Orf Clinical Presentation

  • Author: Lana H Hawayek, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Dec 2, 2011
 

History

  • Orf usually appears as a small papule on the dorsum of the index finger (see the image below) 1 week following contact with an infected animal or contaminated fomite. A classic location of orf on the index finger. A classic location of orf on the index finger.
  • With orf, a low-grade fever may occur but usually subsides within 3-4 days.
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Physical

Orf appears as a solitary lesion or as a few lesions on the fingers, the hands, or the forearms, and orf has even been reported on the face.[3] The orf lesion starts as a small, firm, red-to-blue papule that grows to form a hemorrhagic, flat-topped pustule or bulla. The bulla may have a crust in its umbilicated center as shown below. The fully developed orf lesion is typically 2-3 cm in diameter, but it may reach 5 cm. It is often tender and may bleed easily.

The regenerative stage of orf with a central crustThe regenerative stage of orf with a central crust.
  • Regional adenitis and/or mild lymphangitis may be found.
  • Mild fever and malaise may be associated with orf.
  • Large, fungating orf lesions have been reported in patients who are immunosuppressed and in patients with atopic dermatitis.
  • The orf infection goes through 6 clinical stages, each lasting about 1 week.
    • Stage 1 (maculopapular) - A red elevated lesion (see the image below)An early lesion of orf (papular stage). An early lesion of orf (papular stage).
    • Stage 2 (targetoid) - A bulla with an irislike configuration (nodule with a red center, a white middle ring, and a red periphery) as shown below The target phase associated with edema. The target phase associated with edema.
    • Stage 3 (acute) - A weeping nodule
    • Stage 4 (regenerative) - A firm nodule covered by a thin crust through which black dots are seen (see example below)The regenerative stage of orf with a central crustThe regenerative stage of orf with a central crust.
    • Stage 5 (papillomatous) - Small papillomas appearing over the surface
    • Stage 6 (regressive) - A thick crust covering the resolving elevation
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Causes

Orf is caused by infection with the orf virus that belongs to the Parapoxvirus genus, which also includes the milker's nodule virus.[4] Parapoxvirus is a member of the family Poxviridae, which contains double-stranded DNA viruses known to be the largest viruses.

  • The orf virus is a cylindrical virus measuring 260 X160 nm. Its surface tubules form a long crisscross design that is seen on negatively stained preparations by electron microscopy. This virus resists physical damage and persists through the winter months on hedges, feeding troughs, and barns.
  • Orf is transmitted by direct contact inoculation. Humans acquire the infection from contact with infected animals, carcasses, or contaminated, nonliving material. Orf is very common among shepherds, veterinary surgeons, and farmers' wives who bottle-feed young lambs, as well as in butchers and meat porters from handling infected carcasses.
  • No transmission of orf occurs to cattle, and no human-to-human transmission occurs.
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Contributor Information and Disclosures
Author

Lana H Hawayek, MD  Assistant Professor of Dermatology, Cosmetic Dermatologic Surgery and Laser Specialist, University of Cincinnati, Veterans Affairs Medical Center; Consulting Staff, University Dermatology Consultants

Lana H Hawayek, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Nelly Rubeiz, MD  Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon

Nelly Rubeiz, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Shyam Verma  MBBS, DVD, FAAD, Clinical Associate Professor, Department of Dermatology, University of Virginia; Adjunct Associate Professor, Department of Dermatology, State University of New York at Stonybrook, Adjunct Associate Professor, Department of Dermatology, University of Pennsylvania

Shyam Verma is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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An early lesion of orf (papular stage).
The target phase associated with edema.
A classic location of orf on the index finger.
The regenerative stage of orf with a central crust.
Orf lesion (arrow) associated with erythema multiforme.
 
 
 
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