Tseng HC, et al. - This study incorporated an examination of the clinicopathological characteristics and therapeutic outcomes of cutaneous protothecosis. Although rare, cutaneous protothecosis emerged as being important owing to an increased prevalence of immunocompromised individuals. Individuals were predisposed to high-risk infections due to steroid overuse or iatrogenic adrenal insufficiency and neglecting this disease would result in a chronic and incurable state. In chronic eczematous and ulcerative plaques on the limbs refractory to conventional antibacterial and antiviral treatments, protothecosis ought to be suspected, particularly in subjects with adrenal insufficiency. Clinical confirmation was yielded via skin biopsies, with successful treatment of confirmed cases being noted due to itraconazole.

Methods

• Researchers selected 20 pathology-confirmed cases of cutaneous protothecosis from 2 tertiary medical centers in Taiwan from 1997 to 2015.
• The identification was performed based on skin biopsies.

Results

• At the time of diagnosis, the age of the patients ranged from 48 to 85 years (mean age of 74 years).
• It was determined that all lesions developed on the limbs.
• Adrenal insufficiency was reported in 12 (60%) patients.
• No patients, however, presented with active malignancy at diagnosis.
• Concurrent scabies infestation was revealed in 4 (20%) patients.
• It was clinically deduced that most lesions were erythematous plaques studded with punctate ulcers.
• Microscopic examination disclosed that granulomatous inflammation was the most common finding.
• As per the results, 19 (95%) subjects were successfully treated with itraconazole for 14 to 148 days, displaying only one case of recurrence.
• In the case of pruritus being recalcitrant despite itraconazole therapy, concomitant scabies ought to be suspected.