Journal of the European Academy of Dermatology and Venereology

Original Article

Clinicopathological features and course of cutaneous protothecosis

H.-C. Tseng

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Department of Cosmetic Applications and Management, Yuh Ying Junior College of Healthcare and Management, Kaohsiung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

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C.-B. Chen,

C.-B. Chen

Department of Dermatology, Chang Gung Memorial Hospitals, Linkou, Taipei, and Keelung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

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J.-C. Ho,

J.-C. Ho

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

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Y.-W. Cheng,

Y.-W. Cheng

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

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H.-W. Huang,

H.-W. Huang

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

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P.-L. Sun,

P.-L. Sun

Department of Dermatology, Chang Gung Memorial Hospitals, Linkou, Taipei, and Keelung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

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C.-H. Lee,

Corresponding Author

C.-H. Lee

[email protected]

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

Correspondence: C.-H. Lee. E-mail: [email protected]Search for more papers by this author

H.-C. Tseng,

H.-C. Tseng

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Department of Cosmetic Applications and Management, Yuh Ying Junior College of Healthcare and Management, Kaohsiung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

C.-B. Chen,

C.-B. Chen

Department of Dermatology, Chang Gung Memorial Hospitals, Linkou, Taipei, and Keelung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

J.-C. Ho,

J.-C. Ho

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

Y.-W. Cheng,

Y.-W. Cheng

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

H.-W. Huang,

H.-W. Huang

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

P.-L. Sun,

P.-L. Sun

Department of Dermatology, Chang Gung Memorial Hospitals, Linkou, Taipei, and Keelung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

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C.-H. Lee,

Corresponding Author

C.-H. Lee

[email protected]

Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

College of Medicine, Chang Gung University, Taoyuan, Taiwan

Correspondence: C.-H. Lee. E-mail: [email protected]Search for more papers by this author

First published: 22 January 2018

https://doi.org/10.1111/jdv.14804

Citations: 10

Conflicts of interest

The authors declare no conflict of interests.

Funding source

This study was supported by Taiwan Ministry of Science and Technology (MOST 104-2314-B-182A-079-MY3) and Chang Gung Memorial Research Foundation (CMRPG8D1542 and CORPG8F0022).

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Abstract

Background

Protothecosis is an uncommon infection caused by the achlorophyllic algae found more commonly in tropical areas. Only a limited number of cases have been reported.

Objective

We aimed to evaluate the clinicopathological features and treatment outcomes of cutaneous protothecosis.

Methods

We retrospectively identified 20 pathology-confirmed cases of cutaneous protothecosis based on skin biopsies in two tertiary medical centres in Taiwan from 1997 to 2015.

Results

The age of the patients at the time of diagnosis ranged from 48 to 85 years (mean age of 74 years). All lesions developed on the limbs. Twelve (60%) patients had adrenal insufficiency, but no patients had active malignancy at diagnosis. Interestingly, four (20%) patients had concurrent scabies infestation. Clinically, most lesions were erythematous plaques studded with punctate ulcers. Microscopically, the most common finding was granulomatous inflammation. Nineteen (95%) cases were successfully treated with itraconazole for 14–148 days with only one case of recurrence. Concomitant scabies should be suspected if pruritus is recalcitrant despite itraconazole treatment.

Conclusion

Despite its rarity, cutaneous protothecosis has become more significant due to an increased prevalence of immunocompromised individuals. Steroid overuse or iatrogenic adrenal insufficiency predisposes individuals to high-risk infections. Neglecting the disease leads to a chronic and incurable state. Protothecosis should be suspected in chronic eczematous and ulcerative plaques on the limbs refractory to conventional antibacterial and antiviral treatments, especially in patients with adrenal insufficiency. Clinical suspicion should be confirmed by skin biopsies, and confirmed cases can be successfully treated with itraconazole.

Abstract

Linked article: This article is commented on by H. Schöfer, pp. 1401–1402 in this issue. To view this article visit https://doi.org/10.1111/jdv.15202

Supporting Information

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Citing Literature

Volume32, Issue9

September 2018

Pages 1575-1583

Filename	Description
jdv14804-sup-0001-FigS1.tiffTIFF image, 17.2 MB	Figure S1. The clinical manifestation of cutaneous protothecosis typically includes a large erythematous plaque studded with surrounding pustules and punctate ulcers (right forearm, patient #9).
jdv14804-sup-0002-FigS2.tifTIFF image, 14.7 MB	Figure S2. (a, b) The discrete erythematous papules and scabies nodules distributed on the trunk and limbs, especially on the intertriginous and inguinal areas. (c, d) show typical presentations of protothecosis (a large erythematous plaque studded with surrounding pustules and punctate ulcers, forearm, patient #11).

Clinicopathological features and course of cutaneous protothecosis

Abstract

Background

Objective

Methods

Results

Conclusion

Abstract

Supporting Information

References

Citing Literature

References

Information

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Clinicopathological features and course of cutaneous protothecosis

Abstract

Background

Objective

Methods

Results

Conclusion

Abstract

Supporting Information

References

Citing Literature

References

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