Review of category A bioweapons with cutaneous features: Epidemiology, clinical presentation, and contemporary management strategies

Major health organizations recognize various pathogens as potential bioweapons. Category A bioweapons (anthrax, plague, smallpox, tularemia, and viral hemorrhagic fevers) are the highest priority due to their ease of spread and high mortality rates. As these conditions have cutaneous manifestations, dermatologists may have an important role as front-line responders to indolent or bioterrorism threats. Few dermatologists are adequately prepared to approach the diagnosis and management of these conditions if encountered. Furthermore, despite improvements made in identifying, diagnosing, and treating these conditions over the past 10 years, there persists an absence of a synthesized distribution of these updates customized to adequately equip dermatologists. In this paper, we review the epidemiology, transmission, and dermatologic signs and symptoms of the category A bioweapons listed above. We also offer an overview of the evidence-based strategies for diagnosis and management and provide access to each states' guidelines for reporting these conditions. ( J Am Acad Dermatol 2025;93:165-75.)