Chat GPT vs Clinician: challenging the diagnostic capabilities of A.I. in dermatology.

BACKGROUND: Chat Generative Pre-trained Transformer (Chat GPT) is an online language-based platform, designed to answer questions in a human-like way, using deep learning technology. OBJECTIVE: To examine the diagnostic capabilities of Chat GPT using real world, anonymised, medical dermatology cases. METHODS: Clinical information from 90 consecutive patients referred to a single dermatology emergency clinic between June to December 2022 were examined. Thirty-six patients were included. Anonymised clinical information was transcribed and input into Chat GPT 4.0 followed by the question "what is the most likely diagnosis?". The suggested diagnosis made by Chat GPT was then compared to the diagnosis made in dermatology. RESULTS: After inputting a clinical history and examination by a dermatologist, Chat GPT made a correct primary diagnosis 56% of the time (20/36). Using the clinical history and cutaneous signs from non-specialists, it was able to make a correct diagnosis 38% of the time (14/36). This was similar to the diagnostic rate of non-specialists 36% (13/36), although much lower than dermatologists (83%, 30/36). There was no differential offered by referring sources 27% of the time (10/36), unlike chat GPT which provided a differential diagnosis 100% of the time. Qualitative analysis showed Chat GPT offered responses with caution, often justifying reasoning. CONCLUSION: This study illustrates that whilst Chat GPT has a diagnostic capability, in its current form it does not significantly improve diagnostic yield in primary or secondary care.

Cutaneous sarcoma: a review and practical approach to management.

Sarcomas arising in the skin are rare but potentially fatal. These tumours originate from mesenchymal cells and can be divided between those that arise in soft tissue and those arising from bone. General guidelines exist for the management of soft-tissue sarcomas; however, there are no specific guidelines for cutaneous sarcomas. Current literature was reviewed for management of seven cutaneous sarcomas including atypical fibroxanthoma, pleomorphic dermal sarcoma, dermal and subcutaneous leiomyosarcoma, dermatofibroma sarcoma protuberans, Kaposi sarcoma, cutaneous angiosarcoma and malignant peripheral nerve sheath tumour. All suspected sarcomas should be discussed in a sarcoma multidisciplinary team meeting. This article is not a clinical guideline but should serve as a practical summary of how these tumours present, how they are recognized histologically, and how best to manage and follow-up patients. The aim is to support clinicians and facilitate the best and most evidence-based standard of care available.

Liver fibrosis for the dermatologist: a review.

Methotrexate-induced liver fibrosis is not a well-defined pathology, and many of the reported cases can instead be classified as nonalcoholic fatty liver disease by current diagnostic criteria, which is particularly common in the psoriasis cohort. Liver fibrosis usually takes many years to progress; therefore, screening for liver fibrosis should be done no more regularly than annually at the very most in dermatology practice. An algorithm is presented about how to investigate abnormal liver blood tests and screening tools for liver fibrosis are compared.

A qualitative assessment of patient satisfaction with remote dermatology consultations utilized during the UK's first wave of the COVID-19 pandemic in a single secondary care dermatology department.

During the first wave of the SARS-CoV-2 coronavirus (COVID-19) pandemic, many dermatology departments in the UK delivered remote consultations in order to minimize viral transmission. To assess patient perception of remote consultations delivered in a single dermatology department during this time, we retrospectively contacted patients via an electronic questionnaire and the responses are summarized. We anticipate that increased use of remote consultations will be a legacy of the pandemic, although healthcare professionals will have a responsibility for ensuring appropriate patient suitability.

Impaired neutrophil extracellular trap formation: a novel defect in the innate immune system of aged individuals.

Neutrophil extracellular traps (NETs) are a recently discovered addition to the defensive armamentarium of neutrophils, assisting in the immune response against rapidly dividing bacteria. Although older adults are more susceptible to such infections, no study has examined whether aging in humans influences NET formation. We report that TNF-α-primed neutrophils generate significantly more NETs than unprimed neutrophils and that lipopolysaccharide (LPS)- and interleukin-8 (IL-8)-induced NET formation exhibits a significant age-related decline. NET formation requires generation of reactive oxygen species (ROS), and this was also reduced in neutrophils from older donors identifying a mechanism for reduced NET formation. Expression of IL-8 receptors (CXCR1 and CXCR2) and the LPS receptor TLR4 was similar on neutrophils from young and old subjects, and neutrophils challenged with phorbol-12-myristate-13-acetate (PMA) showed no age-associated differences in ROS or NET production. Taken together, these data suggest a defect in proximal signalling underlies the age-related decline in NET and ROS generation. TNF-α priming involves signalling through p38 MAP kinase, but activation kinetics were comparable in neutrophils from young and old donors. In a clinical setting, we assessed the capacity of neutrophils from young and older patients with chronic periodontitis to generate NETs in response to PMA and hypochlorous acid (HOCL). Neutrophil extracellular trap generation to HOCL, but not PMA, was lower in older periodontitis patients but not in comparison with age-matched controls. Impaired NET formation is thus a novel defect of innate immunity in older adults but does not appear to contribute to the increased incidence of periodontitis in older adults.