Orf 

  • Author: Lana H Hawayek, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 18, 2008
 

Background

Orf is a viral disease that is widespread in sheep and goats. Orf can be transmitted to humans by contact with an infected animal or contaminated fomites. Reindeer have also caused similar lesions in humans. Orf is frequently seen in farming communities[1, 2] and meat handlers. Clinically, reddish weeping nodules of orf are seen on the dorsa of the hands and the fingers that heal spontaneously in approximately 35 days.

An early lesion of orf (papular stage). An early lesion of orf (papular stage).
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Pathophysiology

Orf is primarily a disease involving the skin, though the lymph nodes are occasionally involved.

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Epidemiology

Frequency

International

A higher frequency of orf reports has occurred from Europe and New Zealand compared with North America, but this is of unknown significance.

Mortality/Morbidity

The natural course of orf is spontaneous recovery in 3-6 weeks.

  • Immunocompromised patients with orf can have progressive, destructive lesions requiring medical interventions such as antiviral therapy and surgical debridement. However, reports exist of immunosuppressed individuals with large, fungating lesions that have been refractory to treatment.
  • Mortality from orf has not been reported.

Race

Orf has been reported exclusively in whites.

Sex

No sexual predilection is reported for orf.

Age

No age predilection is described for orf.

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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  Adjunct Clinical Assistant Professor, Department of Dermatology, University of Virginia, State University of New York at Stonybrook, Penn State University

Shyam Verma, MBBS, DVD, FAAD 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 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, Penn State University College of Medicine; Staff Dermatologist, Penn 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, Department of Dermatology, Geisinger Medical Center

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

Disclosure: Nothing to disclose.

References

  1. Buchan J. Characteristics of orf in a farming community in mid-Wales. BMJ. Jul 27 1996;313(7051):203-4. [Medline].

  2. Paiba GA, Thomas DR, Morgan KL, Bennett M, Salmon RL, Chalmers R, et al. Orf (contagious pustular dermatitis) in farmworkers: prevalence and risk factors in three areas of England. Vet Rec. Jul 3 1999;145(1):7-11. [Medline].

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  12. Ara M, Zaballos P, Sánchez M, Querol I, Zubiri ML, Simal E, et al. Giant and recurrent orf virus infection in a renal transplant recipient treated with imiquimod. J Am Acad Dermatol. Feb 2008;58(2 Suppl):S39-40. [Medline].

  13. Geerinck K, Lukito G, Snoeck R, De Vos R, De Clercq E, Vanrenterghem Y, et al. A case of human orf in an immunocompromised patient treated successfully with cidofovir cream. J Med Virol. Aug 2001;64(4):543-9. [Medline].

  14. De Clercq E. Clinical potential of the acyclic nucleoside phosphonates cidofovir, adefovir, and tenofovir in treatment of DNA virus and retrovirus infections. Clin Microbiol Rev. Oct 2003;16(4):569-96. [Medline].

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

  16. Degraeve C, De Coninck A, Senneseael J, Roseeuw D. Recurrent contagious ecthyma (Orf) in an immunocompromised host successfully treated with cryotherapy. Dermatology. 1999;198(2):162-3. [Medline].

  17. Ocampo Candiani J, González Soto R, Welsh Lozano O. Orf nodule: treatment with cryosurgery. J Am Acad Dermatol. Aug 1993;29(2 Pt 1):256-7. [Medline].

  18. Ferrando MF, Léauté-Labrèze C, Fleury H, Taïeb A. Orf and erythema multiforme in a child. Pediatr Dermatol. Mar-Apr 1997;14(2):154-5. [Medline].

  19. Mourtada I, Le Tourneur M, Chevrant-Breton J, Le Gall F. [Human orf and erythema multiforme]. Ann Dermatol Venereol. Apr 2000;127(4):397-9. [Medline].

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  21. White KP, Zedek DC, White WL, Simpson EL, Hester E, Morrison L. Orf-induced immunobullous disease: A distinct autoimmune blistering disorder. J Am Acad Dermatol. Jan 2008;58(1):49-55. [Medline].

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

  23. Centers for Disease Control and Prevention. Orf virus infection in humans--New York, Illinois, California, and Tennessee, 2004-2005. MMWR Morb Mortal Wkly Rep. Jan 27 2006;55(3):65-8. [Medline].

  24. Deane D, McInnes CJ, Percival A, Wood A, Thomson J, Lear A, et al. Orf virus encodes a novel secreted protein inhibitor of granulocyte-macrophage colony-stimulating factor and interleukin-2. J Virol. Feb 2000;74(3):1313-20. [Medline].

  25. Ghislain PD, Dinet Y, Delescluse J. Orf contamination may occur during religious events. J Am Acad Dermatol. May 2000;42(5 Pt 1):848. [Medline].

  26. Inceoglu F. Orf (ecthyma contagiosum): an occasional diagnostic challenge. Plast Reconstr Surg. Sep 2000;106(3):733-4. [Medline].

  27. Mayet A, Sommer B, Heenan P. Rapidly growing cutaneous tumour of the right temple: Orf. Australas J Dermatol. Nov 1997;38(4):217-9. [Medline].

  28. Peeters P, Sennesael J. Parapoxvirus Orf in kidney transplantation. Nephrol Dial Transplant. Feb 1998;13(2):531. [Medline].

  29. Roingeard P, Machet L. Images in clinical medicine. Orf skin ulcer. N Engl J Med. Oct 16 1997;337(16):1131. [Medline].

  30. Yirrell DL, Vestey JP, Norval M. Immune responses of patients to orf virus infection. Br J Dermatol. Apr 1994;130(4):438-43. [Medline].

 
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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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