Medical Care

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.^{[46, 47, 48]}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. The use of interferon alfa-2a and 2b has also been reported in refractory giant orf lesions in immunocompromised patients.^{[49, 50]}Reports also describe effective treatment of orf with cidofovir cream and cidofovir intravenously.^{[51, 52, 53]}

Surgical Care

Because of its self-limited nature, surgical procedures are usually reserved for immunocompromised patients who do not respond to conservative measures.^[27]Cryotherapy (liquid nitrogen) has been reported to speed the recovery process from orf treatment.^{[54, 55]}Shave excision is a procedure that can be diagnostic and therapeutic for small orf lesions. For large exophytic orf lesions, dissection from the underlying dermis has been performed.^[56]If an orf lesion is persistent, curettage and electrodesiccation may be curative. Amputation should only be used as a last resort. Recurrences and delayed healing have been reported after surgical treatment.^{[19, 50]}

Prevention

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.^[57]Once an animal is infected, it should be put in isolation.

To prevent infections in humans taking preventive measures is essential. It is recommend to wear nonpermeable rubber or latex gloves when handling sheep or goats, especially if there is a cut or sore present on 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.^[24]Protective immunity after infection is incomplete, so reinfection can occur unless precautions are taken.^[21]

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.

Medication

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Media Gallery

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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Author

Aaron Z Hoover, MD, FAAD Staff Dermatologist/Dermatopathologist, Front Range Dermatology Associates

Aaron Z Hoover, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Christian Medical and Dental Associations, International Society of Dermatopathology

Disclosure: Nothing to disclose.

Coauthor(s)

Mallory Milroy Medical Assistant, Surgical Assistant, Histology Technician, Front Range Dermatology Associates

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

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, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

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

Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Acknowledgements

Special thanks to Ms. Carmen Urich, Medical Librarian for Banner Western Division, for helping acquire articles for this publication.

Orf Treatment & Management

Medical Care

Surgical Care

Prevention

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