Nigerian dermatologists’ research highlights concerns about mpox treatment as the disease resurfaces and spreads to new areas worldwide.
The dermatologists highlighted the crucial role they play in diagnosing and managing this infectious disease. The study, written by Sebastine Oiwoh, Ayesha Akinkugbe, Folakemi Cole-Adeife, Agarry Jacob, Dasetima Altraide, and Taofeek Salami, emphasizes that dermatologists have been instrumental in the early identification, reporting, and treatment of the monkeypox outbreak since it reappeared in Nigeria in 2017.
The authors pointed out that the distinctive rash associated with monkeypox, as well as its distribution patterns and morphological characteristics, are vital for accurate clinical diagnosis. They also noted that dermatologists specialize in recognizing, describing, and managing the skin-related symptoms of this infection.
Recently, the Africa Centre for Disease Control declared a public health emergency in response to the escalating mpox outbreak across the continent, which has impacted several African nations, particularly the Democratic Republic of the Congo (DRC).
The situation in the DRC is particularly severe, as the outbreak has expanded beyond its borders, with a new viral strain identified outside the DRC for the first time since its emergence in September 2023. The World Health Organization has raised concerns about the rapid spread of a new strain, known as clade 1b, which seems to be primarily transmitted through sexual networks and has been detected in neighboring countries, contributing to the declaration of a Public Health Emergency of International Concern (PHEIC).
As of 2024, there have been approximately 2,863 confirmed mpox cases and 517 fatalities reported across 13 African nations. In Nigeria, there have been a total of 39 confirmed cases and no deaths recorded across 33 states and the Federal Capital Territory since the beginning of the year.
Mpox is a rare zoonotic viral disease, which means it is transmitted from animals to humans, and it is endemic in several African nations, particularly in the tropical rainforests of Central and West Africa. The exact source of the virus remains unidentified, though it is suspected that rodents, squirrels, and monkeys may play a role in its transmission.
The authors of the paper noted that the Nigeria Centre for Disease Control’s National Monkeypox Public Response guidelines reflect a misunderstanding of dermatological terms and treatment protocols. They criticized the incorrect usage of phrases like “skin dermatitis” and noted the lack of specified protocols for managing skin lesions with topical treatments.
They advocated for the importance of recognizing the distinct rash, its distribution patterns, and morphology in the clinical diagnosis of mpox. The authors stressed that dermatologists are essential for the early detection, reporting, and management of mpox due to their expertise in dealing with the skin-related aspects of the infection.
The dermatologists proposed that clinical management, policy formulation, advocacy, monitoring, and evaluation should involve a multidisciplinary team that includes dermatologists. Furthermore, they recommended establishing a national photo gallery to enhance clinical diagnosis and serve as a diagnostic reference for monkeypox in individuals with darker skin tones.
Moreover, the dermatologists called for further research into the clinical presentations, distinctive characteristics, diagnostics, and management of mpox, along with an increase in scientific publications regarding the disease from Nigeria and the African continent.
Parts of the paper read, “Dermatologists have aided in the early detection, notification, and management of the MPX outbreak since its resurgence; and play a key role in training health professionals.”
“There are few publications globally, and locally, on the role of dermatologists and venereologists in the management of human MPX infection.
“After a hiatus of thirty-nine years of diagnosis of monkeypox in Nigeria, a tertiary hospital in the southern part of Nigeria received an eleven (11) year- -old boy, with a history of fever and raised itchy rashes on the skin involving the face, hands, and feet, (including the palms and soles) and the genitals. He also had a sibling with a similar rash. The registrar at the paediatric emergency sought expert opinions for the rash via virtual tele consultation with a group of dermatology senior residents and a request for the visiting consultant dermatologist to review. This prompted further discussions, which resulted in the final diagnosis of monkeypox infection in the index- confirmed case in 2017.
“However, a close examination of the Nigeria Centre for Disease Control’s (NCDC) National Monkeypox Public Response guidelines reveals a compelling need for dermatologists to be more actively involved. This may be evidenced by the incorrect usage of some dermatological terminologies as well as some omissions in the management protocol as mentioned below:
“The use of “skin dermatitis” (dermatitis means inflammation of the skin), and its misclassification under “superimposed bacterial infection” (Table 2 pages 31 & 34, section 6.5 of the guidelines).’
“In section 6.4.3, there is also a lack of variation in the management of skin lesions with topical medications while focusing on the parts of the body affected (intertriginous versus other parts) and the body surface area involved (vehicle of drugs used, open versus closed dressing patterns, and so on).
“There is little to no information on the follow-up with dermatologists on the management of possible post-infection complications like post-inflammatory hypo- or hyperpigmentation, and atrophic or hypertrophic scarring, for example (section 6.4.3).”
Speaking further on recommendations, the dermatologists added, “Therefore, clinical management, policy development, advocacy, monitoring, and evaluation through collaborative efforts of a multidisciplinary team which includes dermatologists among other relevant specialists and health professionals is key to the successful control and elimination of monkeypox in Nigeria.
“It is advised that a national photo gallery be created to aid clinical diagnosis and provide diagnostic references for MPX in people with skin of colour.
“More research is needed on the clinical presentation, distinguishing features, diagnosis, and management of monkeypox. More scientific publications on monkeypox from Nigeria and Africa are needed to increase the visibility of expert knowledge on monkeypox from the region and improve the efficiency of the global response to the outbreak.”
