{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:12:40Z","timestamp":1787015560433,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,2,12]],"date-time":"2018-02-12T00:00:00Z","timestamp":1518393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Taiwan Ministry of Science and Technology","doi-asserted-by":"crossref","award":["MOST 104-2314-B-182A-079-MY3"],"award-info":[{"award-number":["MOST 104-2314-B-182A-079-MY3"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Chang Gung Memorial Research Foundation","award":["CMRPG8D1542 and CORPG8F0022"],"award-info":[{"award-number":["CMRPG8D1542 and CORPG8F0022"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to evaluate the clinicopathological features and treatment outcomes of cutaneous protothecosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively identified 20 pathology\u2010confirmed cases of cutaneous protothecosis based on skin biopsies in two tertiary medical centres in Taiwan from 1997 to 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The age of the patients at the time of diagnosis ranged from 48 to 85\u00a0years (mean age of 74\u00a0years). 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\u2013148\u00a0days with only one case of recurrence. Concomitant scabies should be suspected if pruritus is recalcitrant despite itraconazole treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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\u2010risk 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jdv.14804","type":"journal-article","created":{"date-parts":[[2018,1,22]],"date-time":"2018-01-22T10:25:34Z","timestamp":1516616734000},"page":"1575-1583","source":"Crossref","is-referenced-by-count":11,"title":["Clinicopathological features and course of cutaneous protothecosis"],"prefix":"10.1111","volume":"32","author":[{"given":"H.\u2010C.","family":"Tseng","sequence":"first","affiliation":[{"name":"Department of Dermatology Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan"},{"name":"Department of Cosmetic Applications and Management Yuh Ying Junior College of Healthcare and Management Kaohsiung Taiwan"},{"name":"College of Medicine Chang Gung University Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.\u2010B.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Dermatology Chang Gung Memorial Hospitals Linkou Taipei, and Keelung Taiwan"},{"name":"College of Medicine Chang Gung University Taoyuan Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences College of Medicine Chang Gung University Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.\u2010C.","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Dermatology Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan"},{"name":"College of Medicine Chang Gung University Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.\u2010W.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Dermatology Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan"},{"name":"College of Medicine Chang Gung University Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.\u2010W.","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Dermatology Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan"},{"name":"College of Medicine Chang Gung University Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.\u2010L.","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Dermatology Chang Gung Memorial Hospitals Linkou Taipei, and Keelung Taiwan"},{"name":"College of Medicine Chang Gung University Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.\u2010H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Dermatology Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan"},{"name":"College of Medicine Chang Gung University Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0733-8635(02)00089-X"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/13695780310001653653"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clindermatol.2011.09.016"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00032-06"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/13693780903188698"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-009-0251-6"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0487-x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0691.2003.00600.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajd.12153"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-011-9480-0"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.2310\/7750.2009.08040"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.10.4907-4908.2004"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2012.06.015"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/0035-9203(64)90094-X"},{"key":"e_1_2_7_16_1","first-page":"737","article-title":"Cutaneous protothecosis. 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