Smallpox is a serious and contagious disease that causes a distinctive rash and skin lesions, which have been well documented historically. When someone has smallpox, the first visible signs on the skin typically begin as small red spots called macules. These macules then develop into raised bumps known as papules. Over time, these papules fill with clear fluid to become vesicles and then turn into pustules—raised lesions filled with thick, opaque pus. The pustules are firm and deeply embedded in the skin, often described as feeling like tiny peas under the surface.
The rash usually starts on the face first before spreading to other parts of the body such as the arms, legs, hands, feet, and sometimes inside the mouth or throat. The distribution tends to be more concentrated on the face and extremities compared to other areas like the trunk. As these pustules mature over several days (typically about 7-10 days), they become rounder and harder; eventually they crust over forming scabs.
These scabs remain for about two weeks before falling off naturally. After scabbing falls away, it often leaves behind pitted scars or discoloration of varying severity depending on how intense or widespread the infection was. This scarring was one of smallpox’s most notorious effects because it could cause permanent facial disfigurement.
Before this rash appears though, people infected with smallpox usually experience flu-like symptoms such as high fever (often above 38°C), severe headache, muscle aches (myalgia), back pain, fatigue, chills, vomiting sometimes accompanied by sore throat and swollen lymph nodes (lymphadenopathy). These early symptoms last for a few days before any visible rash develops.
The progression of smallpox lesions is quite characteristic:
1. **Macular stage:** Flat red spots appear.
2. **Papular stage:** Spots become raised bumps.
3. **Vesicular stage:** Bumps fill with clear fluid.
4. **Pustular stage:** Fluid becomes cloudy pus inside firm nodules.
5. **Scabbing stage:** Pustules dry out forming crusts/scabs.
6. **Healing stage:** Scabs fall off leaving scars.
Unlike some other pox viruses that may produce rashes at different stages simultaneously in various parts of their body (like chickenpox), all smallpox lesions tend to progress through these stages uniformly across affected areas at roughly similar times.
Visually speaking from an observer’s perspective during an active infection: The person’s face looks swollen due to inflammation around many raised bumps; their skin shows numerous round blisters filled initially with clear liquid turning yellowish when pus forms; after drying up there are dark brown crusts covering those blister sites; finally once healed there are sunken pits where scars remain permanently visible.
In severe cases especially without medical care historically available prior to vaccination efforts starting in late 18th century Europe onward—the number of pustular lesions could be very high covering large portions of body surface area causing extreme discomfort along with systemic illness including dehydration from fever plus secondary infections complicating recovery chances.
Because this disease was so visually distinct—marked by its uniform progression through specific lesion types ending in characteristic scarring—it became easier for doctors even centuries ago to identify it clinically without modern lab tests simply by observing how these skin changes evolved day by day during illness course.
In summary: Smallpox looks like a widespread rash beginning as flat red spots turning into hard pus-filled blisters that eventually crust over leaving deep scars once healed—all appearing mostly on face first then spreading outward—with accompanying flu-like symptoms beforehand signaling onset long before any visible signs emerge on skin surface itself.
