History: There is a popular meal in Iraq called PACHA which is simply a cooked sheep's head. Housewives or butchers during cleaning, preparing and cooking PACHA, they come in contact with the causative pox virus, so few days later they develop orf or as a one famous dermatologist in Iraq used to call it as PACHA DISEASE. This lady presented one week after contact with the sheep's head with multiple painful papulo-pustules with central necrosis superimposed on an erythematous base involving the fingers of both hands..