Author(s): Bozena Riedel-Baima
In May 2022 several cases of monkeypox transmitted among humans in the UK, the USA and Europe were detected. The images of monkeypox skin lesions that were widely published in the media consisted exclusively of deeply seated vesicles and pustules on brown and black skin from endemic outbreaks in Africa. However, as cases accumulated in non-endemic countries, it has become clear that the clinical presentation of the current outbreak outside of Africa shows a very different picture, and that at least some of these cases might mimic pityriasis lichenoides et varioliformis acuta (PLEVA). It is a rare dermatologic condition of unknown aetiology, which has been described also as a reaction to vaccines.
Currently, the World Health Organisation recommended laboratory tool for diagnosing monkeypox is the real time polymerase chain reaction test. Antigen and antibodies detection methods are not considered useful due to cross-reactivity between different orthopoxviruses.
In this paper, I present the classic dermatologic criteria used for distinguishing between monkeypox and pityriasis lichenoides et varioliformis acuta as described in the literature. Further, as a hypothesis, I suggest considering pityriasis lichenoides et varioliformis acuta, a non- infectious skin reaction associated with extrinsic factors, including vaccines (also Covid-19 vaccines) as a possible differential diagnosis for monkeypox cases in the non-endemic countries.
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