Milking knot

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,

• Locally drying and antiseptic, e.g.:

• Iodine povidone solution
  • Application: Leave to act for 2-3 min.
  • KI: Hyperthyroidism, Duhring's disease, in the context of radioiodine therapy
    According to the product information, pregnancy and breastfeeding are also contraindications. In our assessment, use is also well justified here.

• Soothing the fingers

1. Adriano AR, Quiroz CD, Acosta ML, Jeunon T, Bonini F. Milker's nodule--Case report. An Bras Dermatol 2015;90:407-10.
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.