Triaging cases of fever with vesicular rash relevant to the monkeypox epidemic

Fever with a vesicular rash is a common clinical scenario and monkeypox (MPX) characteristically presents as a fever with a vesiculopustular rash. The clinical morphology of MPX mimics many infectious and non-infectious disorders, and narrowing down the differentials of vesiculopustular rash necessitates thorough history taking and physical examination. The clinical evaluation involves the assessment of the primary skin lesions, sites of involvement, distribution, number and size of lesions, and pattern of progression of the rash, along with the onset of the rash relative to the occurrence of fever and other systemic signs. Common disorders which are close differentials include Varicella, Erythema Multiforme, enteroviral exanthems, and disseminated herpes simplex. Distinct clinical indicators of MPX include the presence of deep-seated umbilicated vesiculopustules, lymphadenopathy, involvement of the palms and soles, centrifugal spread, and genital involvement. We delineate and enlist features of common disorders presenting as vesiculopustular rash, which can help the clinician differentiate them from MPX.