September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 34 year old man presented with a painful lesion on his left hand, this had arisen over a few days. The patient felt otherwise well.
There was no other relevant personal or family history of skin problems.
The patient had no other health issues and took no medications.
He had just returned from a family holiday where he stayed on a farm.
A solitary, tender lesion, with a crusted centre, a white mid-zone, and a red periphery.
What is the diagnosis?
The diagnosis is Orf.
Orf is a parapox viral infection of the skin contracted from sheep, especially lambs, and goats. It can be transmitted to humans by direct inoculation from an infected animal or carcass. In this case the patient had been bottle-feeding an infected lamb, unknown to the farmer.
Orf lesions are generally solitary or few in number. They occur most commonly on the fingers, especially the dorsum of the index finger, hands or forearms but can appear on the face.
After an incubation period of 5 or 6 days a small, firm, red or red-blue papule enlarges to form a target-like nodule with a red centre, a white middle and a red periphery. The lesion then begins to weep and crust, which is followed by the development of black dots and small papilloma's on the surface. The crust becomes thickened and then falls off. The fully developed lesion is usually 2-3 cm in diameter but may be as large as 5 cm.
Orf is usually self-limiting and no specific treatment is necessary. In most cases orf usually clears within six weeks, with lifelong immunity after the infection.
For more information refer to the chapter on Orf.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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