreads from the face to the body. Next comes this typical pox and starts with small blisters, then turns into small blisters and eventually develops into a bumpy blister. Purulent vesicles are characteristic. In the present cases, pimples begin in the genital and anal area. So at the point where the first contact with monkeypox virus occurred.

It remains unclear whether it resulted from close physical contact with infected skin blisters or possibly from semen and vaginal secretions, which would be similar to HIV transmission. But we don’t know that at the moment.

Do monkeypox scars remain?

Yes, scars can remain after smallpox heals. Chickenpox, a completely different type of virus, also heals with scars, for example.

It is estimated that 30 percent have no symptoms.

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Should you go to a dermatologist if you have symptoms, or is your family doctor the place to go first?

YA: Unfortunately, patients often don’t get a dermatologist appointment so quickly, and GPs are trained accordingly and can see at first glance whether and how to take the procedure. In Berlin, for example, you often have to wait up to nine months to get an appointment with a dermatologist. General practitioners are a good first point of contact. If anything is unclear, they usually send the patient to a dermatologist.

Or to the emergency room! You also have to be very careful not to injure anyone. So an initial contact by phone would make sense. It is no coincidence that the pediatrician says: “Babies with an unexplained rash wait outside first.”

Do you have to deal with outbreaks in daycare groups?

YA: Children can also be infected, and there are also serious training courses in children, but not in Germany. This is more common in children who are immunocompromised, for example in Africa. It is not impossible for children to get monkeypox, but with a mild course. But they do not belong to the high-risk group. So at the moment I don’t think there is any major cause for concern in daycares.

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How can we protect ourselves from monkeypox?

yesMonkeypox vesicles are highly contagious. You should definitely protect yourself from this content. This applies to us in the doctor’s office and in the health sector, gloves and a face mask should always be worn when shaking hands and of course during examinations.

In the private sphere, I advise you to be more careful, for example in the nightlife. You probably shouldn’t rub yourself against a complete stranger in the cabaret that I can’t see in the dark, and you don’t know who the person has been in contact with. Especially in Berlin and other big cities there are very physical clubs. Open your eyes when it comes to love, keep the lights on and reduce the stakes.

I’m not “against sex” and I don’t mind if people have sex with strangers, but especially in Berlin we have an increase in sexually transmitted diseases. Since HIV is incurable, but at least treatable, people are more likely to leave condoms off again. People have become neglected again. There are serious risks involved and that should be on the radar right now, also against the backdrop of monkeypox.

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