An evaluation of ChatGPT compared with dermatological surgeons' choices of reconstruction for surgical defects after Mohs surgery.

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.

Uncoiled linear looped vessels in basal cell carcinoma: a novel morphology.

We describe two cases of nodular basal cell carcinoma presenting with novel morphology of linear looped hairpin vessels under dermoscopy.

Dermoscopic features of actinomycetoma: a case series.

Dermoscopy of mycetoma has white structures as the predominant feature, while white scale and yellowish structures were also consistent in our findings with available literature.

Local secretion of stress hormones increases in alopecia areata lesions after treatment with UVA-1 phototherapy.

Alopecia areata (AA) is an autoimmune disease of the hair follicle. Keratinocytes of the hair follicle generate an immunosuppressive environment by the local secretion of hormones of the hypothalamic-pituitary-adrenal axis of the skin (skin HPA analog). Our objective was to measure the local production of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and α-melanocyte-stimulating hormone (α-MSH) in the scalp tissue of patients with AA before and after ultraviolet A1 (UVA-1) phototherapy to determine their role in the pathogenesis of AA and the effect of UVA-1 on the AA hormonal environment. This was a retrospective and descriptive study of skin samples from 22 patients with AA before and after UVA-1 treatment. We compared the changes in the local hormonal environment by measuring CRH, ACTH, type 2 melanocortin receptor (ACTH receptor) and α-MSH with immunohistochemical stains. The positivity of MSH was significantly higher (P = .037) in the post-treatment samples compared with the baseline value. ACTH was significantly higher in intensity (P = .032) in the post-treatment samples compared with the initial value. CRH was significantly higher in intensity (P = .013) in baseline samples compared with the final biopsies. The positivity of the ACTH receptor MC2R was not different between the two groups (P = .626). In AA, an interruption in the signalling of CRH could decrease the local concentration of ACTH and MSH, and consequently, the immunosuppressive effect of these hormones. This phenomenon is normalized in the skin treated with UVA-1. A defective signalling system in the cutaneous HPA axis may be involved in the pathogenesis of AA.

Acral bullous lichen sclerosus intolerant to UVA-1 successfully treated with narrowband ultraviolet B phototherapy.

Lichen sclerosus (LS) is an uncommon, chronic, lymphocyte-mediated, inflammatory dermatosis characterized by ivory-white patches with scar-like atrophy. Extragenital bullous lichen sclerosus may rarely affect palms and soles, causing severe pain and substantially impairing quality of life. We present the first case of acral bullous lichen sclerosus intolerant to UVA-1 phototherapy successfully treated with low doses of narrowband ultraviolet B phototherapy.

A Case of Bullous Morphea Resistant to Methotrexate and Phototherapy Successfully Treated With Mycophenolate Mofetil.

Bullous morphea is rare clinical variant of localized scleroderma characterized by the formation of bullae on sclerotic morphea plaques. Severe disease may be highly disabling and greatly impair quality of life. Current treatment strategies are based on anecdotal reports of clinical experience and include topical corticosteroids, methotrexate and phototherapy. Herein, we describe the case of a 56-year-old woman with progressive bullous sclerotic lesions who was successfully treated with mycophenolate mofetil after treatment failure with psoralen plus ultraviolet A therapy, ultraviolet A1 phototherapy, and methotrexate. Treatment with mycophenolate mofetil halted disease progression after 8 weeks. No major adverse effects were recorded in a 3-year follow-up with continuous treatment. This case suggests mycophenolate mofetil may be considered as an alternative for the treatment of resistant bullous morphea lesions. J Drugs Dermatol. 2018;17(10):1123-1125.

Comparison of microneedling and CO2 laser with adipose-derived stem cells for facial rejuvenation: a randomized split-face study.

BACKGROUND: Facial aging, characterized by structural decline and loss of collagen and elastin, has led to increased demand for rejuvenation treatments. Adipose-derived stem cells (ADSCs) have emerged as a promising option, but comparative studies on their application methods are limited. OBJECTIVE: Our aim was to compare the efficacy of ADSC combined with microneedling or CO2 laser for facial rejuvenation. METHODS: Twenty-seven participants were randomized into two groups: Microneedling (MN, n = 14) or CO2 laser (n = 13). Each group underwent three treatment sessions at 4-week intervals. The ADSC solution was applied to one side and the placebo to the other using a split-face design. We performed objective evaluations (UV spots, brown spots, wrinkles, texture, pores, red areas, and porphyrins) and subjective assessments, including clinical photographs, patient satisfaction scales, and histological analysis of skin biopsies. RESULTS: The CO2 laser with the ADSC group showed significantly more significant improvements in UV spots (P = 0.002) and wrinkles (P = 0.002) compared to the MN with the ADSC group. Histological analysis revealed superior elastin fibers and epidermal thickness improvements with CO2 laser treatment. Patient satisfaction was higher in the CO2 laser group, with 84.6% reporting complete satisfaction compared to 50% in the MN group. CONCLUSIONS: The combination of CO2 laser with ADSCs demonstrated superior efficacy for facial rejuvenation compared to MN with ADSCs. This approach improved UV spots, wrinkles, skin structure, and overall patient satisfaction. Further studies with larger cohorts and extended follow-up are needed to confirm long-term efficacy.