Dermatology online journal最新文献

ChatGPT is a publicly available chatbot released by OpenAI. Its usefulness in responding to medical questions has been assessed in several specialties, but there is limited literature in dermatology. This study seeks to understand how well ChatGPT4 can provide accurate diagnoses and appropriate workup suggestions for clinical vignettes describing common dermatologic conditions. Ten vignettes were input into ChatGPT4 representing presentations of common dermatologic conditions, written from the perspective of a physician not board-certified in dermatology. ChatGPT4 was asked to identify the top five most likely diagnoses and its recommended workup for each vignette. Responses were assessed quantitatively by calculating the percentage of correct diagnoses, with accurate diagnoses defined by three board-certified dermatologists, and qualitatively using Likert scales describing the accuracy of diagnoses and appropriateness of workups scored by eleven board-certified dermatologists. Overall, 52% of ChatGPT4's diagnoses were accurate and 62% of its recommended workup suggestions were deemed completely correct by board-certified dermatologists. ChatGPT4 was better at recommending an appropriate workup than identifying accurate diagnoses across vignettes. ChatGPT4 was able to accurately diagnose and workup common dermatologic conditions in slightly more than half of cases. ChatGPT4 was better at determining an appropriate workup than an accurate diagnosis.Keywords: artificial intelligence, ChatGPT, dermatology, diagnosis, OpenAI, workup.

Macular amyloidosis is a variant of primary localized cutaneous amyloidosis in which amyloid protein is believed to be derived from keratinocytes. The care of this variant generally focuses on addressing the associated symptoms without the need to assess for underlying disease. However, an increasing number of cases of primary localized cutaneous amyloidosis have been reported in association with systemic diseases, particularly autoimmune diseases. A few cases of biphasic primary localized cutaneous amyloidosis have been reported in association with chronic hepatitis C infection. Herein, we report an unusual patient, a 38-year-old man with widespread macular amyloidosis concurrently presenting with dual hepatitis B virus and hepatitis C virus infections. Collecting similar cases can further validate this uncommon association.

Bullous pemphigoid is an autoimmune blistering disease that is characterized by pruritus, cutaneous urticarial plaques, and tense bullae, with mucosal involvement. On histopathology, a subepidermal blister is predominantly evident with eosinophilic inflammatory infiltrates in the upper dermis. In a few bullous dermatoses, milia can manifest at the scar of blistering lesions or in non-lesional skin. Milia are classically associated with epidermolysis bullosa acquisita, porphyria cutanea tarda, and mucous membrane pemphigoid. We report a case of bullous pemphigoid with milia manifesting within healing blistering lesions.

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, although it has many clinicopathological variants. Zosteriform MF is an extremely rare variant characterized by dermatomal distribution. To date, only six patients with zosteriform MF have been reported. We report a 57-year-old man with tumor-stage zosteriform MF localized on the left T4, T7-8, and bilateral L4 dermatomes for seven years after the first visit. Local skin-target therapy radiotherapy effectively led to complete remission, which was maintained with a combination of oral etretinate (30mg/day) and narrow-band ultraviolet B phototherapy. No other reports exist of zosteriform MF occurring in multiple dermatomes. We reviewed the literature to add to our understanding of the nature of rare variants of MF and discuss therapeutic options for zosteriform MF.

Leflunomide can be used in management of psoriatic disease. Leflunomide's active metabolite, teriflunomide, is used in the treatment of multiple sclerosis and has unexpectedly been rarely reported to induce pustular psoriasis. In this report, we present a patient with multiple sclerosis who developed inverse psoriasis after starting teriflunomide.

Dogs are susceptible to a diverse spectrum of dermatologic conditions, several of these skin disorders are analogous to dermatologic conditions occurring in humans. Pool toes appears on the plantar surface of the feet and toes; it is an aquatic pool-associated frictional dermatosis that results from repeated rubbing of the feet and toes against the rough cement at the bottom of the pool or its border. A frictional dermatosis that can develop on the uncalloused paw pads of puppies, resulting from repeated rubbing of the paws against ambient temperature, not heated, paved road is pavement paws. Neither pool toes nor pavement paws result from contact with a hot surface; these dermatoses are distinctive from beach feet, a thermal-associated superficial burn to the skin resulting from the hot temperature of the sand that contacts that the plantar feet and toes. In conclusion, similar to pool toes, the pathogenesis of pavement paws is a frictional dermatosis that can develop on the uncallused paw pads of puppies resulting from repeated rubbing of the paws against ambient temperature, not heated, pavement.

Fibroelastolytic papulosis (FEP) is an acquired cutaneous disorder of elastin that encompasses both white fibrous papulosis of the neck (WFPN) and pseudoxanthoma elasticum (PXE)-like papillary dermal elastolysis (PDE). Although FEP is a benign acquired disorder, it shares overlapping clinical features with pseudoxanthoma elasticum (PXE), a genetic disorder with systemic manifestations. We report two cases of FEP, including the WFPN and PXE-like PDE variants, in elderly women. In one case, a woman in her 70s with hyperlipidemia and chronic kidney disease presented with white-to-yellow, smooth, monomorphic papules coalescing into plaques on the posterior neck and bilateral antecubital fossa. A punch biopsy and elastic stain revealed a loss of elastic fibers in the papillary dermis. Based on these findings, we diagnosed our patient with PXE-like PDE. In another case, a woman in her 60s with no significant medical history similarly presented with skin-colored, smooth monomorphic papules on the posterior and anterior neck. A punch biopsy was also performed and an elastic stain showed a loss of elastic fibers in the papillary dermis, confirming the diagnosis of WFPN. Although rare, FEP is an important entity for dermatologists to recognize and differentiate from PXE given the potential for systemic complications in PXE.