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Off-Center Fold
September 2009

Acute Onset of Erythematous Scalp Nodules in a Child—Diagnosis

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Arch Dermatol. 2009;145(9):1053-1058. doi:10.1001/archdermatol.2009.184-b

Histologic examination of the biopsy specimen demonstrated ballooning degeneration of the epidermis and prominent granulation tissue and dense inflammatory infiltrate in the dermis. In addition to abundant bacterial colonization, necrotic keratinocytes and prominent crust consisting of intracellular, eosinophilic inclusion bodies were also identified.

The orf virus, from the Parapoxvirus genus, principally causes zoonotic infections in ruminants, such as sheep, goats, and reindeer. Humans are incidentally infected through occupational or recreational exposure like herding, butchering, or petting infected animals or herd animals recently vaccinated with live unattenuated virus. Children may be at elevated risk owing to less inhibited contact behaviors with animals as well as poor adherence to personal protective measures and hand hygiene.1 Our patient's guardian reported that 1 of the family's sheep—to which the patient was exposed—had a “sore mouth” about a month before the child's initial examination.

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