Human orf virus (family Poxviridae) infection following a lamb bite in Hungary.

Human orf disease (called ecthyma contagiosum or contagious/infectious pustular dermatitis in animals) was confirmed on the fingers of both hands of a 24-year-old female, after feeding diseased lambs with a nursing bottle in April 2023. In addition to skin symptoms, she had low-grade fever (37.6°C) and swollen lymph nodes in both axilla. The presence of orf virus (genus Parapoxvirus, family Poxviridae) was confirmed, and this strain, Baja/2023/HUN (OR372161-OR372163), was found to have > 98% nucleotide sequence identity to sheep-origin orf viruses in four tested genome regions (ORF011/B2L, ORF019, ORF020/VIR, and ORF056). This is the first report of a human case of infection with the neglected zoonotic orf virus in Hungary.

Immunothrombotic Mechanisms Induced by Ingenol Mebutate Lead to Rapid Necrosis and Clearance of Anogenital Warts.

Ingenol mebutate (IM) is highly effective in the treatment of human papillomavirus (HPV)-induced anogenital warts (AGW) leading to fast ablation within hours. However, the exact mode of action is still largely unknown. We performed dermoscopy, in vivo confocal microscopy (CLM), histology, immunohistochemistry, and immunofluorescence to gain insights in mechanisms of IM treatment in AGW. In addition, we used in vitro assays (ELISA, HPV-transfection models) to further investigate in vivo findings. IM treatment leads to a strong recruitment of neutrophils with thrombosis of small skin vessels within 8 h, in a sense of immunothrombosis. In vivo and in vitro analyses showed that IM supports a prothrombotic environment by endothelial cell activation and von Willebrand factor (VWF) secretion, in addition to induction of neutrophil extracellular traps (NETosis). IM superinduces CXCL8/IL-8 expression in HPV-E6/E7 transfected HaCaT cells when compared to non-infected keratinocytes. Rapid ablation of warts after IM treatment can be well explained by the observed immunothrombosis. This new mechanism has so far only been observed in HPV-induced lesions and is completely different from the mechanisms we see in the treatment of transformed keratinocytes in actinic keratosis. Our initial findings indicate an HPV-specific effect, which could be also of interest for the treatment of other HPV-induced lesions. Larger studies are now needed to further investigate the potential of IM in different HPV tumors.

[Dermoscopy of inflammatory skin diseases]. / Dermatoskopie entzündlicher Hauterkrankungen.

The dermoscope was initially used in dermatology to distinguish between pigmented and nonpigmented tumors, both benign and malignant. Over the last two decades, however, the spectrum of dermoscopy has broadened and its role in the diagnosis of nonneoplastic diseases, in particular inflammatory skin diseases, has become increasingly important. In the diagnosis of general and inflammatory skin diseases, it is recommended that dermoscopic evaluation should be performed after clinical examination. In the following summary, the dermoscopic features of the most common inflammatory skin diseases are described. Among the detailed parameters are the vascular structures, color, scaling, follicular findings, and specific signs associated with each disease.

Congenital ichthyosis associated with Trichophyton rubrum tinea, imitating drug hypersensitivity reaction.

Tinea corporis and congenital ichthyoses are common dermatological diseases. The association of the two disorders is plausible due to the immunological and barrier defects of ichthyoses; however, relatively limited literature is available in this field. Since superficial fungal infections possess atypical morphology in keratinization disorders, and could imitate other dermatological conditions, the correct diagnosis can be challenging. We present the case of a 54-year-old woman with ichthyosis, who was initially treated for drug-hypersensitivity reaction.