Clinical and Experimental Dermatology最新文献

Background: ChatGPT is an open-access chatbot developed using artificial intelligence (AI) that generates human-like responses.

Objective: To evaluate the ChatGPT-4's concordance with three dermatological surgeons on reconstructions for dermatological surgical defects.

Methods: The cases of 70 patients with nonmelanoma skin cancer treated with surgery were obtained from clinical records for analysis. A list of 30 reconstruction options was designed by the main authors that included primary closure, secondary skin closure, skin flaps and skin grafts. Three dermatological surgeons who were blinded to the real reconstruction, along with ChatGPT-4, were asked to select two reconstruction options from the list.

Results: Seventy responses were analysed using Cohen's kappa, looking for concordance between each dermatologist and ChatGPT. The level of agreement among dermatological surgeons was higher compared with that between dermatological surgeons and ChatGPT, highlighting differences in decision making. In the selection of the best reconstruction technique, the results indicated a fair level of agreement among the dermatologists, ranging between κ 0.268 and 0.331. However, the concordance between ChatGPT-4 and the dermatologists was slight, with κ values ranging from 0.107 to 0.121. In the analysis of the second-choice options, the dermatologists showed only slight agreement. In contrast, the level of concordance between ChatGPT-4 and the dermatologists was below chance.

Conclusions: As anticipated, this study reveals variability in medical decisions between dermatological surgeons and ChatGPT. Although these tools offer exciting possibilities for the future, it is vital to acknowledge the risk of inadvertently relying on noncertified AI for medical advice.

Psoriasis is a common inflammatory skin condition with an estimated prevalence of 1.5% in the UK. Its management has evolved rapidly over the past 15 years as our understanding of its pathogenesis has progressed. Treatment initiation often overlaps with peak reproductive years, posing specific therapeutic challenges for individuals hoping to conceive. Certain systemic agents are well established to be teratogenic during pregnancy, such as methotrexate and acitretin, but data on newer drug classes for psoriasis remain limited. This literature review evaluated recent data on the systemic agents for psoriasis, explicitly considering the context of male and female fertility, pregnancy and breastfeeding. Our goal was to equip clinicians with an accessible, concise summary of up-to-date evidence to help them educate patients and facilitate informed, shared decision-making aligned with their reproductive health.

We report the cases of 10 patients with oral squamous cell carcinoma (SCC) post-haematopoietic stem cell transplant (HSCT). Median latency from HSCT to oral SCC diagnosis was 10 years (range: 4-17 years), with 90% (9/10) reporting a history of chronic graft-versus-host disease (cGVHD) and 40% (4/10) exhibiting active severe manifestations of oral GvHD. Clinical findings at diagnosis included induration, ulceration, tenderness, bleeding, hyperkeratosis, speckling and lymphadenopathy. The tongue and buccal mucosa were the most common sites affected. The disease stage at presentation ranged from T1N0M0 to T4N2M0. Management included surgical resection in 90% (9/10) of patients with or without chemotherapy and/or radiotherapy. The median follow-up for the cohort was 1 year, with a 50% (5/10) mortality rate. SCC-specific mortality was 30% (3/10). Our data highlight the importance of regular, active oral and cutaneous surveillance of patients post-HSCT in specialized dermatology clinics, irrespective of GvHD severity and length of iatrogenic immunosuppression.

Basal cell carcinomas (BCCs) are slow growing keratinocyte tumours with limited literature reporting the natural history of untreated BCCs. This study evaluated the natural progression and patient outcomes of BCCs whilst awaiting surgical intervention. Only patients with histologically proven BCCs were included in the data collection. Retrospective data analysis was performed on 55 patients (total of 70 lesions) and showed a statistically significant correlation between average growth of BCCs and time waiting for a procedure. Twenty percent of the cases had a larger procedure than originally planned at the time of booking. The top three symptoms reported include itching (39.4%), crusting (36.4%) and bleeding (30.3%). In conclusion, we reported a positive relationship between BCC growth and length of time from initial presentation to surgical treatment where patients often ended up with more symptoms, larger and complex surgical procedure than originally planned especially on the head and neck.

Background: Seeking health information online has drastically increased. Isotretinoin is one of the agents used to treat acne.

Objectives: In this study, we aimed to investigate the reliability and quality of YouTube videos related to acne treatment. There is a misconception that use of isotretinoin increases risk of suicide.

Methods: We used the terms 'isotretinoin suicide' and 'acne treatment suicide' to search YouTube videos. Videos that were not in English, were irrelevant, or were devoid of audio were not included. The information in the videos was primarily categorized as 'reliable' or 'unreliable' based on its scientific validation. DISCERN and the Global Quality Score were used to evaluate the videos' overall quality.

Results: In total, 200 videos were examined and 112 videos were included in the study. Of these, 39 videos (34.8%) were found to be reliable, and 73 videos (65.2%) were found to be unreliable. The DISCERN values of videos uploaded by physicians or professional organizations, and health information websites were found to be significantly higher. There were statistically significant negative correlations between DISCERN score and both video length and the length of time the video was on YouTube, while a positive correlation was observed between DISCERN score and the number of subscribers.

Conclusions: Although videos created by dermatologists have become widespread in recent years, they are still insufficient. Patient experience videos mostly contain information that does not reflect reality, and they emphasize that isotretinoin increases the risk of suicide without evidence. As the number of dermatologists posting videos on YouTube increases, the chances of people accessing correct information will increase.