The band-aid sign: A clue to monkeypox diagnosis in susceptible populations.

Challenge

In the last three months, many patients presented with multiple band-aids on their skin at the Sandoval Health Center in Madrid, Spain.

Solution

Since May 2022, approximately 400 confirmed cases of monkeypox have been diagnosed at the Sandoval Health Center, which is a reference clinic for sexually transmitted diseases and HIV infection in Madrid, Spain. None of the patients had traveled to the endemic areas of monkeypox in Africa. In our patients, the disease presented as a sexually transmitted infection. The initial lesions were most often located on the genitalia and perianal area, and a history of unprotected sex contacts in the previous three weeks was commonly reported. So far, all of our patients are men who have sex with men, with no cases reported in women.

Patients with monkeypox frequently come to the consultation with small band-aids covering their skin lesions (Figs 1 and 2). They use band-aids to hide their lesions and to protect them, as these lesions are painful on rubbing. There is a certain analogy between the use of band-aids to cover monkeypox lesions in our patients and the use of false moles to cover human smallpox marks during the 17th, 18th, and 19th centuries.

Fig 1

Monkeypox lesions covered with small band-aids.

Fig 2

Monkeypox lesions covered with small band-aids.

Of note, standard band-aids do not prevent the transmission of viruses, as band-aids are made from porous material.

When we see a male patient with multiple band-aids on his skin, we immediately suspect monkeypox. It is the “band-aid sign,” which is useful in the context of a clinic for sexually transmitted infections.

Conflicts of interest

None disclosed.