Ask the Ecz-Perts: Monkeypox

Many members of the NEA community have requested information about the health risks associated with contracting the monkeypox virus as relates to eczema and with corresponding vaccines. NEA’s current recommendation is to review the ongoing guidance about monkeypox from the Center for Disease Control (CDC) as new information about the virus is updated regularly. For people who have additional questions about monkeypox and eczema, we reached out to Dr. Peter Lio, assistant professor of dermatology at Northwestern University’s Feinberg School of Medicine, and Dr. Vivian Shi, associate professor of dermatology at the University of Arkansas for Medical Sciences.

As this is a developing story, this article will be updated with new information as published by the CDC.

Do people who have eczema have a higher risk of severe disease with monkeypox?

Dr. Lio: Yes. Because of the skin barrier issues that are present in patients with eczema, it is possible that a virus such as monkeypox could take advantage of the impaired skin barrier and result in a more severe, more widespread infection. This is similar to what is called “eczema herpeticum” with the herpes (cold sore) virus and “eczema vaccinatum,” which can happen from being vaccinated with the smallpox vaccine.

Is the monkeypox vaccine safe for people with eczema?

Dr. Lio: At this time, there are two monkeypox vaccines. ACAM2000 is a live vaccine that can replicate and thus should be avoided in patients with atopic dermatitis or eczema. See information here.  

The other vaccine is called Jynneos and involves a replication-deficient virus, so this vaccine option is probably safer and has fewer contraindications. Per the CDC’s guidance, this one is probably okay for patients with eczema: “Studies evaluating Jynneos in persons with atopic dermatitis have demonstrated immunogenicity in eliciting a neutralizing antibody response. No safety signals were revealed. However, persons with these conditions might be at increased risk for severe disease if an occupational infection occurs despite vaccination.” 

Dr. Vivian Shi: For patients who are on biologic medications, such as dupilimab (Dupixent^TM), be sure to check the actual package insert for approved biologics and JAK inhibitors with regards to the live vaccine: these should not be recommended while a patient is taking an immunomodulator.

Is there any concern for people with eczema being around others who receive a monkeypox vaccine?

Dr. Lio: Probably, yes, people with eczema should avoid people who were vaccinated against monkeypox, especially with ACAM2000, for about 30 days. There are reports in the literature where people with eczema have simply been exposed to vaccinated individuals for other conditions and become very sick with eczema vaccinatum.

If a person has eczema and they are exposed to or contract monkeypox, what steps should they take to protect themselves? Is there any treatment available?

Dr. Lio: The most important thing is to contact a healthcare professional immediately and evaluate the individual situation if there is concern for monkeypox infection. Currently, there are no treatments specifically for monkeypox infections, but smallpox is similar genetically, suggesting that treatments for smallpox may be used for monkeypox as well. Antivirals, such as tecovirimat, may be used in patients more likely to get severely ill, like patients with weakened immune systems.  

Prevention is also very important: monkeypox virus can spread via direct contact with the rash, skin breakage, scabs or fluids. It can also be passed along via prolonged face-to-face contact and especially during intimate contact such as kissing, cuddling or intercourse. It can transmit via fomites: items such as clothing that have previously touched the rash or body fluids. Monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed and it typically lasts a few weeks. The good news is that people who do not have monkeypox symptoms cannot spread the virus to others.

Is there anything we didn’t ask that you think our community should be aware of in relation to eczema and monkeypox?

Dr. Lio: While it may sound a bit scary, most people are able to do fine, as it’s generally a mild and self-limited disease. As always, be sure to refer to the CDC for the all latest guidance. And if you have any additional questions about monkeypox and eczema, send them to Editor@NationalEczema.org and we’ll share with our ecz-perts. Stay safe!