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

Abstract

Orf is a zoonosis caused by an epitheliotropic DNA parapox virus. Human orf is a generally benign, self-limiting condition that usually regresses in 6-8 weeks without specific treatment. However, it may be accompanied by local symptoms including pain, pruritus, lymphangitis and axillary adenitis, or less frequently by systemic symptoms such as fever or malaise. Furthermore, it may be complicated by erythema multiforme, Stevens-Johnson syndrome, erysipelas, generalized mucocutaneous eruption, toxic erythema, eyelid oedema and giant, persistent or recurrent lesions in immunocompromised patients. Imiquimod, a potent topical immune response modifier, enhances both the innate and acquired immunity by stimulation of immune system cells resulting in local antiviral, antitumour and immunoregulatory activity. We present, for the first time, four complicated cases of orf successfully treated by topical imiquimod resulting in rapid regression of both orf and associated lesions. Two of the cases were complicated with erythema multiforme, one with recurrent eyelid oedema, and another had giant orf associated with axillary lymphadenitis. We suggest that topical imiquimod may be an effective and safe therapy for complicated orf cases.

Erythema multiforme after orf virus infection: a report of two cases and literature review

“…In two patients with EM who failed to respond to corticosteroid and antihistamine treatment, the primary orf lesion and EM rapidly resolved after topical treatment of the orf lesion with the immunomodulatory drug imiquimod [16].…”

“…EM) are most frequently reported in association with orf [9]. A search of the scientific literature using the terms orf or contagious pustular dermatitis and erythema multiforme or hypersensitivity found 10 case reports [10][11][12][13][14][15][16][17][18] and about 30 instances of EM identified in epidemiological [4,[19][20][21] and immunological [22] studies of human orf infections. Among patients receiving a diagnosis of orf, an estimated 7-18% experience EM [19][20][21].…”

Nosocomial outbreak of disseminated orf infection in a burn unit, Gaziantep, Turkey, October to December 2012

“…The incubation period is three to seven days [1]. In Turkey, sporadic or small clusters of zoonotic cases have been described previously [2,3]. Human infection typically is acquired through animal contacts during occupational activities [4], or following the Islamic feast of the sacrifice (eid el adha) in Islamic communities [2,[5][6][7].…”

Facial Orf

“…Enfeksiyona bölgesel lenfadenopati, lenfanjit ve ateş eşlik edebilir. Karşılaşılabilecek komplikasyonlar eritema multiforme, deri ve mukozaların papüloveziküler döküntüsü, lentiküler ya da makülopapüler tipte döküntüler ve lenfanjittir (9)(10)(11)(12)(13)(14). Literatürde orf sonrası gelişen müköz membran pemfigoidi ve büllöz pemfigoid olguları da bildirilmiştir (15,16).…”