Orf Treatment & Management

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

Medical Care

Although orf is a self-limited disease, symptomatic treatment with moist dressings, local antiseptics, and finger immobilization is helpful. Secondary bacterial infection from orf is not uncommon and must be treated with topical or systemic antibiotics. Several reports describe complicated orf cases of orf successfully treated with topical imiquimod, resulting in rapid regression of the lesions.[10, 11, 12] Reports also describe promising results in treating orf lesions with cidofovir cream.[13, 14]

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Surgical Care

For large exophytic orf lesions, dissection from the underlying dermis is performed.[15] If an orf lesion is persistent, curettage and electrodesiccation may be curative. Shave excision is another procedure used to treat orf lesions. Cryotherapy (liquid nitrogen) has been reported to speed up the recovery process from orf treatment.[16, 17] Radiation or amputation must be avoided.

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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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  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].

  3. Bodnar MG, Miller OF 3rd, Tyler WB. Facial orf. J Am Acad Dermatol. May 1999;40(5 Pt 2):815-7. [Medline].

  4. Groves RW, Wilson-Jones E, MacDonald DM. Human orf and milkers' nodule: a clinicopathologic study. J Am Acad Dermatol. Oct 1991;25(4):706-11. [Medline].

  5. Centers for Disease Control and Prevention. Human orf mimicking cutaneous anthrax---California. MMWR. 1973;22:108.

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  8. Olson VA, Laue T, Laker MT, Babkin IV, Drosten C, Shchelkunov SN, et al. Real-time PCR system for detection of orthopoxviruses and simultaneous identification of smallpox virus. J Clin Microbiol. May 2004;42(5):1940-6. [Medline].

  9. Gallina L, Dal Pozzo F, Mc Innes CJ, Cardeti G, Guercio A, Battilani M, et al. A real time PCR assay for the detection and quantification of orf virus. J Virol Methods. Jun 2006;134(1-2):140-5. [Medline].

  10. Erbagci Z, Erbagci I, Almila Tuncel A. Rapid improvement of human orf (ecthyma contagiosum) with topical imiquimod cream: report of four complicated cases. J Dermatolog Treat. 2005;16(5-6):353-6. [Medline].

  11. Lederman ER, Green GM, DeGroot HE, Dahl P, Goldman E, Greer PW, et al. Progressive ORF virus infection in a patient with lymphoma: successful treatment using imiquimod. Clin Infect Dis. Jun 1 2007;44(11):e100-3. [Medline].

  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].

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  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].

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  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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