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Milker's Nodules Treatment & Management

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

Medical Care

Most milker's nodules resolve by 5-7 weeks without treatment. Some reports of the related orf virus infection advocate prophylactic antibiotics to prevent local superinfection. Antiviral medications are not effective.[4] Direct local care for milker's nodules at avoiding secondary infection.

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Surgical Care

Milker's nodule is typically small, and the natural history is self-limited with spontaneous healing; however, superficial shave excision or curettage in conjunction with cautery of the base will remove lesions. The rationale for this technique, reported in the literature by some authors, is to decrease the amount of virion, which may promote more rapid healing and perhaps prevent lymphadenitis and progression of the lesion to a larger size.[14]

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Acknowledgements

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.

References
  1. Tikkanen MK, McInnes CJ, Mercer AA, et al. Recent isolates of parapoxvirus of Finnish reindeer (Rangifer tarandus tarandus) are closely related to bovine pseudocowpox virus. J Gen Virol. 2004 Jun. 85:1413-8. [Medline]. [Full Text].

  2. Hautaniemi M, Ueda N, Tuimala J, Mercer AA, Lahdenperä J, McInnes CJ. The genome of pseudocowpoxvirus: comparison of a reindeer isolate and a reference strain. J Gen Virol. 2010 Jun. 91:1560-76.

  3. Lauder IM, Martin B, Martin WB, Nagington J. Milkers' nodule virus infection and its resemblance to orf. Vet Rec. 1966 Jun 25. 78(26):926. [Medline].

  4. Wolff, Klaus, Richard Johnson, and Thomas Fitzpatrick. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. 6th Ed. New York, NY: McGraw-Hill Professional; 2009. 768.

  5. Bolognia J, Jorizzo J, Rapini R, eds. Dermatology. 2nd ed. Spain: Mosby; 2008. Vol. 2: 1231.

  6. Schuler G, Hackl JM. [Multiple atypical milker's nodes in scalded areas]. Hautarzt. 1982 Jul. 33(7):388-90. [Medline].

  7. Schuler G, Hönigsmann H, Wolff K. The syndrome of milker's nodules in burn injury: evidence for indirect viral transmission. J Am Acad Dermatol. 1982 Mar. 6(3):334-9. [Medline].

  8. Li Y, Meyer H, Zhao H, Damon IK. G+C content based universal PCR assays for poxviruses detection: "Pan_Pox". J Clin Microbiol. 2009 Nov 11. [Medline]. [Full Text].

  9. Töndury B, Kühne A, Kutzner H, Palmedo G, Lautenschlager S, Borelli S. Molecular diagnostics of parapox virus infections. J Dtsch Dermatol Ges. 2010 May 18. [Epub ahead of print]:

  10. Davis CM, Musil G, Trochet JA. Electron microscopy for the rapid diagnosis of pseudocowpox and Milker's nodule. Am J Vet Res. 1970 Aug. 31(8):1497-503. [Medline].

  11. Davis CM, Musil G. Milker's nodule. A clinical and electron microscopic report. Arch Dermatol. 1970 Mar. 101(3):305-11. [Medline].

  12. Requena L, Requena C. Histopathology of the more common viral skin infections. Actas Dermosifiliogr. 2010 Apr. 101(3):201-216.

  13. Weedon D & Strutton G. Skin Pathology. 2nd Ed. London, England: Churchhill Livingstone; 2002. 461.

  14. Shelley WB, Shelley ED. Surgical treatment of farmyard pox. Orf, milker's nodules, bovine papular stomatitis pox. Cutis. 1983 Feb. 31(2):191-2. [Medline].

  15. Ceovic R, Pasic A, Lipozencic J, et al. Milker's nodule--case report. Acta Dermatovenerol Croat. 2007. 15(2):88-91. [Medline].

  16. Kuokkanen K, Launis J, Morttinen A. Erythema nodosum and erythema multiforme associated with milker's nodules. Acta Derm Venereol. 1976. 56(1):69-72. [Medline].

  17. Taieb A, Guillot M, Carlotti D, Maleville J. Orf and pregnancy. Int J Dermatol. 1988 Jan-Feb. 27(1):31-3. [Medline].

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