Mpox (formerly called monkeypox) produces a distinctive rash that progresses through several visible stages, from flat spots to firm, raised bumps with a characteristic dimple in the center. The rash can appear anywhere on the body, but the face, hands, feet, genitals, and anal area are the most common locations. Understanding what each stage looks like can help you distinguish mpox from other skin conditions.
The Hallmark Feature: A Dimple in the Center
The single most recognizable feature of an mpox lesion is a small indentation, or dimple, in the center of each bump. This is called umbilication, and it looks like someone pressed a tiny dot into the top of the lesion. Not every bump develops this feature immediately, but as the rash matures, most lesions will show it. The bumps themselves feel firm or rubbery to the touch, not soft or squishy like a blister from a burn. They also appear deep-seated, meaning they look anchored in the skin rather than sitting lightly on the surface.
How the Rash Changes Over Time
Mpox lesions move through a predictable sequence of stages, and each one looks different:
- Macules: The rash starts as flat, discolored spots on the skin. They may look red, pink, or darker than the surrounding skin depending on your skin tone.
- Papules: Within a day or two, those flat spots rise into small, firm, raised bumps. They feel solid rather than fluid-filled at this point.
- Vesicles: The bumps fill with clear fluid, giving them a blister-like appearance. They’re still firm and well-defined, with sharp borders.
- Pustules: The clear fluid turns opaque, yellowish, or white as the lesions fill with pus. This is typically when the central dimple becomes most visible. The bumps are round, tense, and often described as looking like a pearl sitting on the skin.
- Scabs: The pustules dry out and crust over, forming a thick scab. The scab eventually falls off, revealing new skin underneath. Some people are left with lighter or darker patches, and in some cases, pitted scars.
The entire cycle from first spot to scab falling off generally takes two to four weeks. A person remains contagious until every scab has separated and fresh skin has formed beneath it.
Where the Rash Shows Up
Mpox follows what’s called a centrifugal pattern, meaning lesions tend to concentrate on the extremities and face rather than the trunk. You’re more likely to see bumps on your hands, arms, legs, feet, and face than on your chest or abdomen. However, during recent outbreaks, many cases have presented primarily in the genital and anal areas, likely reflecting sexual transmission as the route of exposure.
The rash isn’t limited to the skin. About 70% of people in recent outbreaks developed lesions inside the mouth or on the tongue, according to CDC data. Oral lesions often appear as small ulcers with a red center surrounded by a whitish ring. They can form on the tongue, the floor of the mouth, the lips, the tonsils, and the back of the throat. Many people with oral involvement report a painful sore throat and difficulty swallowing. Inside the mouth, blisters and pustules tend to rupture quickly, leaving shallow, painful sores on the mucous membranes.
Lesions around or inside the anus can cause significant pain, bleeding, and a persistent feeling of needing to use the bathroom. Genital lesions follow the same progression as skin lesions but can be especially painful given the sensitivity of the area. In some cases, genital or anal lesions appear first, before any rash develops elsewhere on the body.
How Mpox Looks Different From Chickenpox
Mpox and chickenpox can look similar at first glance since both cause blistering rashes, but several visual differences set them apart. The biggest distinction is where the rash concentrates. Chickenpox clusters most heavily on the trunk (chest, back, abdomen) and then spreads lightly to the arms, legs, and face. Mpox does the opposite, favoring the face and extremities over the trunk.
The timing of the lesions also differs. With chickenpox, new crops of blisters appear in waves, so you’ll see spots at different stages all at once: some fresh, some blistered, some already crusting. Mpox lesions tend to progress through stages more uniformly. All the bumps in a given area often look like they’re at roughly the same stage of development.
Texture is another clue. Chickenpox blisters are thin-walled and fragile, breaking easily. Mpox lesions are firm, deep, and well-defined, with that characteristic rubbery quality that makes them feel distinctly different under the skin.
Other Symptoms That Accompany the Rash
Before the rash appears, many people experience a flu-like prodrome: fever, chills, headache, muscle aches, and exhaustion. One symptom that helps distinguish mpox from many other viral illnesses is swollen lymph nodes. You may notice tender, enlarged lumps along the jaw, in the neck, in the armpits, or in the groin. These swollen nodes often appear before or at the same time as the rash and can be felt as firm, marble-sized lumps under the skin. Not everyone gets every symptom, and some people develop the rash with little or no preceding illness.
What to Watch For on Different Skin Tones
Most clinical images of mpox show the rash on lighter skin, where early macules appear pink or red. On darker skin tones, the initial flat spots may look brown, purplish, or simply darker than the surrounding skin rather than red. The raised stages (papules, vesicles, pustules) are easier to identify on all skin tones because you can feel the firmness and see the characteristic shape regardless of color. The central dimple and the well-defined borders remain visible across all complexions. If you’re checking a suspicious bump on darker skin, running your finger over it to feel for firmness and depth can be just as useful as looking at the color.