Orf is an infectious disease caused by an epitheliotrophic double stranded deoxyribonucleic acid parapoxvirus which primarily affects sheep and goats but humans can also be infected by contact with infected animals. In Muslim countries, especially after the Feast of Sacrifice, the incidence of human orf increases. Although orf infection is benign and self limiting, it can interfere with work and result in repetitive visits to the emergency. Also recently, complications including erythema multiforme (EM) and bullous pemphigoid like eruptions, papulovesicular eruptions, epidermolysis bullosa acquisita have been reported with orf. Awareness of orf infection and related possible hypersensitivity reactions by the physicians, can reduce the unnecessary use of antibiotics and visits to the emergency.
___
Coskun O, Gul CH, Bilgeturk A, et al. Human orf complicated with erythema multiforme. Int J Dermatol. 2008;47(12):1333-4.
Ozturk P, Sayar H, Karakas T, et al. Erythema multiforme as a result of orf disease. Acta Dermatovenerol Alp Pannonica Adriat. 2012;21(2):45-6.
Biazar T, Shokri M, Hosseinnia H, et al. Erythema multiforme as a result of orf disease; a case report. Emerg (Tehran). 2016;4(3):163-5.
Erbağci Z, Erbağci I, Almila Tuncel A. Rapid improvement of human orf (ecthyma contagiosum) with topical imiquimod cream: report of four complicated cases. J Dermatolog Treat. 2005;16(5):353-6.
Joseph RH, Haddad FA, Matthews AL, et al. Erythema multiforme after orf virus infection: a report of two cases and literature review. Epidemiol Infect. 2015;143(2):385-90.
Hiernickel C, Elsner P. Erythema multiforme as a complication of vaccination (occupational accident). J Dtsch Dermatol Ges. 2017;15(8):848-9.
Chan MYL, Kennedy J, Oakley A. Erythema multiforme triggered by imiquimod 5% cream. Australas J Dermatol. 2017;59(4):257-8
Siedner-Weintraub Y, Gross I, David A, et al. Paediatric erythema multiforme: epidemiological, clinical and laboratory characteristics. Acta Derm Venereol. 2017;97(4):489-92.
Zuelgaray E, Salle de Chou C, Gottlieb J, et al. Human orf complicated by epidermolysis bullosa acquisita. Br J Dermatol. 2017;24.
White KP, Zedek DC, White WL, et al. Orf-induced immunobullous disease: A distinct autoimmune blistering disorder. J Am Acad Dermatol. 2008;58(1):49-55.