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Dermoscopy case of the month
Dermoscopy of contagious ecthyma (orf nodule)

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Clinical presentation

A 48-year-old housewife, a sheepherder, presented with a 4-month history of a violaceous nodule on the external aspect of the distal right finger that was associated with intermittent sharp pain. The patient recalled the presence of skin lesions in the snout of a sheep that she had been handling. The patient's general practitioner treated the nodule with antibiotics and anti-inflammatory medication without success. The lesion persisted without improvement (Fig 1, A).

Dermoscopic appearance

Dermoscopic examination found a well-defined nodule with a central crust, white structureless areas, and white shiny streaks, surrounded by dotted vessels, hairpin vessels, and a fine peripheral scale (Fig 1, B).

Histologic diagnosis

Biopsy results determined a diagnosis consistent with contagious ecthyma (orf nodule) (Fig 1, C).

Key message

Ecthyma contagiosum (orf nodule) is caused by a parapox virus from sheep and goats. It is usually asymptomatic and diagnosed by clinical appearance and a history of contact with farm animals.1

Ecthyma contagiosum has 6 clinical stages, each lasting approximately 1 week: the maculopapular stage, target stage, regenerative stage, papillomatous stage, and regressive stage.

The differential

References (2)

  • S. Al-Salam et al.

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

    J Cutan Pathol

    (2008)
  • J.V. Johannessen et al.

    Human orf

    J Cutan Pathol

    (1975)

Cited by (11)

  • Identification of strain diversity and phylogenetic analysis based on two major essential proteins of Orf viruses isolated from several clinical cases reported in Malaysia

    2020, Infection, Genetics and Evolution
    Citation Excerpt :

    Therefore, it is recommended for proper detection and identification of the pathogen by using gene amplification employing specific primers. Early identification and diagnosis of Orf disease is very important for its control and prevention (Chavez-Alvarez et al., 2016; Jesse et al., 2018b; Spyrou and Valiakos, 2015). The lack of rapid diagnosis and effective treatment given by the farmers is major contributing factor for disease occurrence (Bala et al., 2018a; Sadiq et al., 2017).

View all citing articles on Scopus

Funding sources: None.

Conflicts of interest: None declared.

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