Zoonotic transmission of parapoxvirus from animals to humans has been reported; clinical manifestations are skin lesions on the fingers and hands after contact with infected animals. We report a human infection clinically suspected as being ecthyma contagiosum. The patient, a 65-year-old woman, had 3 nodules on her hands. She reported contact with a sheep during the Aïd-el-Fitr festival in France during 2017. We isolated the parapoxvirus orf virus from these nodules by using a nonconventional cell and sequenced the orf genome. We identified a novel orf virus genome and compared it with genomes of other orf viruses. More research is needed on the genus Parapoxvirus to understand worldwide distribution of and infection by orf virus, especially transmission between goats and sheep.

Background and Objectives: Combining the efficacy of ablative fractional carbon dioxide lasers (AFXL) to laser-assisted hyaluronic acid delivery (LAHAD) has not yet been studied. The objective of our study was to evaluate the safety and the efficacy of laser-assisted hyaluronic acid (HA) delivery with AFXL in facial skin remodeling.Study Design/Materials and Methods: We conducted a prospective, double-blinded, randomized split-face study on 20 patients from 30 to 70 years old, with a skin phototype from I to IV. Each patient received fullface treatment with AFXL, immediately followed by the application in droplets into the fractional ablative tunnels of 1 ml of HA gel on one hemiface and 1 ml of physiological saline on the other hemiface. To evaluate postlaser aftermath, the intensity of erythema, edema, and crusts was graded. To assess facial skin remodeling, we scored the improvement of skin texture, firmness, fine lines, and skin radiance from baseline. Patients were evaluated on the 3rd and 7th day, 1st and 3rd month using clinical evaluations, photographs, and patient questionnaires.Results: We showed equivalence in postlaser aftermath between HA-treated and nontreated hemiface. Trend data analyses at the 3rd month suggested that immediate application of HA after AFXL resulted in a greater improvement in facial skin remodeling, especially for skin texture (mean score of 2.60 vs. 2.45) and skin firmness (mean score of 2.55 vs. 2.40). Skin radiance showed the best improvement, reaching almost a score of 5/10. Conclusions: LAHAD with AFXL is a safe treatment showing promising results in facial skin remodeling. These findings need to be confirmed by a larger study to evaluate the value of LAHAD in daily clinical practice. Lasers Surg. Med.

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A 47-year-old man presented with a febrile ulceronecrotic dermatosis. He reported intense use of levamisole-contaminated cocaine during the previous weeks.Physical examination revealed a high fever (40°C) combined with diffuse necrotic papulopustules involving 90% of the body surface ( Fig. 1a,b). The patient's condition rapidly worsened with severe respiratory distress. Biological investigation revealed elevated C-reactive protein (60 mg/L, normal range 0-5 mg/ L) normocytic anaemia (haemoglobin 9.5 g/dL; normal range 13.0-18.0 g/dL) and hepatic cytolysis (transaminases and alkaline phosphatase three times the normal value, and gamma-glutamyltransferase 2fold above the normal value). Tests for infectious disease (blood tests for varicella zoster virus, herpes simplex virus, human immunodeficiency virus, hepatitis B and C viruses, human herpes virus(HHV)-6 and HHV-8, syphilis, Epstein-Barr virus, cytomegalovirus, Pneumococcus, Mycoplasma pneumoniae, bacterial and mycological cutaneous samples and blood cultures) were negative, as were screening tests for autoimmunity.Thoracic computed tomography scan showed ground-glass opacities in the upper lobes combined with perihilar cylindrical bronchodilation.Histopathology of a skin biopsy revealed a diffuse dermoepidermal lymphocyte and neutrophil infiltrate. Leucocytoclastic vasculitis was associated with necrosis of the blood vessel walls and extravasation of erythrocytes (Fig. 2).Based on the clinicopathological findings, febrile ulceronecrotic Mucha-Habermann disease (FUMHD) was suggested.Systemic steroids 1 mg/kg/day were promptly administered, but the patient's condition deteriorated with severe dyspnoea and extension of the cutaneous lesions. Chest radiography confirmed a worsened interstitial pneumonia, leading to an emergency orotracheal intubation. Intravenous immunoglobulin (IVIG) 2 g/kg (IVIG) resulted in a favourable respiratory and cutaneous response in a few days. IVIG was continued twice a month for a year, producing improvement in skin lesions (Fig. 1c) and liver function tests. After 22 months of follow-up, only hyperpigmented scars (Fig. 1d) were noted. Since then, the patient has completely stopped his cocaine use.FUMHD is considered as a rare and severe variant of pytiriasis lichenoid and varioliformis acuta (PLEVA), with a potentially life-threatening prognosis due to severe systemic visceral involvement. The pathogenesis of FUMHD is unclear. A complex immune vasculitis related to a hypersensitivity reaction towards an infectious antigen has been suspected. 1 The infiltration of CD8 lymphocytes around the epidermis and dermis, suggesting a cytotoxic attack of lymphocytes to altered epidermal antigens, could be an argument in favour of an immunological process. 2 Levamisole is an imidazothiazole drug often used as an adulterant in drugs to produce a better stimulant effect and to increase the drug weight. It has immunostimulant properties, which may result in a leucocytoclastic vasculitis. Levamisole has been reported to cause severe cutaneous vascul...