Milking knot

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 1E7Y

Jenner, 1798

Paravakine nodules, milking pox.

Rare zoonosis of low infectivity caused by parapoxviruses.

  • Incubation period: 5-7 days
  • occurring in contact with cow's udders
  • Mostly only the hands are affected

Hemispherical, pea-sized, plump, yellowish-brown nodules with a blue-blackish crest. Locoregional lymphadenopathy.

  • Anamnesis
  • Clinical
  • Dermatopathology
  • Electron microscopy (negative contrast)
  • Culture

Vascular epidermal granulation tissue with ballooned cells, multilocular vesicles,

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  2.  Batalla A, Alvarez-Arguelles ME, Gonzalez-Martinez MB, Curto JR. [Milker's nodule complicated with erythema multiforme]. Med Clin (Barc) 2013;141:e5. 
  3. Henriques AM, Fagulha T, Duarte M, et al. Avian Poxvirus Infection in a Flamingo (Phoenicopterus Ruber) of the Lisbon Zoo. J Zoo Wildl Med 2016;47:161-74. 
  4. Osadebe LU, Manthiram K, McCollum AM, et al. Novel poxvirus infection in 2 patients from the United States. Clin Infect Dis 2015;60:195-202. 
  5. Novel poxvirus discovered in sea otters. J Am Vet Med Assoc 2014;245:265. 
  6. Werchniak AE, Herfort OP, Farrell TJ, Connolly KS, Baughman RD. Milker's nodule in a healthy young woman. Journal of the American Academy of Dermatology 2003;49:910-1.