Orf

Published on 19/03/2015 by admin

Filed under Dermatology

Last modified 22/04/2025

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Orf

Jane C. Sterling

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports

Orf (ecthyma contagiosum) is an infection by a parapoxvirus, which causes inflammation and necrosis of the skin at the site of viral entry. It is predominantly an occupational disease because the orf virus is carried by sheep and occasionally goats or deer. It has been reported as a result of animal contact with home husbandry or in association with religious observances. Orf infection usually presents as a single lesion, most commonly on the hands or occasionally the face, but lesions can be multiple or very large in immunosuppressed individuals.

Management strategy

Orf is a self-limiting infection and treatment is usually not necessary. The immune response to the virus usually results in resolution of the disease within 2 to 7 weeks without any specific treatment. There is no available treatment that is specifically antiviral for the orf virus and no human vaccine has been produced. Treatment is usually only indicated if there is secondary bacterial infection or immunosuppression. Erythema multiforme can be triggered by orf infection.

Preventive measures include vaccination of sheep before the lambing period to boost immune response and the wearing of gloves if possible when handling animals with any sign of the disease.

Various treatments have been reported anecdotally. Idoxuridine, surgery, and cryotherapy have been suggested to reduce the time to healing. For immunosuppressed individuals, infection with orf may result in a more persistent or progressive infection or giant orf. In such cases, interventional treatment is warranted. Surgery may be performed to remove the bulk of the infected tissue. Idoxuridine, cidofovir, and cryotherapy have also been reported to improve time to healing or to clear persistent infection. Interferon and more recently topical imiquimod cream have shown some potential benefit.

Specific investigations

Electron microscopy of scrapings from lesion

Biopsy

Polymerase chain reaction

Diagnosis is usually clinical, but can be confirmed by the above investigations if required.

Ecthyma contagiosum (orf) – report of a human case from the United Arab Emirates and review of the literature.

Al-Salam S, Nowotny N, Sohail MR, Kolodziejek J, Berger TG. J Cutan Pathol 2008; 35: 603–7.

More detailed method for molecular diagnosis of orf used in a clinical case.

First-line therapies

No specific treatment usually necessary

Orf. Report of 19 human cases with clinical and pathological observations.

Leavell UW, McNamara MJ, Muelling R, Talbert WM, Rucker RC, Dalton AJ. JAMA 1968; 204: 657–64.

Lymphangitis and lymphadenopathy occurred in three of 19 cases.

Awareness of the risk of secondary bacterial infection is important.

Second-line therapies

Surgery	D
Cryotherapy	E
Idoxuridine	E
Cidofovir	E
Interferon	E
Imiquimod	D

Orf nodule: treatment with cryosurgery.

Candiani JO, Soto RG, Lozano OW. J Am Acad Dermatol 1993; 29: 256–7.

A healthy female with orf received a single treatment with liquid nitrogen (two freeze–thaw cycles) and the lesion healed in 2 weeks.

A case of ecthyma contagiosum (human orf) treated with idoxuridine.

Hunskaar S. Dermatologica 1984; 168: 207.

The orf lesion of a healthy female was treated with 40% idoxuridine in dimethylsulfoxide three times daily for 6 days. The lesion healed in under 4 weeks.

Parapoxvirus orf in kidney transplantation.

Peeters P, Sennesael J. Nephrol Dial Transplant 1998; 13: 531.

A large lesion on the thumb recurred after excisional surgery. After 40% idoxuridine topically, further surgery, and repeated cryotherapy, the lesion resolved.

‘Giant’ orf of finger in a patient with a lymphoma.

Savage J, Black MM. Proc R Soc Med 1972; 65: 766–8.

A patient who had received chemotherapy developed an enlarging orf lesion on one finger. Amputation of the finger was performed.

Giant orf in a patient with chronic lymphocytic leukaemia.

Hunskaar S. Br J Dermatol 1986; 114: 631–4.

A large palmar orf lesion was excised and small local recurrences treated with 40% idoxuridine.

A case of human orf in an immunocompromised patient treated successfully with cidofovir cream.

Geerinck K, Lukito G, Snoeck R, De Vos R, De Clercq E, Vanrenterghem Y. et al. J Med Virol 2001; 64: 543–9.

An immunosuppressed renal transplant patient developed a persistent giant orf lesion. Treatment with 1% cidofovir cream daily for five cycles of 5 days of treatment alternating with 5 rest days plus debridement as necessary led to full resolution of the lesion.

Recurrent orf in an immunocompromised host.

Tan ST, Blake GB, Chambers S. Br J Plast Surg 1991; 44: 465–7.

A tumor-like orf lesion in an immunosuppressed patient was unresponsive to surgery and idoxuridine. Temporary improvement occurred after 2 weeks of daily intralesional interferon of 1 million IU per injection with clearance following repeat surgery with subcutaneous interferon (1 million IU daily).

Rapid improvement of human orf (ecthyma contagiosum) with topical imiquimod cream; report of four complicated cases.

Erba˘ci Z, Erba˘ci I, Tuncel AA. J Dermatolog Treat 2005; 16: 353–6.

Treatment with imiquimod 5% applied twice daily for up to 10 days to orf lesions complicated by erythema multiforme, angioedema or as giant orf possibly hastened clearance of the orf lesion and the secondary effects.

Giant and recurrent orf virus infection in a renal transplant recipient treated with imiquimod.

Ara M, Zaballos P, Sánchez M, Querol I, Zubiri ML, Simal E, et al. J Am Acad Dermatol 2008; 58: S39–40.

Two enlarging lesions cleared with debridement then 5% imiquimod cream three times a week for 16 weeks.

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Orf

Management strategy

Specific investigations

The structure of the orf virus.

Orf. Report of 19 human cases with clinical and pathological observations.

Polymerase chain reaction for laboratory diagnosis of orf virus infections.

Ecthyma contagiosum (orf) – report of a human case from the United Arab Emirates and review of the literature.

First-line therapies

Orf. Report of 19 human cases with clinical and pathological observations.

Second-line therapies

Orf nodule: treatment with cryosurgery.

A case of ecthyma contagiosum (human orf) treated with idoxuridine.

Parapoxvirus orf in kidney transplantation.

‘Giant’ orf of finger in a patient with a lymphoma.

Giant orf in a patient with chronic lymphocytic leukaemia.

A case of human orf in an immunocompromised patient treated successfully with cidofovir cream.

Recurrent orf in an immunocompromised host.

Rapid improvement of human orf (ecthyma contagiosum) with topical imiquimod cream; report of four complicated cases.

Giant and recurrent orf virus infection in a renal transplant recipient treated with imiquimod.

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