If you’re staring at a weird bump in the mirror and wondering what does monkey pox look like, you aren't alone. It’s scary. One day you’re fine, the next you have a "pimple" that feels like a cigarette burn. Honestly, the most frustrating thing about mpox (the name health officials prefer now) is how much it mimics other things. It can look like a regular zit, a stray herpes blister, or even a nasty ingrown hair.
But there are "telltale" signs. These aren't just random spots.
The virus, which is an orthopoxvirus closely related to the one that caused smallpox, has a very specific, almost mechanical way of evolving on your skin. Unlike a heat rash that shows up and vanishes, mpox is a slow-motion transformation. You’ve got to know the stages to catch it early.
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The Visual Evolution: From "Zit" to "Volcano"
Most people think you just wake up covered in spots. Not usually. In the 2022 and 2024-2026 outbreaks, doctors like Dr. Lida Zheng from Northwestern University have noted that the rash often starts quite small. We're talking the size of a grain of rice.
Stage 1: The Macule (Flat)
It starts as a flat, red spot. No bump yet. It’s basically just a change in skin color. If you have darker skin, these might look more like a dark brown or purple patch. They usually last a day or two. You might think you just got bit by a bug.
Stage 2: The Papule (Raised)
The spot becomes raised. It’s firm now. If you try to squeeze it (please don’t), it feels "deep-seated." This is a major clue. While a pimple feels like it’s on the surface, an mpox lesion feels like a tiny, rubbery pebble embedded under the skin.
Stage 3: The Vesicle (Clear Fluid)
This is where it gets "blistery." The bump fills with clear fluid. At this point, it might start to hurt quite a bit. It’s not just "itchy"—many patients report a sharp, stabbing pain at the site of the lesion.
Stage 4: The Pustule (Opaque Fluid and Umbilication)
This is the classic look. The clear fluid turns cloudy or yellowish. But the real giveaway? Umbilication. Basically, the top of the blister develops a little "divot" or indentation in the center. It looks like a tiny volcano or a belly button. If you see a cluster of blisters with little holes in the middle, that is a massive red flag.
Where Does It Show Up?
Historically, we were told mpox starts on the face and moves to the hands. While that still happens—especially with the Clade I strain—the more recent Clade II outbreaks often start in the genital or anal areas.
It depends on where the virus first touched you.
If you caught it through close skin-to-skin contact, that’s where the first "herald" lesion will pop up. You might only have one or two spots. Or, you could have hundreds. There is no "standard" number. Some people get proctitis—internal inflammation that you can't even see—which causes intense rectal pain and makes you feel like you have to go to the bathroom constantly.
Is It Chickenpox or Mpox?
People mix these up all the time. They both have "pox" in the name, but they aren't even in the same family.
- The Timing: Chickenpox arrives in waves. You’ll have new red bumps next to old scabs. Mpox lesions usually "age" together. They all look like macules at the same time, then all turn into pustules together.
- The Lymph Nodes: This is the big one. Mpox makes your lymph nodes swell up like marbles. Look for lumps in your neck, armpits, or groin. Chickenpox doesn't really do that.
- The Feel: Chickenpox is itchy. Mpox is often described as agonizingly painful until it starts to scab over.
The Viral Timeline
You don't get the rash the second you're exposed. There is an incubation period of roughly 3 to 17 days.
Often, you’ll get "the crud" first. Fever, exhaustion, a headache that won't quit, and muscle aches. Doctors call this the prodrome phase. You feel like you’re coming down with a bad flu. Then, about 1 to 4 days later, the rash makes its debut.
However, keep in mind that in recent years, some people have been skipping the fever entirely and going straight to the rash.
What to Do If You See a Suspicious Spot
First, don't panic. But definitely don't ignore it.
- Isolate immediately. Cover the lesion with a bandage and wear long sleeves/pants.
- Avoid contact. This includes your pets. The virus can jump from humans to animals, and you don't want to start a cycle in your household.
- Call your doctor. Don't just walk into a waiting room. Call ahead so they can prep a room for you. They will likely use a synthetic swab to rub the lesion vigorously to get a DNA sample for a PCR test.
- Don't "pop" it. You will just spread the live virus to your fingers and then to everything else you touch.
- Wash everything. Use hot water for clothes and linens. The virus is surprisingly hardy on surfaces.
According to the CDC and WHO, you are considered contagious from the moment symptoms start until the very last scab falls off and fresh, pink skin has formed underneath. This can take 2 to 4 weeks. It’s a long haul.
If you're at high risk, look into the JYNNEOS vaccine. It's a two-dose series that has been remarkably effective at preventing severe disease. Even if you've already been exposed, getting the shot within four days can sometimes stop the infection in its tracks or at least make the symptoms much milder.
Keep an eye on your skin. If a spot looks "different"—rubbery, deep, or indented—get it checked out. It’s always better to be the person who went to the doctor for a false alarm than the person who accidentally spread a virus to their best friend.