Orf Treatment & Management

Updated: Jun 06, 2018
  • Author: Aaron Z Hoover, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

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]

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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]

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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.

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