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GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA
A Journal on Dermatology and Sexually Transmitted Diseases
Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,014
Giornale Italiano di Dermatologia e Venereologia 2006 August;141(4):325-35
Human orf and milker’s nodules: a clinicopathologic study of 12 cases and review of the literature
Bonamonte D., Filotico R., Angelini G.
Department of Internal Medicine Immunology and Infectious Diseases Section of Dermatology, University of Bari, Bari, Italy
Aim. The clinicomorphological and histopathological data on 9 patients with orf and 3 with milker’s nodules, observed in the last 2 decades are reported.
Methods. Eleven of the subjects were males. All the patients, aged between 26 and 70 years, referred a history of contact with sheep or cows.
Results. In most cases the lesions, single of more frequently multiple, involved the hands and forearms; only in 1 case were the legs also affected. The onset of the infection occurred after a mean of 8-9 days from exposure. From the clinical standpoint, the lesions presented with different morphological aspects (6 stages): maculo-papular, polymorpho-like, acute nodulo-exudative, nodular, papillomatous and regressive scabbed lesions. The histopathological study was performed in different clinico-morphological stages. The findings were peculiar: the epidermis presented vacuolization of superficial keratinocytes, inclusion of intracytoplasmic eosinophilic bodies, multi-lobulated vesicles and finger-like endophytic proliferations. The dermis showed marked capillary proliferation and dilation and an inflammatory infiltrate of variable density. All the patients healed spontaneously within 3-8 weeks, and suffered no complications or sequelae.
Conclusions. In our opinion, the prevalence of orf and milker’s nodules, diseases which are correlated from the etiological and mainly clinico-histopathological standpoints, is underestimated because the relatively well-defined population at risk is familiar with the two diseases and rarely seeks medical attention. Finally, it is our opinion that the histopathological picture, which is quite specific, can be sufficient to diagnose these two diseases and to make a differential diagnosis with other skin viroses, even without an etiological demonstration of the virus by electron microscopy.