Orf Treatment & Management
- Author: Aaron Z Hoover, MD, FAAD; Chief Editor: Dirk M Elston, MD more...
Although orf is a self-limited disease, symptomatic treatment with moist dressings, local antiseptics, and finger immobilization is helpful. Secondary bacterial infection of orf is not uncommon and must be treated with topical or systemic antibiotics. Several case reports describe orf successfully treated with topical imiquimod resulting in rapid regression of the lesions.[30, 38, 39] Imiquimod has been effective in both immunocompetent and immunocompromised patients. Regimens range from once every other day to twice daily application topically to the lesion. Reports also describe effective treatment of orf with cidofovir cream and cidofovir intravenously.[40, 41, 42]
Because of its self-limited nature, surgical procedures are usually reserved for immunocompromised patients who do not respond to conservative measures. Shave excision is a procedure that can be diagnostic and therapeutic of small orf lesions. For large exophytic orf lesions, dissection from the underlying dermis is performed. If an orf lesion is persistent, curettage and electrodesiccation may be curative. Cryotherapy (liquid nitrogen) has been reported to speed up the recovery process from orf treatment.[44, 45] Amputation should only be used as a last resort.
The best preventive measure in animals is an orf vaccination every 6-8 months. The orf vaccine is an attenuated vaccine, and, therefore, recently vaccinated animals do pose an infection risk to humans. Once an animal is infected, it should be put in isolation.
It is recommend to wear nonpermeable rubber or latex gloves when handling sheep or goats, especially if there is a cut or sore present and handling the mouth/muzzle area. Practice good hand washing with warm soapy water for 20 seconds or by using a waterless alcohol-based hand sanitizer when soap is not available. Protective immunity after infection is incomplete, so reinfection can occur unless precautions are taken.
Patients who are immunosuppressed or persons with compromised skin barriers (eg, trauma, skin disease) must avoid contact with infected animals because they have an increased susceptibility for contracting the orf infection.
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