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Milker's Nodules Follow-up

  • Author: Justin J Finch, MD, FAAD; Chief Editor: William D James, MD  more...
Updated: Mar 25, 2016


Isolate clinically infected animals from contact with humans who have not had previous exposure. Animals have typical lesions of circinate or horseshoe-shaped crusted erosions around the moist surfaces of the mouth and the nose or papules and erosions around the teats. They may have alopecia of lesions on hair-bearing surfaces. Lesions can be recurrent or chronic in cows.



Various reports caution against the possibility of bacterial superinfection in milker's nodules, although the authors' literature search did not find any reported cases.

Reports exist of generalized exanthem, erythema multiforme, or bullous erythema multiforme following infection with milker's nodule.[16] One case reported spontaneous resolution of exanthem at 1 week.



The prognosis is excellent in milker’s nodules, a self-limited disease that results in little or no scarring.

Lymphangitis, lymphadenitis, and fever, which may last from a few days to a few weeks, may occur in milker's nodules patients.

No reports exist describing milker's nodule infection during pregnancy; however, two reports exist of orf virus, a related Parapoxvirus, being contracted in the third trimester (33rd and 34th wk), resulting in maternal lesions but normal-term infants.[17]

Contributor Information and Disclosures

Justin J Finch, MD, FAAD Assistant Professor, Director of Clinical Photography, Director of the Center for Cutaneous Laser Surgery, Department of Dermatology, University of Connecticut Health Center

Justin J Finch, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Society for Pediatric Dermatology, New England Dermatological Society, Connecticut Society of Dermatology and Dermatologic Surgery, Midwest Arts in Healthcare Network, Arts & Health Alliance

Disclosure: Nothing to disclose.


Steven Brett Sloan, MD Associate Professor, Department of Dermatology, University of Connecticut School of Medicine; Residency Site Director, Connecticut Veterans Affairs Healthcare System; Assistant Clinical Professor, Yale University School of Medicine

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Connecticut State Medical Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Journal of the American Academy of Dermatology;Up to Date;Medical Review Institute of America.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Franklin Flowers, MD Department of Dermatology, Professor Emeritus Affiliate Associate Professor of Pathology, University of Florida College of Medicine

Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Surgery

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Gary W. Cole, MD, and Lily L. Tinkle, MD, PhD, to the development and writing of this article.

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