Dermatology最新文献

Introduction: Artificial intelligence (AI) can potentially assist in triaging suspicious skin lesions as malignant or benign. General-purpose multimodal large language models (LLMs), such as GPT-4o, have not been rigorously evaluated for this task. This study assessed GPT-4o's ability to triage skin lesions and compared its performance to specialised neural networks.

Methods: We evaluated GPT-4o using 1000 random cases from the PAD-UFES-20 dataset with 50 repeated trials. GPT-4o was tested using clinical data-only, image-only, and multimodal inputs. GPT-4o's performance, consistency, and fairness across different demographic subgroups was evaluated. Its performance metrics were compared against specialised unimodal and multimodal neural networks trained on a separate subset of the PAD-UFES-20 dataset.

Results: GPT-4o exhibited poor diagnostic performance across all modalities, with average balanced accuracies of 0.571, 0.602, and 0.622 for clinical data, image, and multimodal inputs, respectively. Sensitivity was consistently high (>0.95) with the tradeoff of very low specificity. Mean agreement rates were high (>0.90), however Fleiss' κ indicated only moderate consistency due to a strong bias toward malignant classifications. Fairness evaluations showed poorer discriminative performance in younger patients compared to middle-aged and elderly patients, but no notable differences between different sex and skin tone subgroups. Specialised neural networks significantly outperformed GPT-4o on most pairwise comparisons. Multimodal inputs significantly improved GPT-4o performance over unimodal inputs.

Conclusion: Although GPT-4o consistently triaged skin lesions with high sensitivity, its very low specificity limits clinical utility. Thus, general-purpose LLMs like GPT-4o are currently unsuitable for clinical dermatological diagnostics without significant field-specific developments and validation.

Introduction: The differences in all-cause and cause-specific mortality among patients with generalized pustular psoriasis (GPP), palmoplantar pustulosis (PPP), and psoriasis vulgaris (PV) are not well understood. The aim of our study was to compare all-cause and cause-specific mortality in patients with GPP, PPP, and PV.

Methods: We conducted a nationwide, retrospective cohort study using data from the Korean National Health Insurance Service and National Death Registry between 2002 and 2022. Patients with GPP, PPP, and PV aged ≥18 years were identified based on ≥3 visits with principal diagnosis codes. Baseline characteristics, including demographics, general health data, socioeconomic status, and comorbidity profiles, were balanced using inverse probability weighting. Participants were followed-up from the index date until the occurrence of death, emigration, or the end of the observation period to investigate all-cause and cause-specific mortality.

Results: Multivariate regression analysis showed that patients with GPP had significantly higher all-cause mortality than those with PV (adjusted hazard ratio [aHR], 1.23; 95% confidence interval [CI], 1.20-1.25), while patients with PPP had lower all-cause mortality (aHR, 0.89; 95% CI, 0.87-0.91). GPP was associated with higher cause-specific mortality, particularly from hematologic (aHR, 1.76; 95% CI, 1.27-2.44) and respiratory diseases (aHR, 1.37; 95% CI, 1.30-1.46), whereas PPP patients had lower mortality from gastrointestinal (aHR, 0.57; 95% CI, 0.52-0.63) and infectious diseases (aHR, 0.71; 95% CI, 0.63-0.80). Subgroup and sensitivity analyses confirmed these findings.

Conclusions: GPP is associated with higher all-cause and cause-specific mortality than PV, while PPP is linked to lower mortality, indicating potential epidemiological and biological differences among these subtypes.

Background: Children with atopic dermatitis (AD) appear to have higher skin permeation, which may increase the risk of systemic adverse events following administration of potent topical corticosteroids, such as clobetasol propionate (CP). However, the assessment of dermal absorption in a controlled clinical trial in children is not feasible. Using model-based approaches, this study aimed to characterise stratum corneum (SC) and systemic exposure to CP following topical application of the cream formulation, and to investigate its effects on circulating cortisol levels and growth velocity in children with AD.

Methods: Physiologically-based pharmacokinetic (PBPK) and pharmacokinetic-pharmacodynamic (PKPD) modelling were utilised to describe the dermal absorption of CP in a virtual cohort of paediatric patients (1 - < 18 years old). Based on a skin impairment model for lesional and non-lesional skin, CP concentrations in the SC and in plasma were described over time. Simulation scenarios were then implemented to evaluate the effect of varying treatment conditions on the systemic exposure to CP, cortisol levels and growth velocity. Subsequently, clinical case scenarios were simulated to illustrate typical cases of AD in the paediatric population.

Results: Surface area had the largest impact on the local and systemic concentrations of CP, while body site and age had a minor effect. When comparing similar surface areas and site of application, the dose, dosing regimen (o.d. vs. b.i.d.) and occlusion had no clinically relevant effect on the local and systemic exposure. Assuming a uniform application (1.2 mg/cm2), CP cream can be applied on up to 20% of the body surface area in children with AD over a period of 2 weeks. The short-term use of CP cream had no effect on the growth velocity of children with AD.

Discussion: Surface area affected by AD should be considered when assessing the risk of systemic side effects. CP can be applied up to 20% of the BSA of a child (> 1 year old) without clinically relevant changes to circulating cortisol levels. In contrast to the systemic effects of oral corticosteroids, the short-term use of CP has no impact the growth velocity of paediatric subjects with AD.

Introduction: Generalized pustular psoriasis (GPP) and pyoderma gangrenosum (PG) are rare, severe neutrophilic dermatoses with overlapping autoinflammatory pathways. Although case reports suggest a link between GPP and PG, no populationbased studies have quantified this risk.

Methods: We performed a retrospective cohort study using the TriNetX federated electronic health record network. Adults (≥18 years) with ICD10 codes for GPP (L40.1) or nonGPP psoriasis (L40.0-L40.9 excluding L40.1) from 2018-2023 were identified. Controls had no psoriasis diagnosis. Cohorts were 1:1 propensityscore matched for age, sex, race, ulcerative colitis, Crohn's disease, systemic lupus erythematosus, and rheumatoid arthritis. The primary outcome was new PG diagnosis (L88) postindex. Hazard ratios (HRs) for PG were estimated via matched survival analysis.

Results: After matching, the GPP cohort (n = 44,187) had a significantly higher risk of PG than controls (n = 44,187; HR 5.14; 95% CI 2.77-9.53). NonGPP psoriasis patients (n = 393,833) also showed elevated PG risk versus controls (n = 393,833; HR 3.83; 95% CI 3.00-4.90). In direct comparison (n = 193,208 each), GPP had greater PG risk than nonGPP psoriasis (HR 2.33; 95% CI 1.46-3.71). Median followup ranged from 687 to 886 days across comparisons.

Conclusion: This first populationbased evidence demonstrates that GPP confers a markedly increased risk of PG compared to both controls and other psoriasis subtypes. These findings underscore the need for heightened clinical vigilance for PG in GPP patients and may inform targeted surveillance strategies.

Introduction: Autoimmune blistering diseases (AIBDs) are severe, life-threatening conditions known for their debilitating physical and psychological impacts. The conditions also have a high rate of recurrence, leading to patient distress. This study adapted and validated a widely-used measure, the Fear of Cancer Recurrence Inventory - Short Form, for use with patients with AIBDs.

Methods: Adult volunteers (n=219) with AIBD completed an anonymous online questionnaire battery. In addition to the Fear of Blistering Disease Recurrence Inventory - Short Form (FBDRI-SF), participants provided demographic and disease course information and completed the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4).

Results: The FBDRI-SF demonstrated excellent psychometric properties. Scores on the FBDRI-SF were associated with disease course, depression, and anxiety, suggesting that it a valid indicator of clinically significant psychological distress.

Conclusion: The FBDRI-SF is a brief and useful screen to identify AIBD patients likely to benefit from psychological evaluation and support.

Introduction: Pyoderma Gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful, rapidly progressive ulcerations, often associated with systemic inflammatory diseases. Despite advancements in diagnostic criteria, PG remains a diagnostic challenge, and recent increases in reported cases may reflect improved recognition rather than true incidence. This study evaluates epidemiological trends in PG diagnosis in Italy (2013-2024) across four dermatology centers (Bologna, Milano, Pisa, Torino) to determine whether increased number of diagnoses are due to refined diagnostic methodologies or external immunological factors.

Methods: A cross-sectional analysis was conducted using anonymized data from four major dermatology centers in Italy. Data analysis deployed one-way ANOVA and Poisson regression models to assess temporal trends in PG diagnoses. Significance was set at α = 0.05.

Results: Between 2013 and 2024, 213 PG cases were diagnosed across four Italian referral centers, with a female predominance (126 vs. 87). Diagnostic rates showed marked annual variability, including a 150% rise in 2015, a 68.8% drop in 2020, and a 360% rebound in 2021. Diagnoses more than doubled after 2018 (68 vs. 145; p<0.05). Trends varied by center: Bologna (+0.25/year, p=0.003) and Milano (+0.09/year, p=0.03) showed significant increases; Pisa and Torino did not. Overall, the rise in diagnoses post-2018 aligns with the broader adoption of standardized diagnostic criteria.

Conclusion: The increase in PG diagnoses recorded since 2018 is more plausibly explained by improved clinical recognition and widespread adoption of structured diagnostic frameworks than by a true rise in incidence. Regional variability and limitations of retrospective data caution against firm epidemiological conclusions. Prospective multicenter studies and standardized registries are needed to validate diagnostic tools, reduce misclassification, and clarify the true burden of PG.

Background: Assessing the risk of incontinence-associated dermatitis (IAD) in clinical settings can be subjective, which makes early detection difficult. We aim to verify the ability of skin barrier monitoring technology (SBMT) in predicting IAD.

Methods: This was a cohort study. Using a convenience sampling method, 330 patients who were admitted to adult intensive care units were included in the study and were monitored for 7 days. The risk of IAD was assessed with the perineal assessment tool (PAT), and skin barrier indicators (SBIs) of the perianal area were measured with a skin barrier instrument once a day.

Results: Skin barrier monitoring technology was better at predicting early incontinence-associated dermatitis than the perineal assessment tool. Relative transepidermal water loss (R-TEWL) was positively correlated with the risk of IAD. Based on the optimal cut-off value for R-TEWL (47.5 g/m2h), the Kaplan-Meier survival curve showed that the incidence of IAD in the high-risk group was 9.701-fold higher than that in the low-risk group (hazard ratio: 9.701, 95% confidence interval: 4.560-20.640; P < 0.001).

Conclusion: Skin barrier monitoring technology can objectively and accurately predict incontinence-associated dermatitis.

Background: Vitiligo is a condition characterized by the loss of pigmentation in certain areas of the body. It occurs when pigment-producing cells, called melanocytes, die or stop producing melanin, the pigment responsible for skin color. This loss of pigmentation can affect any part of the body, including the lips, hair, and eyes. In the eyes, individuals with vitiligo may present a reduction or absence of pigmentation in the protective pigmentary layer, thereby increasing their susceptibility to light exposure, which raises the question of how does light pollution may affect the vision of individuals with vitiligo.

Summary: This review examines the intersection between light pollution from light emitting diode (LED) sources and vitiligo, highlighting experimental findings from adult albino rats as a model of ocular depigmentation, exposed to white LED light.

Key messages: We discuss the biological mechanisms of retinal vulnerability in the absence of melanin and the implications for understanding sub-clinical retinal changes in individuals with vitiligo.

Introduction: Many treatments for multiple actinic keratoses (mAKs) have been proven effective in clinical trials. However, there is a lack of evidence regarding the long-term impact of therapies on disease progression in patients with mAKs. This study aimed to investigate the long-term clinical trajectory of mAKs patients undergoing repeated topical interventions and to evaluate the clinical effectiveness of these treatments and patients' adherence to an extended follow-up protocol in a real-world setting.

Methods: We conducted a prospective follow-up of a cohort comprising 81 treatment-naïve mAKs patients from 2012 to 2023. Patients received examinations and, when necessary, interventions every 6 months. Instances of treatment cycle discontinuation and refusals to continue with specific therapies were systematically recorded. Descriptive statistics alongside the Student's t test were employed to evaluate improvements in the Physician Global Assessment (PGA) scores following treatment with the same medication.

Results: The average total number of medical examinations and treatments administered per patient was 23.0 ± 0.4 and 16.1 ± 2.4, respectively. Annually, the average number of examinations and treatments per patient was 1.9 ± 0.1 and 1.3 ± 0.2, respectively. We completed 539 (41.6%) treatment cycles using photodynamic therapy with red light and methyl aminolevulinate (MAL-PDT), 182 (14.0%) with diclofenac plus hyaluronate (DHA), 97 (7.5%) with imiquimod (IMI), 101 (7.8%) with 5-fluorouracil (5-FU), 25 (1.9%) with FU, and 353 (27.2%) with cryosurgery. PGA values indicated a statistically significant reduction following each treatment at the 30-day post-treatment mark; however, these values exhibited an increase by the 6-month follow-up visit. The rates of treatment cycle discontinuation were as follows: 28.0% with MAL-PDT, 22.0% with DHA, 27.8% with IMI, 22.8% with 5-FU, and 24.0% with FU. Refusal rates for subsequent treatment cycles with the same drug were documented as 32.7% for MAL-PDT, 17.6% for DHA, 24.7% for IMI, 21.8% for 5-FU, 20.0% for FU, and 12.2% for cryotherapy. Throughout the study duration, 223 cases of squamous cell carcinoma (SCC), 46 cases of basal cell carcinoma (BCC), and 4 malignant melanomas (MMs) emerged on the face or scalp, along with 71 SCCs, 64 BCCs, and 8 MMs in other body regions.

Conclusion: Immunocompetent patients with mAKs require lifelong follow-up accompanied by repeated treatment cycles, as the clearance rates, regardless of the degree achieved after a single treatment cycle, tend to be temporary. These patients are at a heightened risk of developing skin tumors.