Medicines for Orf

What it is

Orf is a skin infection caused by a virus that is spread to people from infected sheep and goats (and occasionally other animals). It is an occupational and rural infection, mainly affecting people who handle sheep or goats — such as farmers, shepherds, vets, abattoir workers, and, sometimes, others in contact with these animals (for example around lambing time, or when bottle-feeding lambs). The virus causes a similar skin condition in the animals (around the mouth and nose), and people catch it through direct contact with infected animals or contaminated materials, with the virus entering through a small break in the skin. Orf usually causes a single (sometimes a few) sore or lump on the skin, most commonly on the hands or fingers (the areas that contact the animals), though it can occur elsewhere. The lesion typically develops and changes over a few weeks: it usually starts as a small, firm, red or reddish-blue lump, which enlarges, may develop into a blister-like or weepy, crusted nodule (sometimes with a targetoid appearance), and can be sore or tender; it then gradually crusts over, dries up, and heals. There may be some swelling around it, and occasionally swollen glands nearby or a mild feverish feeling. Orf is harmless in most people and heals on its own, usually over about three to six weeks, without leaving a scar in most cases. It is not spread from person to person. Because orf usually heals by itself, treatment is generally not needed, and care mainly involves keeping the lesion clean and covered to prevent it becoming infected with bacteria and to avoid spreading the virus (for example to other parts of one’s own skin, or to the animals), and not squeezing or picking it. Occasionally, orf can be more troublesome — for example if it becomes infected with bacteria, is very large or in an awkward site, or in people with a weakened immune system (in whom it can be more severe) — in which case medical advice and treatment may be needed. Because orf can resemble other skin lesions, and given its link with animal contact, mentioning the animal exposure to a doctor helps with diagnosis if assessment is needed. The key messages are that orf is a harmless viral skin infection caught from infected sheep or goats (usually causing a sore lump on the hands), that it heals on its own over a few weeks, and that keeping it clean and covered and not picking it help.

How it is treated

Orf usually heals on its own over a few weeks and needs no specific treatment; care mainly involves keeping the lesion clean and covered and not picking it, with medical advice for troublesome cases. Because orf is caused by a virus and is self-limiting, treatment is generally not needed for the typical case, and the lesion heals by itself, usually over about three to six weeks, often without scarring. Self-care helps recovery and prevents complications: keeping the lesion clean and covered (with a dressing) helps prevent it becoming infected with bacteria and reduces the risk of spreading the virus to other parts of one’s own skin or to the animals; avoiding squeezing, picking, or bursting the lesion is important (as this can worsen it, cause bacterial infection, or spread it); and simple measures for any discomfort help. It is worth being aware that orf can resemble other skin lesions (including some that would need different management), so if there is uncertainty about the diagnosis, or if assessment is needed, seeing a GP — and mentioning the contact with sheep or goats, which helps point to the diagnosis — is worthwhile. Medical advice and treatment may be needed in certain situations: if the lesion becomes infected with bacteria (increasing pain, redness, swelling, pus, or feeling unwell), which may need antibiotics; if it is very large, in an awkward or sensitive site, or particularly troublesome; if it is not healing as expected; or in people with a weakened immune system, in whom orf can be more severe or persistent and may need specific treatment and specialist input. Preventing orf is relevant for people who handle sheep and goats: good hygiene and hand-washing after handling animals, covering any cuts or breaks in the skin, wearing gloves when handling animals (particularly around lambing or when animals may be infected), and good animal husbandry (including managing the infection in the flock) reduce the risk. The reassuring messages are that orf is a harmless, self-limiting viral skin infection that heals on its own over a few weeks (usually without scarring), that keeping the lesion clean and covered and not picking it help it heal and prevent complications and spread, and that medical advice is worthwhile for troublesome or uncertain cases or in those with a weakened immune system; so simple self-care and, where relevant, mentioning the animal contact to a doctor are the keys to managing it.