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Image Number 1145 (Orf)


Diagnosis: Orf

Site: Finger

Sex: F

Age: 36


Description: Red nodule with a target appearance.

Submitted by: Nameer Al-Sudany

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Differential Diagnosis


Orf (ecthyma contagiosum) is caused by a parapox virus that can be transmitted to those handling infected sheep or goats. The most common presentation is a circumscribed solitary nodule or papule on the fingers or hands. Diagnosis is usually simple if contact with sheep is recognized. During a period of approximately 6 weeks, the lesions pass through six clinical stages, each lasting about 1 week:

  1. Maculopapular stage
  2. Target stage, during which the lesions have red centers, white rings, and red halos
  3. Acute weeping stage
  4. Nodular stage, which shows hard, non-tender nodules
  5. Papillomatous stage (nodules have irregular surfaces)
  6. Regressive stage (the lesions involute without scarring)

The current case is a middle-aged house wife presented with a single painful erythematous nodule on the radial side of the base of the left index finger. The lesion has appeared 5 days after sheep handling (sheep’s head cooking) as a small papule that transformed into a hard nodule with central pustulation within a few days. The nodule has typical target appearance.

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